A watchdog group called Patient Rights Advocate has issued a report claiming six Georgia hospitals are not fully complying with new federal transparency laws.
One of the hospitals is Northeast Georgia Medical Center in Gainesville.
Cynthia Fisher, a spokeswoman for the group, told Georgia News Network that most of the 500 hospitals researchers sampled did not provide easy access to online tools to allow patients to compare prices for medical procedures.
"Most of them were deficient in not posting their actual negotiated rates with the insurers and by naming the plan and the payer," Fisher told GNN. She said the hospitals and the insurers are able to keep their negotiated rates secret to the detriment of patients.
Brian Steines, Chief Financial Officer for Northeast Georgia Health System, said in an email statement healthcare pricing is a complex issue.
"We agree with the spirit of the CMS Price Transparency rules, which is that people need to have easier ways to comparison shop services to find the best price for their unique situation. Unfortunately, healthcare pricing is much more complicated than traditional retail pricing," Steines said. "There’s a lot of data required by the CMS rules, and much of it doesn’t help even the most educated consumers understand what they will actually pay out of pocket. In fact, looking at just charges alone could lead a person to choose a facility that looks less expensive on the surface – but may be more expensive for out-of-pocket expenses after insurance benefits are applied."
Fisher said Patient Rights Advocate believes it is possible for hospitals to make it easier for patients to comparison shop.
"Posting their prices clearly for consumers to see online, as well as mobile app shopping tools like we have with the airlines - like Kayak or Expedia - we could soon have that in healthcare if these hospitals comply," Fisher said.
Steines said while that may sound good in theory, pricing for healthcare is more complicated.
"Pricing can vary widely based on your specific insurance plan benefits, specific diagnosis codes or services ordered by your referring physician and more," he said. "That’s why NGHS has long provided free personalized, free estimates to help you determine what you will pay out of pocket before you commit to a costly visit or service. Real people will work with you to help understand your insurance benefits and give you specific questions to ask your doctor’s office, explain any additional charges that may not be included in the hospital bill and help answer any questions you may have."
Steines also said NGHS has a pricing tool on the hospital system website, but getting patients the information they want is not always quick.
"It takes some time to get the details right for personalized price estimates, but it results in getting the most accurate estimate possible – which ensures you’re using the best number to compare to other hospitals and providers," Steines said.
The new price transparency rule was part of an executive order signed by President Joe Biden on July 9, 2021.
