How much, Doc? New laws aim to help Maine consumers understand medical bills

Eric Zelz | BDN
Posted July 31, 2014, at 2:18 p.m.
Last modified Aug. 01, 2014, at 1:28 p.m.

Sashie Misner of Harrison took her 16-year-old son to the local hospital last fall for an inflamed appendix. With no health insurance, she knew she’d get hit with a bill. She asked what their options were and how much to expect.

Her son was in stable condition, so Misner inquired about having him discharged and arranging for a less expensive outpatient visit.

“They couldn’t give me any information at all,” she said.

As she waited for answers, the costs piled up: the hospital room, acetaminophen for her son’s pain, water to keep him hydrated. As he was wheeled into surgery that evening for an appendectomy, a nurse gave her an estimate of $12,000, she said.

Her son spent just shy of a day at the hospital.

“For about 23 hours, the bill was over $19,000,” Misner said.

Months later, Misner’s still negotiating with Bridgton Hospital.

David Frum, CEO of Bridgton and Rumford Hospitals, said as a member of the Central Maine Medical system, the facility uses centralized billing.

“Central Maine Medical Family makes every effort to provide clear and accurate pricing for services provided within our organization,” he said in a statement. “We welcome feedback that will help us continually improve and deliver the best possible experience for our patients and their families.”

The two acetaminophen pills cost $90, Misner said. The hospital charged $622 for hydration packets, which Misner learned medical supply distributors sell for $45, she said.

So far, the hospital has offered to shave $367 off her bill, she said.

“It’s really just a joke reducing it that much,” Misner said.

While the surgery may have been unavoidable, Misner says the lack of transparency about her options and the potential costs kept her in the dark.

“It needs to be part of the conversation when you’re making decisions,” she said.

Two new state laws taking effect Friday are designed to help consumers like Misner.

One will allow patients to learn about costs for elective procedures and compare prices. Hospitals and ambulatory surgical centers must provide the average charge for any inpatient service or outpatient procedure upon request, and display a notice informing individuals about the availability of the information.

Uninsured patients also can request an estimate of the total price of medical services to be rendered during a visit. If the health care facility can’t make an accurate estimate in advance, it must provide a brief description of how the price will be determined.

Under the second law, health practitioners and organizations in Maine must provide prices for their most common procedures — anything performed more than 50 times per year — that would be paid by an uninsured patient. Practitioners, from chiropractors to hospitals, must inform patients about the information and provide it upon request.

“As a nation of seasoned shoppers, we have honed our skills at yard sales, in bargain basements, and over the backyard fence,” Sen. Geoff Gratwick, a Bangor rheumatologist who was chairman of a study commission that explored the transparency of health care costs in Maine, said in a statement. “It makes common sense that we should also be informed shoppers for our health care.”

Lawmakers overrode an April veto of the bill by Gov. Paul LePage, who said while he supports disclosure of health care pricing, he feared patients could be misled about their individual costs.

Prices for the same medical procedures can vary widely from one hospital or doctor to the next, according to federal data. In Maine, common treatments for sepsis, a severe blood infection, ranged from $56,028 at Parkview Adventist Medical Center in Brunswick to $20,130 at Cary Medical Center in Caribou.

Andrea Irwin, legal and policy director for the Augusta-based advocacy group Consumers for Affordable Health Care, said the organization pushed for even stronger laws to help patients better navigate the complicated maze of health care pricing.

“I think it’s an incremental step forward,” she said.

Health care prices in Maine are more transparent than in most states, however, according to a March report by the the Catalyst for Payment Reform and the Health Care Incentives Improvement Institute. The group issued 45 states a failing grade and none received an A.

Maine was one of just two states to earn a B.

Patients who can plan ahead for medical services will be savvier consumers armed with the new legislation, “but it’s certainly not going to be as easy as getting your car serviced,” Irwin said.

While high medical bills often hit uninsured patients hardest, even those with coverage are paying more attention to how much hospitals and doctors charge, she said.

“Whether their deductible is $100 or $2,000 … we’re hearing that a lot of people want to understand how prices are set and the best facilities to go to,” Irwin said.

In Harrison, Misner’s still trying to make sense of her son’s medical bill. A landscape architect at a small firm, she since has purchased health insurance under the Affordable Care Act. But that won’t help her to pay off the thousands of dollars she already owes.

“Who would shop at a place that was marking their prices up so high?” she said.

Correction: This story has been updated to reflect that health-care organizations must provide prices for their most common procedures, but not compile a price list, as the bill originally required before amendment.

SEE COMMENTS →

ADVERTISEMENT | Grow your business
ADVERTISEMENT | Grow your business