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New rules in 2021 require hospitals to make prices more transparent

Published: Jan. 1, 2021 at 7:26 PM EST
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CHARLOTTE, N.C. (WBTV) - Starting Jan. 1, 2021, all hospitals will be required to be more transparent with you about pricing.

It’s been a complex issue that our WBTV Investigates team explored in 2020.

“I wish I had known how much this was going to cost because I wouldn’t have gotten the stitches or would have gone to urgent care,” said Emily Plazek, who was surprised by a medical bill.

Over and over, we found patients across the Carolinas would go in for a medical procedure and after then be shocked with the actual bill after.

Another person shocked by a medical bill was Todd Meixner.

“When I went and spoke with a nurse, I told them I have UnitedHealthcare. ‘you guys accept UnitedHealthcare?’ And they told me, ‘yes we do,’ and that ‘you should be fine,’” Meixner said.

But that doesn’t guarantee you’ll be billed the price you were expecting.

“Consumers need to know what’s covered and what’s not covered so they won’t get any surprises like this,” said North Carolina Insurance Commissioner Mike Causey.

Starting on Jan. 1, 2021, a new rule from the Centers for Medicare and Medicaid Services will require all hospitals to offer patients access to a price estimator tool and a public list of prices.

Vice President of Pricing Strategy at Novant Health Melonie O’Connell said, “This rule is intended to improve price transparency and increase access to pricing information to patients.”

Novant Health says it’ll be easier for a patient to access information.

“If a patient wants to know what they’re out of pocket responsibility—the amount they’ll actually be expected to pay - they can call a financial navigator or they can use this new online tool.”

At Novant, a price estimator tool will provide an estimate of the patient’s out of pocket financial responsibility for the hospital service.

It’s a big step forward in what has been a complex healthcare issue.

“Healthcare is complicated, but it’s also very personal and that’s why creating estimates are – it’s so difficult. We can’t ever say with 100% predictability the exact services that a patient will need.”

With this new rule in effect, hospitals must make a public file with a list of all standard charges and a list of standard charges for shoppable services.

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