In most cases it does not matter what a physician or hospital designates as their standard price for a coded item. The insurance plan, the medicare agency, the medicaid agency, the supplemental plan insurance or others all tell the hospital what they will pay for the diagnosis related. With Medicare, for example it is a gross allowable that usually about 30% average of the listed charge less 20%.
If your hospital and related service providers charge 115,000 the agencies may wipe out 15k as not allowed and then authorize the 100k as being allowed at 30k gross. Medicare pays 80% of the 30k (24K) and your supplemental insurance pays the other 6k.
If a different hospital charges gross 85k for the same services, the agency still looks over all the detail to the paper work and cuts as they see fit but pay subsequently the same amounts for the coded procedure or service.
The consumer will be unable to use these changes to negotiate cash cafeteria care without a very detailed understanding of the codes and rules for allowable.
Doesn’t every hospital use the same “codes” for procedures/tests?
I admit I know little about how hospitals bill in practice, but my -ahem- assumption was that for a given list of codes, (whatever they are for) a hospital would have to list a price - and those prices could be compared with the same codes from other hospitals.
This, to me, could be a high-level measure of cost efficiency of a hospital - an inefficient hospital with lots of overhead would have a noticeably higher cost across the codes it delivers, while a cost efficient hospital would have a noticeably lower cost across the codes it delivers.
So I ask you since you are obviously knowledgeable in this stuff.... Would a consumer - even an unsophisticated consumer might be able to tell when comparing one hospital to another which one is more cost effective - in general by examining which one is most/least expensive across the broad array of codes?.