Understanding potential healthcare costs is an important part of planning for care, and North Carolina hospitals and health systems are committed to helping patients navigate that process to get the care they need. 

New federal price transparency laws require hospitals and insurance carriers to provide healthcare cost information online, which includes posting machine-readable files with a variety of different rate information, as well as a consumer-friendly display of rate information for at least 300 shoppable services.  Click here for links to hospital and health system price transparency pages.

While this requirement is meant to make healthcare costs easier for patients to understand, some components of the law may make it more confusing and have unintended consequences like causing people to postpone care.

When you search for a common procedure, you will find data that breaks it down by CPT (Current Procedural Terminology) code and charge by payor. There is a lot of data to comb through but none of the information is what a patient will pay to receive care or what a hospital will receive as payment.  

What healthcare consumers really want to know is how much they will be expected to pay out of their own pocket. This amount will vary based on a consumer’s insurance provider and where they are in their benefit year – so how much of their deductible or out of pocket maximum has been met. 

Healthcare is also extremely personal. Patient care is designed for the exact needs of that patient. And while estimates of how much that care should cost can be provided, there is also a level of variability to it. There is no way to fully predict what care is necessary because no patient is the same. For example, a gall bladder operation for one patient may be relatively simple; however, for another patient, there could be unforeseen complications, making meaningful up-front pricing difficult.  

For non-emergency services that give consumers time to shop, the best way to find information about your healthcare costs is to contact your health insurance provider, who will have answers pertaining to hospitals, providers and services covered under your plan’s network.

Health insurance companies will also have patient-specific information regarding costs they will be responsible for, such as deductibles and out-of-pocket maximums. Insurance companies negotiate with hospitals and other healthcare providers to establish contracts that specify what insurers will pay for various health care services. In most contracts, these payment rates are lower than charge rates.  

North Carolina hospitals and health systems also have information readily available to help patients estimate their healthcare bill. Financial navigators are often able to provide the patient with a more robust view of the services they may need, helping patients understand what other services may go along with the care for which they are looking to receive a quote. 

If a patient does not have health insurance, the best way to get accurate pricing information is by calling their hospital or provider directly and requesting a price estimate. Most hospitals offer discounted rates and charity care for patients that qualify.