Hospital Price Transparency 101: Understanding the Basics

Introduction

Hospital price transparency is one of the most discussed topics in modern healthcare. Patients are increasingly asking for information about out-of-pocket costs for healthcare services, yet for providers, coming up with an answer that is understandable is not always easy. Since it can be difficult to determine exactly what treatment a person might need until tests and examinations are complete, it can be a challenge to estimate total cost to the patient. Even when it is possible for a patient to get an estimate, the complexity of the healthcare jargon associated with price can make the answer difficult to decipher. The following hospital price transparency Q & A was designed to help demystify the most common questions pertaining to hospital pricing and cover topics such as commonly used pricing terminology, the reasons behind price differences and the importance of considering quality.

Click through the questions below for answers that will help you better understand the hospital price transparency basics or download the complete list of questions on price transparency.

Price & Payment Questions

• What is “price transparency” and why is it important?
• Why do purchasers and consumers need price transparency?
• What are the different types of healthcare costs?
• Is there a difference between price, cost and payment (negotiated contract rate)? 
• How are charges set? 
• Who sets charges? 
• Why do charges for similar services vary among hospitals? 
• Where can I find payment information? 
• Is the payment I am responsible for all I should consider in selecting a provider? 
• Where can I find information on quality measures? 

Coverage Questions

• Does the type of coverage I have (e.g., Private, Medicaid and Medicare) impact my costs? 
• Why do some people on Medicare pay a different amount for the same procedure than others?
• What are the financial responsibilities of insured patients? 
• What’s the difference between a covered and non-covered service? 
• If I am uninsured, do I pay the hospital’s charges? 
• What is "charity" care?
• What options do I have if I’m uninsured?