Rochester, N.Y. – Allison Diedreck had her second child by Cesarean section last summer at Rochester General Hospital.
Her family had health insurance with a high deductible. The out-of-pocket bill came to $6,200.
“We kept getting bills and bills and bills for months,” Diedreck said. “We’d never had a high deductible plan before. We knew would have to pay a lot more, but we didn’t think it would be that much.”
Cheryl Ragland-Haas had a hysterectomy in August. She also had a high deductible plan and a Health Savings Account. Her out-of-pocket expense was $4,300.
“I knew I had a deductible, but you think that insurance is your security blanket and that’s not the case anymore,” Ragland-Haas said. “It was a little scary when you start getting bills in the mail.”
There will be more and people in the same boat. Half of the local companies surveyed by Rochester Business Alliance are moving away from traditional co-pay insurance to high deductible plans. That means workers sometimes have to pay thousands of dollars before insurance kicks in.
“I think people tend to think it’s all going to be taken care of by the insurance company,” said Kim Benedetto, Director of Financial Counseling for Rochester General Hospital.
Patients are getting sticker shock. While most people know the price of a gallon of milk or movie ticket, they don’t know how much it costs to have an operation.
“It’s surprising to me how much surgeries can cost,” said Diedreck.
“I drained my savings to pay half of it off,” said Ragland-Haas.Finding Out the Price
How does a consumer find out the price of an operation? 13WHAM News asked local hospitals for the average prices of common surgeries and found widely different answers.Only Rochester General posts its price list online.
“We decided, we’re going to be transparent. We’re going to put that pricing out there,” said Benedetto.
Rochester General estimates the price of a Cesearean section is $6,176.21. Unity said its average price is $5,219.18. Strong Memorial Hospital said it charges between $17,590 and $20,590. Only Strong said it estimated the full price, including the cost of the surgeon, anesthesiologist and other items.
We also got widely different prices for a hysterectomy. Rochester General’s website indicates the price is $5,973.19. Unity charges $9,058.96. Strong charges between $17,180 and $22,180. Again, only Strong estimated the full price.
It’s very common for surgeons to send patients a separate bill. “We’re not going to be able to quote you the entire cost for that surgery,” said Unity’s Chief Financial Officer Thomas Crilley. Unity doesn’t have its own surgeons.
Unity plans to post its pricing online in the coming months. Strong believes online price lists are confusing. Rochester General’s online list has numerous billing codes and add-ons patients might not be able to decipher.
“We felt that putting a price list out there could be very confusing,” said Adam Anolik, Associate Director of Financial Services for Strong Memorial Hospital “We actually did research some other institutions that have that information online. Depending on how you interpret it, you might make a misinformed decision, so we felt it was better to do a one on one conversation with the patient.”Strong
have dedicated phone lines for patients to get price estimates within a few days. Patients give the staff their surgeon’s name, procedure and insurance. Rochester General also answers price questions by phone. We All Get Charged Different Prices
There are multiple reasons hospitals say it can difficult to provide uniform prices for surgeries. The price can vary based on the length of hospital stay, complications, the expertise level of the surgeon and the techniques used by the surgeon. But perhaps the most important thing dictating price is a patient’s insurance.
Few people are charged full price for an operation. Insurance providers negotiate with hospitals what they will pay for each surgery. The government sets rates for Medicaid and Medicare. But Excellus may pay Strong one amount for a hysterectomy and Unity another amount. Rochester General may get different reimbursements for a Cesearean section from MVP and Excellus. This means two patients who have the exact same procedure by the same surgeon at the same hospital may be charged different prices if they have different insurance plans. This price information is usually considered proprietary and is not available to the public.
Bills in Congress to mandate transparency in health care pricing have not passed. But Crilley said as more patients move into high deductible plans, providers will have to be more transparent.
“I think we’re all moving in that direction,” said Crilley. “As that whole insurance industry changes, some patients without insurance or some patients with less insurance than in the past, they’re having to be more educated about what it costs.”
Crilley does not think there's much variation in pricing among local hospitals in Rochester.
All of the local hospitals encourage patients to talk to their doctors, hospitals and insurance providers to get the best information on cost. They work with patients who do not have insurance and provide charity care.
"If it’s a planned event, it allows them to make informed decisions," said Benedetto. "How am I going to prepay for this or pay for it after the procedure?"
Even though it can be a hassle, it might be worth it to shop around if a surgery is planned.
“It didn’t even occur to me to shop around at all,” said Diedreck.