It’s no secret that health care expenses can add up quickly. What might surprise you, though, is just how much costs can swing depending on the hospital you choose.
A new report by Trilliant Health [1] highlights the wide gap. For example, ankle replacement surgery can cost anywhere from $22,011 to $197,057, depending on where you go.
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Costs can vary ninefold [3] across state lines and about threefold within the same state. That means you could pay nine times more if you don’t shop beyond your state, or three times more if you don’t compare options locally.
For patients, digging into health care prices can feel murky at best. Most know to check whether a doctor is covered by their insurance, but few feel equipped to shop around on cost since hospitals rarely make total out-of-pocket prices clear
Why the gap?
It’s easy to assume higher costs mean better care, but Trilliant’s report suggests otherwise. The report looked at hospitals featured on multiple “best of” lists and found no connection between price and quality.
Another assumption is that hospitals in pricier cities naturally charge more. While the cost of living does play some role, the report found only a weak connection.
So what’s really driving the price difference? While multiple factors are at play, it comes down to the negotiations between hospitals and insurance companies.
Behind the scenes, insurers haggle with providers over rates. For example, a colonoscopy with a sticker price of $5,000 might end up costing $2,500 after the hospital and insurer settle on a rate. But those rates vary widely by payer. Another example could be that one insurer might negotiate $85,000 for a hip replacement, while another pays $112,000 for the same procedure.
Those discrepancies filter down to consumers. But, hopefully, increased data and increased scrutiny on this issue will push prices lower, especially for informed consumers.
Read more: Here are 5 ‘must have’ items that Americans (almost) always overpay for — and very quickly regret. How many are hurting you?
How to protect your wallet
In his first term, President Donald Trump called for transparency through an executive order [2]. Essentially, it requires hospitals and healthcare providers to submit clear, comprehensive pricing online about their services in a consumer-friendly format. While the date can be overwhelming, it also arms patients with the power to shop around [3].
The potential savings are huge. According to Trilliant, a coronary bypass can cost $39,579 in Ville Platte, Louisiana, to $354,745 in Hackensack, New Jersey.
If you want to find affordable care, start by calling the hospitals you’re considering. Have your insurance information and procedure details ready. The billing department should be able to give you an estimate, so you can compare it with other facilities.
Reputation and quality of care should be factored in, too, but a little shopping could save you thousands.
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[1]. Trilliant Health. “Leveraging Transparency in Coverage Data to Reveal Actionable Information on Commercial Negotiated Rates”
[2]. The White House. “Making America Healthy Again by Empowering Patients with Clear, Accurate, and Actionable Healthcare Pricing Information”
[3]. Centers for Medicare & Medicaid Services. “Hospital Price Transparency”
This article provides information only and should not be construed as advice. It is provided without warranty of any kind.