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Dad says new hospital price lists don't match real ER costs

New law requires prices posted online as of Jan 1
Posted: 10:03 AM, Jan 03, 2019
Updated: 2019-01-15 11:04:54-05

As of January 1, 2019, hospitals are required to post their prices online. It's part of a new wave of consumer transparency on the part of health providers.

But as one family just learned, the price posted online and what you pay can be very different.

Simple arm fracture, big bill

Justin Binik-Thomas is spending his new year fighting a hospital bill, after his 7-year-old daughter fractured her arm on the playground.

He didn't think it would be too costly, since she was treated in an outpatient clinic, not the main emergency room, at a hospital near him.

"They sent me from the ER to their clinic instead," he said, "and according to them and my insurance, that would lower the cost," Binik-Thomas said.

But after his daughter received an arm x-ray and cast from a technician, in a process that lasted less than an hour, Binik-Thomas couldn't believe what arrived in the mail.

"We got a bill for more than $2,000," he said.

Binik-Thomas knew that the hospital had recently begun posting its prices online.

So he checked their website to see what the procedures should have cost, and was stunned to learn her clinic visit apparently clocked in at the highest ER cost.

"The clinic price point they charged her," he said, "was higher than the level 5 emergency room."

Online prices give grounds to question the bill

Binik-Thomas says it was great to finally see prices posted online, as that gave him grounds to question the bill.

But he says when he looked at the itemization of his bill, he discovered his prices were completely different than what were posted on the hospital website.

The hospital's posted rate online for an arm X-ray was $157, but his daughter's bill showed she was charged $227, substantially more.

Instead of a basic ER fee, which were listed at several levels depending on severity of the injury, his daughter was billed for surgery at $1,264 even though he says she didn't have any surgery. He said she never even saw a doctor, just several nurses and a cast technician.

"I was very surprised that casting her arm would be coded as a surgery," he said, "at a higher rate than the emergency room."

Why online price won't match your bill

A spokesman for Cincinnati Children's Hospital. where the girl was treated, could not discuss Binik-Thomas's bill due to HIPAA privacy rules.

But Jim Feuer said "people seldom pay these listed prices because of the coverage terms of their health insurance plans," meaning these new prices are just guidelines.

He explained that each insurance company negotiates its own rates, and the published prices are simply the cash price, that almost no one pays. In addition, hospitals have many facility fees that you may not see when just looking up a procedure online, such as an arm X-ray or an MRI.

However, the hospital promised to reexamine his bill.

But Binik-Thomas found one good thing about rates now being posted online: it gives you a place to start when trying to find out what a procedure should cost.

That way you don't waste your money.

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Contact John at jmatarese@wcpo.com
Contact John at jmatarese@wcpo.com