Price Transparency: Shopping in Florida

Hospitals were required to comply with the federal price transparency rule on January 1, 2021, and it has made for (exhausting) shopping for health care in Florida. ClareFolio presented its analysis of 202 hospitals at the Health Benefits Conference & Expo (“Price Transparency: The Consumer Perspective in Florida”).

Shopping is about making choices, especially with employer-sponsored insurance. Employers choose carriers and plans for their employees, and employees choose plans and hospitals for themselves and their families. Consumers with employer coverage would have learned the following when shopping for three hospital services:

  • Diabetic care (DRG 639): At one hospital, a carrier’s negotiated rates were $21,000 for its HMO plan, $25,000 for its PPO plan, and $31,000 for its Indemnity plan. A consumer’s cost would vary depending on which plan she enrolled in during open enrollment.
  • Joint replacement (DRG 470): A carrier’s negotiated rates for the same plan type were $28,000 in Hospital A and $56,000 in Hospital B. A consumer’s cost would vary depending on which hospital she chose to receive care.   
  • Vaginal delivery (DRG 807): Carriers’ negotiated rates varied from $8,000 for Carrier A, $11,000 for Carrier B, $13,000 for Carrier C, to $16,000 for Carrier D. A consumer’s cost would vary depending on which carrier was selected by an employer.

Nearly 90 percent of Florida hospitals made a cost calculator available on their websites. While the ability to link to a specific health insurance plan was limited in most calculators, consumers were often able to learn their estimated out-of-pocket cost after deductible, coinsurance, and maximum were considered.

Price transparency efforts were not perfect in Florida, but many hospitals provided consumers with important lessons about the cost of their health care. These consumers are Mastering Health Insurance. The lessons were as important–if not more so–for employers, payers, and providers.

Photo: Beach at Clearwater, FL, home of HBC&E’s annual conference (2020). Here’s to being there again soon.