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How to use new tools built to prevent surprise medical bills

Most items you buy are marked with a price tag. But healthcare costs can be a mystery.

Now, a new rule hopes to provide you with more information about medical fees.

As of January 1, 2021, every United States hospital must offer accessible pricing information on their website.  

You should be able to find a single digital file listing all of the hospital’s rates. The rate categories can sound confusing. Here are some terms you might need to know.

  • Standard gross charges — the total price charged for an item or service
  • Discounted cash prices —the amount a patient pays if they don’t use insurance
  • Payer-specific negotiated charges — prices settled with a third-party such as a health insurance carrier
  • De-identified minimum and maximum negotiated charges — the lowest and highest payment amount a hospital will accept for an item or service

The list must include every procedure, medication, or service that the hospital offers. For example, giving birth or having a knee replaced.

Those who championed the new rule believe it will help people shop for healthcare by allowing them to compare prices. 

That could be particularly helpful for people who don’t have insurance or for those with high-deductible plans. High-deductible plans feature lower monthly costs – or premiums – but require plan holders to pay more for care and services before insurance coverage kicks in.

The information may also interest employers that offer health insurance to their workers. 

The change meets a demand. A 2019 survey from patient financing solutions company AccessOne found that 59% of those polled wanted healthcare providers to share cost information.

Becker’s Hospital Review reported hospital groups fought the rule. They argued it would create more confusion about out-of-pockets costs – not less. 

That’s because your total bill depends on more than hospital pricing. It depends on your insurance carrier, if you have one, and your specific plan. 

The most foolproof way to know your cost is to contact your insurance carrier and ask. 

Price transparency requirements for health insurers take effect in two years. 

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