New law could revolutionize how health care costs are handled — if providers heed it
Author: Kevin Lundberg - January 15, 2018 - Updated: January 31, 2018
Last year I sponsored Senate Bill 17-065, which the governor signed into law in April. It requires hospitals, doctors offices and other medical clinics to publicly post their most common charges for medical services. It is not intended to be a burdensome requirement, as there is a limited number of services to be listed. The purpose is to give citizens a better idea of what medical procedures cost before they get the treatment or the bill, and to start that much-needed conversation concerning the cost of medical services between a doctor and their patient.
The law required the information to be available by Jan. 1, 2018, so on Jan. 2 I visited my local hospital to see how and where they were making the information public. I went to the front information desk; they knew nothing. Next I went to the emergency room staff who admit patients; they knew nothing. Finally I went to the billing department and the first person I talked to had no knowledge of the law. However, the second person in that department was aware of the law, but after several minutes of looking he could not find the information on their website. Sometime later they finally found the web pages, but that is hardly what I would call “conspicuous posting.”
I eventually found those web pages, but it took a long search and several clicks to get there. The costs listed included a line that says that the cost for a “straightforward” ER visit is $163 for their self-pay discounted price. Wow, I hope everyone who goes to the ER sees this, as the actual charges most will see is in the thousands of dollars.
A clear reading of the law (see below) states that the prices they post are to be as close to the actual prices charged to real people who self-pay. Therefore quoting a few hundred dollars for a simple ER visit seems like a strange number because this is not the charge most see and it is therefore not posting what the law requires. Unless, of course, the hospital really intends on charging that amount for a “straightforward” ER visits from here forward.
This law will revolutionize the way medical costs are handled in Colorado — if we all know the law, insist our medical providers are following that law and whenever possible, send our business to the most cost-effective providers.
In part, the law says:
CRS 25-49-104 (4) (a) HEALTH CARE PRICE” MEANS THE PRICE, BEFORE NEGOTIATING ANY DISCOUNTS, THAT A HEALTH CARE PROVIDER OR HEALTH CARE FACILITY WILL CHARGE A RECIPIENT FOR HEALTH CARE SERVICES THAT WILL BE RENDERED. “HEALTH CARE PRICE” IS THE PRICE CHARGED FOR THE STANDARD SERVICE FOR THE PARTICULAR DIAGNOSIS AND DOES NOT INCLUDE ANY AMOUNT THAT MAY BE CHARGED FOR COMPLICATIONS OR EXCEPTIONAL TREATMENT. THE HEALTH CARE PRICE FOR A SPECIFIC HEALTH CARE SERVICE MAY BE DETERMINED FROM ANY OF THE FOLLOWING:
(I) THE PRICE CHARGED MOST FREQUENTLY FOR THE HEALTH CARE SERVICE DURING THE PREVIOUS TWELVE MONTHS;
(II) THE HIGHEST CHARGE FROM THE LOWEST HALF OF ALL CHARGES FOR THE HEALTH CARE SERVICE DURING THE PREVIOUS TWELVE MONTHS; OR
(III) A RANGE THAT INCLUDES THE MIDDLE FIFTY PERCENT OF ALL CHARGES FOR THE HEALTH CARE SERVICE DURING THE PREVIOUS TWELVE MONTHS.
The law also says that health care providers are to post their most common charges in a “conspicuous” fashion and put it in “plain English.” What I am seeing so far is the information is being buried in complicated webpages without the staff even knowing the law exists.
Finally, “health care provider” includes almost every business in the industry — “Medical, mental, dental, or optometric care or hospitalization… services for the purpose of preventing, alleviating, curing, or healing a physical or mental illness or injury.” This transparency is now required for just about all health care providers.
On your next visit to any (and every) health care provider ask them where their cost information is posted. Article 25, section 49 is now a part of the Colorado statutes, but it won’t mean anything unless we insist it is followed.