Need surgery? Good luck getting hospital cost info
CHICAGO (AP) - Want to know how much a hip replacement will cost? Many hospitals won't be able to tell you, at least not right away - if at all. And if you shop around and find centers that can quote a price, the amounts could vary astronomically, a study found.
Routine hip replacement surgery on a healthy patient without insurance may cost as little as $11,000 - or up to nearly $126,000.
That's what researchers found after calling hospitals in every state, 122 in all, asking what a healthy 62-year-old woman would have to pay to get an artificial hip. Hospitals were told the made-up patient was the caller's grandmother, had no insurance but could afford to pay out of pocket - that's why knowing the cost information ahead of time was so important.
About 15 percent of hospitals did not provide any price estimate, even after a researcher called back as many as five times.
The researchers were able to obtain a complete price estimate including physician fees from close to half the hospitals. But in most cases, that took contacting the hospital and doctor separately.
"Our calls to hospitals were often greeted by uncertainty and confusion," the researchers wrote. "We were frequently transferred between departments, asked to leave messages that were rarely returned, and told that prices could not be estimated without an office visit."
Many hospitals "are just completely unprepared" for cost questions, said Jaime Rosenthal, a Washington University student who co-authored the report.
Most hospitals aren't intentionally hiding costs, they're just not used to patients asking. That's particularly true for patients with health insurance who "don't bother to ask because they know insurance will cover it," said co-author Dr. Peter Cram, a researcher at the University of Iowa's medical school.
But he said that's likely to change as employers increasingly force workers to share more health care costs by paying higher co-payments and deductibles, making patients more motivated to ask about costs.
The study was published online Monday in JAMA Internal Medicine. A California study published last year about surgery to remove an appendix found similar cost disparities.
Commenting on the study, American Hospital Association spokeswoman Marie Watteau said hospitals "have a uniform set of charges. Sharing meaningful information, however, is challenging because hospital care is unique and based on each individual patient's needs."
She said states and local hospital associations are the best source for pricing data, and that many states already require or encourage hospitals to report pricing information and make that data available to the public.
U.S. insurance companies typically negotiate to pay less than the billing price. Insured patients' health plans determine what they pay, while uninsured patients may end up paying the full amount.
The study authors noted that Medicare and other large insurers frequently pay between $10,000 and $25,000 for hip replacement surgery.
Sean Toohey, a grains broker at the Chicago Board of Trade, had hip replacement surgery last summer at Loyola University Medical Center in Maywood, Ill. An old sports injury had worn out his left hip, causing "horrendous" pain on the job, where he's on his feet all day filling orders.
Toohey, 54, said his health insurance covered most of the costs, and it didn't occur to him to ask about price beforehand. He was back at work two weeks later and is pain free. That's what matters most to him.
"I never really looked or paid attention" to the cost, he said.
He paid about $7,900, but wasn't sure what the total bill amounted to.
The average charge for hip replacement surgery at Loyola is about $42,000, before the negotiated insurance rates. The most expensive items on a typical hip replacement bill include about $11,000 for the hip implant, said Richard Kudia, Loyola's vice president of patient financial services
Kudia said some patients do ask in advance about costs of surgery and other medical procedures, and those questions require "a little bit of research" to come up with an average estimate. Costs vary from center to center because "there is no standard pricing among hospitals across the country. Each hospital develops its own pricing depending on its market," he said.
An editorial accompanying the hip replacement study said "there is no justification" for the huge cost variation the researchers found.
A few online sites provide price comparisons for common medical procedures, but the editorial said that kind of information "is of almost no value" without information on hospital quality.
A proposed federal measure that would have required states to force hospitals to make their charges public failed to advance in Congress last year but could be revived this year, the editorial says.
"It is time we stopped forcing people to buy health care services blindfolded," the editorial said.
Routine hip replacement surgery on a healthy patient without insurance may cost as little as $11,000 - or up to nearly $126,000.
That's what researchers found after calling hospitals in every state, 122 in all, asking what a healthy 62-year-old woman would have to pay to get an artificial hip. Hospitals were told the made-up patient was the caller's grandmother, had no insurance but could afford to pay out of pocket - that's why knowing the cost information ahead of time was so important.
About 15 percent of hospitals did not provide any price estimate, even after a researcher called back as many as five times.
The researchers were able to obtain a complete price estimate including physician fees from close to half the hospitals. But in most cases, that took contacting the hospital and doctor separately.
"Our calls to hospitals were often greeted by uncertainty and confusion," the researchers wrote. "We were frequently transferred between departments, asked to leave messages that were rarely returned, and told that prices could not be estimated without an office visit."
Many hospitals "are just completely unprepared" for cost questions, said Jaime Rosenthal, a Washington University student who co-authored the report.
Most hospitals aren't intentionally hiding costs, they're just not used to patients asking. That's particularly true for patients with health insurance who "don't bother to ask because they know insurance will cover it," said co-author Dr. Peter Cram, a researcher at the University of Iowa's medical school.
But he said that's likely to change as employers increasingly force workers to share more health care costs by paying higher co-payments and deductibles, making patients more motivated to ask about costs.
The study was published online Monday in JAMA Internal Medicine. A California study published last year about surgery to remove an appendix found similar cost disparities.
Commenting on the study, American Hospital Association spokeswoman Marie Watteau said hospitals "have a uniform set of charges. Sharing meaningful information, however, is challenging because hospital care is unique and based on each individual patient's needs."
She said states and local hospital associations are the best source for pricing data, and that many states already require or encourage hospitals to report pricing information and make that data available to the public.
U.S. insurance companies typically negotiate to pay less than the billing price. Insured patients' health plans determine what they pay, while uninsured patients may end up paying the full amount.
The study authors noted that Medicare and other large insurers frequently pay between $10,000 and $25,000 for hip replacement surgery.
Sean Toohey, a grains broker at the Chicago Board of Trade, had hip replacement surgery last summer at Loyola University Medical Center in Maywood, Ill. An old sports injury had worn out his left hip, causing "horrendous" pain on the job, where he's on his feet all day filling orders.
Toohey, 54, said his health insurance covered most of the costs, and it didn't occur to him to ask about price beforehand. He was back at work two weeks later and is pain free. That's what matters most to him.
"I never really looked or paid attention" to the cost, he said.
He paid about $7,900, but wasn't sure what the total bill amounted to.
The average charge for hip replacement surgery at Loyola is about $42,000, before the negotiated insurance rates. The most expensive items on a typical hip replacement bill include about $11,000 for the hip implant, said Richard Kudia, Loyola's vice president of patient financial services
Kudia said some patients do ask in advance about costs of surgery and other medical procedures, and those questions require "a little bit of research" to come up with an average estimate. Costs vary from center to center because "there is no standard pricing among hospitals across the country. Each hospital develops its own pricing depending on its market," he said.
An editorial accompanying the hip replacement study said "there is no justification" for the huge cost variation the researchers found.
A few online sites provide price comparisons for common medical procedures, but the editorial said that kind of information "is of almost no value" without information on hospital quality.
A proposed federal measure that would have required states to force hospitals to make their charges public failed to advance in Congress last year but could be revived this year, the editorial says.
"It is time we stopped forcing people to buy health care services blindfolded," the editorial said.
Another thing they need to do is make sure the patient gets an itemized copy of their bill BECAUSE they use a patients arm band like an ATM machine. If I could have proved it I know my last bill contained things that either I didn't need or use. I was in the hospital overnight and I received a water pitcher when admitted. About midnight a nurse came in swiped my wristband and gave me a new water pitcher. Just one of many things I noticed in about 12+ hours.
Do they even tell you how many random out-of-network doctors will visit you without asking and then send a bill for "services" several months later?
 @therunner Exactly. You will receive bills for facility fees form the hospital, professional fees from the doctors, anesthesia fees and lab fees.Â
This is exactly why companies like OptumSurgical are starting. There are much more efficient and effective ways to deliver healthcare in the US and folks should not have to make tons of calls or travel outside the country for quality care at a lower, consistent price. As an example, OptumSurgical will provide a robotic knee replacement for 20-50% less cost and include a trip for you and a partner to San Francisco, all expenses paid. We need more groups willing to push the envelope and get away from the old standard of how healthcare is done in the US.
They won't tell you until it is done. Even if they do, there will be an undisclosed expense where they will knock the final price up. They WILL take you to the cleaners. That's why you go to another country to have it done. My wife is going for IVF in India. Here in Seattle, it will cost nearly $35,000. Go to India and the cost is about $8,000 and this includes the plane tickets and hotel stay. We are making it a vacation!!
If patients knew beforehand how much a visit, or procedure was going to cost and requested the quote in writing, it would help defer a lot of Doctors from adding things to the final bill to insurance companies and drive down the over inflated cost of health care in general. I caught a major discrepency on my insurance statement once and when I questioned the Doctor about it, he had the office reverse the charge and credit the insurance company.  I did this knowing my insurance would pay the whole bill anyway.Â
Ive had this problem. Have never had health insurance in my whole life so I pay cash for everything. And in order to do that I have to know how much its going to cost up front so that I can see if I can afford it. And rarely can they tell me how much it costs. And even if people do have insurance you still have to deal with all the copays and deductibles. And obam/Romney care isn't any better. Is it insurance or isn't it? If its insurance then pay for the stuff.