Why Can’t I Find out what my Medical Care will Cost?

 Few things are more confusing then determining costs for medical care.

Lots of factors contribute to the lack of transparency in healthcare pricing.  Here are the major contributors:

1. A Third Party Payer structure leads to patients asking less questions surrounding pricing since they are generally not charged directly.
2. Negotiations between insurance carriers and providers are bound by confidentiality
3. Different care venues have wildly different pricing structures for given procedures.  For example, a hospital may charge $80,000 while an Ambulatory Surgery Center specializing in the procedure may charge $20,000. 

There are several ways to get a baseline of what your medical care should cost.  The most common baseline used is Medicare rates.  The Center for Medicare & Medicaid Services (CMS) negotiates rates with medical providers.  These rates are typically multiples below what private insurers pay.  If you are a cash buyer, don’t expect to pay Medicare rates.  However, it is not unreasonable to negotiate a rate between 120% and 160% of Medicare rates.

There are not many great resources to easily access pricing benchmarks for medical procedures.