The lack of readily available information on the price of health care services can lead patients to be quite surprised after they receive a bill for the service.  For insured patients, bills can take months to be adjudicated resulting in delays that make financial planning difficult.  For uninsured patients, they often receive treatment without any sense of the cost of the care they are receiving.

Proponents of consumer directed health care are demanding that price information be available at the time of treatment.   Some states have passed laws requiring the posting of rate cards or rate information.   In some cases, niche providers have developed clearer schedules for the fees they charge for services.

Minute Clinics:  Minute Clinics use a team of board-certified practitioners trained to diagnose, treat and write prescriptions for a variety of common family illnesses.  MinuteClinic practitioners are considered to be in-network for most major insurers, so patients are responsible for either their copay or the price clearly listed on there treatment/services menu. For uninsured patients or those who prefer to pay out-of-pocket, MinuteClinic accepts cash, checks and credit cards.

The cost of laser eye surgery can vary widely depending on the area of the country in which the procedure is performed, the level of experience a surgeon possesses, the technology used during the surgery, and the degree of your refractive error. Prices can range anywhere from $499 per eye to $2,500 per eye.  Rates usually vary depending on whether patients have a special eye condition. Some people may have one problem in one eye and quite another problem in the other eye. Folks with different eye conditions are charged different rates for different treatments.

As most people need to undergo corrective procedures and follow up treatment after laser surgery only around three percent of people end up paying less than $1,000 per eye.

Public Policy: In 2003, the State of California established a Payer’s Bill of Rights to make certain hospital pricing information available to the public and to discourage hospitals from establishing charges that adversely affect private payers and patients..  Current law requires each California hospital to submit a copy of its chargemaster for 25 commonly charged services or procedures annually to the Office of Statewide Health Planning and Development.  Effective January 2006, state law requires each hospital to provide, upon request, a written estimate of the amount the hospital will require an uninsured person to pay for hospital services that are reasonably expected to be provided, based on average length of stay and services provided for the person′s diagnosis. Estimates are not required for emergency services.

The Public is able to obtain hospital pricing information from the website of the Office of Statewide Health Planning and Development or can make requests in writing.

• The lack of transparency around prices does not enable patients to be prudent consumers of health care
• The lack of price transparency causes patients to be surprised when they receive bills for services.
• The lack of pricing transparency creates an adversarial relationship between patient and provider.
• Posting of chargemasters not sufficient to understanding what patient is actually expected to pay
• Making prices transparent may make providers that do so more appealing to cost-conscious patients.
• Clear price posting may be necessary for marketing services to uninsured patients who will pay the entire fee charged for a service.

Transparency around pricing – It is necessary, though probably no sufficient, to publicly post prices in order to achieve transparency.  However, give that there is a difference between what is charged and what is expected to be reimbursed, the mere posting of chargemasters does not make pricing transparent.

The posting of prices by niche providers enables consumer and provider alike to understand the financial terms of the exchange.