Massachusetts is the only state in the nation that requires hospitals and other providers to furnish cost estimates to patients if they ask ahead of time. But that law works in practice far differently than it does in theory, according to Kaiser Health News.
The Bay State rolled out the price transparency law in October 2013, requiring hospitals and doctors to provide price quotes to patients within two days of a request so they can comparison shop. Instantaneous price quotes will become mandatory in October of this year. An estimate is also binding, which means if the bill is more than the estimate, the patient's insurer must make up the difference.
But one patient interviewed by Kaiser Health News said that when she called for estimates for the price of a vaginal delivery, she was either transferred to other hospital employees, put on hold or left messages but never received a returned call, even though state law mandates callbacks within two days.
The pregnant patient was only able to obtain a price from one of three providers she contacted during initial phone calls. University of Massachusetts Memorial Health could only provide a price range of $10,000 to $16,000. Another provider requested CPT codes even though they're not publicly available without paying licensing fees.
"The experience was pretty frustrating from beginning to end," Janice Collins, the patient followed by Kaiser Health News, said. "It was definitely surprising how many machines I spoke to within the last few days."
A UMass Memorial Health spokesperson told Kaiser Health News that it intended to install a dedicated phone line in the coming days to better accommodate patients seeking price information.
"It's very different from, you go into Best Buy, you want to buy a refrigerator," Karen Granoff, senior director for managed care at the Massachusetts Hospital Association, told the publication. "They know they need to do this. They are not opposed to the transparency. I think they are worried about the challenge of getting the information to the patient."
To learn more:
- read the Kaiser Health News article