As healthcare costs continue to rise, California Attorney General Rob Bonta today issued a consumer alert reminding Californians of their right to access hospital price information online pursuant to federal regulations that went into effect on January 1, 2021.
“Healthcare should be a right, not a privilege. Yet, families across our state face dire economic stress due to surprise healthcare costs,” said Attorney General Bonta. “With today’s consumer alert, we are pulling back the curtain and ensuring Californians know their right to price transparency, which allows them to make the best-informed decisions on their care. Californians who believe they have been the victim or target of deceptive, misleading, unfair, or unlawful conduct should immediately file a complaint at oag.ca.gov/contact/consumer-complaint-against-business-or-company.”
Since the regulations went into effect in 2021, a significant number of hospitals, including those in California, have refused to comply. In fact, the regulations were amended in 2022 to increase penalties for noncompliance in response. Recent reports have indicated that many hospitals are still not in compliance. With today’s alert, DOJ strongly urges hospitals to comply with these laws and encourages consumers to assist DOJ's efforts in tracking noncompliance by filing a complaint with the department here.
The federal government has strong laws in place to provide healthcare transparency, which includes requiring hospitals to publish online annually the price of all their items and services, such as supplies and procedures, room and board, facility fees, physician professional charges, and shoppable services, such as imaging and laboratory services, medical and surgical procedures, and outpatient clinic visits. In today’s alert, Attorney General Bonta urges Californians seeking medical attention to do their research to learn more about the price transparency information available to them, including:
- A Description of Each Item, Service, or Shoppable Service: This may include any code used by the hospital for accounting or billing purposes.
- Gross Charge: The charge that applies absent any discounts.
- Payer-Specific Negotiated Charge: The discounted rate the hospital has negotiated with a third-party payer, such as your medical insurer. Each charge must be clearly associated with the name of the third-party payer and plan.
- De-Identified Minimum Negotiated Charge: The lowest charge the hospital has negotiated with a third-party payer, including with your medical insurer.
- De-Identified Maximum Negotiated Charge: The highest charge the hospital has negotiated with a third-party payer, including with your medical insurer.
- Discounted Cash Price: The price for those who pay cash. Hospitals that do not provide a cash discount for a shoppable service must provide the gross charge for the service.
Below are a few important tips for consumers to keep in mind while shopping for or comparing rates for healthcare services:
- Price information for a hospital’s items and services and shoppable services are required to be posted online, typically on the hospital’s website. While hospital websites can be difficult to navigate, most hospitals place this information in the patient billing section of their website. Also, most hospitals have search functions on their website to help with searching for information on the website.
- When comparing price information, it may be helpful to look at the discounted cash price the hospital charges and your medical insurer’s negotiated rate with the hospital.
- Compare prices for planned surgeries and medical procedures. It may be helpful to look up the prices of what other medical providers charge and use those prices to negotiate. You can also use third-party online healthcare price checking platforms for assistance.