New Yorkers in need of medical treatment often choose their hospital based on several factors: reputation, the affiliation of their practitioners, or perhaps location.
But there’s one variable that rarely gets into the mix: how much hospitals charge for the same service.
The lack of transparency has left patients across the country in trouble, sometimes prompted by widely publicized stories of overbilling for relatively simple hospital visits — a problem that is especially troubling for those without insurance.
On Thursday, the New York City Council plans to rectify the problem by passing a bill that would allow New Yorkers to compare the prices of procedures at different hospitals online.
The bill would create the nation’s first “health care accountability office” to analyze hospital costs and provide pricing information online.
“There’s no other area where you, as a consumer, purchase a service and you have no idea what you’re being charged,” said Manhattan city councilor Julie Menin, who sponsored the bill. “This is a simple, straightforward consumer protection measure.”
The bill has the support of a majority of the city council, with 42 co-sponsors of the 51 members. Mayor Eric Adams, a Democrat in his second year in office, said in a statement that he supports the bill.
“This bill will make it easier for New Yorkers to find information about hospital pricing, and we are grateful to our partners in labor and the municipality for moving this forward,” said Kate Smart, a spokeswoman for the mayor.
The Greater New York Hospital Association, the state’s most powerful hospital and health systems industry association, strongly opposes the bill, arguing that hospitals were already working to comply with federal regulations set in 2021 requiring them to publish complete list of prices at which they negotiate private insurers.
But many hospitals ignored the requirement. a study by a non-profit patient rights group found that only about 24 percent of the 2,000 hospitals surveyed complied. In New York City, the rate was even lower, about 6 percent.
David Rich, an executive vice president of the Greater New York Hospital Association, suggested at a Board hearing in February that the bill incorrectly targeted hospitals rather than insurance companies.
“It pretty much ignores the colossal for-profit national health insurers that make huge profits in New York’s healthcare economy and send those profits out of New York to their parent organizations and shareholders,” he said.
Costs in New York can vary widely. A caesarean section at Montefiore Hospital in the Bronx – which one lists the cost of procedures on their website — typically costs about $55,000, while the same procedure costs about $18,000 in New York City-run hospitals, according to a recent study.
Data from hospitals across the country that have complied with federal regulations shows why powerful industries wanted cost information hidden from the public. Hospitals charge patients vastly different amounts for the same basic services, including an X-ray or a pregnancy test.
Other states have adopted price transparency measures for hospitals. An effort in California has contributed to cheaper costs for knee and hip replacements. In 2007, New Hampshire started a website that showed the cost of proceduresincluding magnetic resonance imaging scans.
In New York, about a million people are uninsured, even after the introduction of the Affordable Care Act. For those residents it is even more important to understand in advance how much an intervention will cost, says Ms Menin.
“If you’re uninsured, this bill is a game-changer,” she said.
The price estimates for hospital procedures came from a report of the powerful trade union 32BJ health fund, whose leaders support the bill.
The new health care accountability office would list prices of common hospital procedures on its website in a “simplified and publicly accessible format” that would allow consumers to compare prices.
Michael D’Anvers, 40, who lives in Brooklyn and works on accessibility issues, recalled his frustration when he was charged $430 for a 15-minute virtual visit to a Mount Sinai Health System physician in 2021 to discuss neck pain which he suffered while working from home. The bill was reduced to $220, but he said he was still upset.
“They need to be upfront about their costs,” he said. “If I knew it was going to be this much, I would have found another way to get referred to a pain specialist.”
Sometimes it’s not so much about being overcharged, but more about the seemingly haphazard calculation that determines how much a patient ends up paying after paying a co-pay on the spot.
Michelle D. Winfield, 76, a retired teacher living in Manhattan, said after getting an electrocardiogram this year during a routine physical exam at a New York University health center in Manhattan, she was surprised when she later got a bill of another $18.56.
“It’s not the amount — it could have been $500,” she said. “It’s about transparency. I should have been told there was a cost involved and I could decide if I wanted to do it.”