Last year I sponsored SB-65, which was signed into law in April, to require 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 patients an idea of the costs of medical procedures before they get the bill and start the much needed conversation of the cost of medical services between a doctor and their patient.
The law took effect on January 1st, so on January 2nd I visited my local hospital to see how and where they were making the information public. I went to the front information desk – they had never heard of it. Next I went to the emergency room staff who admit patients – they had never heard of it. Finally I went to the billing department and the first person I talked to had never heard of it. 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 publicly available.
I found those web pages but it took a long search and several clicks to get there. The lists of costs included a line that says that the cost for a “straight forward” 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 (given below) states that the prices they post are to be as close to the actual prices charged to real people as can be determined. Therefore quoting a few hundred dollars for a simple ER visit is not what the law requires, unless the hospital really intends on charging that amount for ER visits from here onward.
This law has the potential to revolutionize the way medical costs are handled in Colorado, but only if we all know the law, insist our medical providers are following that law and when ever possible, send our business to the most cost effective providers.
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 healthcare 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.
The next time you go to any health care provider ask them where their cost information is posted, as per the requirements of Article 25, section 49 of the Colorado statutes.