Hidden charges? Patients often face massive bills when Florida hospitals don't provide costs upfront

Yahoo

2 days ago

A Jacksonville woman posted on Facebook a $3,000 hospital bill for an MRI of her foot.
'Paying $3,000 for something that costs $400 … pretty absurd,' she wrote.
For Floridians, knowing how much a procedure costs before getting hit with a humongous hospital bill can be the difference in whether someone struggles for years with medical debt. Now, Florida's attorney general announced he is launching an investigation to ensure hospitals provide patients with transparent pricing for medical services.
Florida hospitals are supposed to make it easy for patients to know costs upfront and compare prices. However, it is not happening in the way federal and state laws require.
Try to compare the cost of a chest X-ray or colonscopy at hospitals anywhere in the state and you will discover that many fail to provide clear and accessible pricing information on their websites.
'Hospitals know the prices to the penny, and the amount of profit they will make,' said Cynthia Fisher, founder and chair of PatientRightsAdvocate.org. 'They know what insurance plans pay and the cash prices. Yet, it is egregious and deceptive and unfair to make every patient sign that they will financially cover whatever the hospital chooses to charge them without knowing what the cost will be.'
Shoppers in Florida are savvy consumers, comparing prices of property insurance, gasoline and cruise vacations. However, when it comes to price shopping for healthcare services, many Floridians are unaware that, before they get care, by law, they should be able to compare prices at different hospitals or look up cash versus insurance prices within the same hospital for a medical procedure or service. Patient advocates say hospitals often require that patients give their electronic signature — accepting full financial responsibility — without providing them any information on prices.
'If one hospital charges $3,000 for an MRI and another charges $7,500, that difference is a lot of money to a family,' Fisher said. At a time when many people choose high-deductible insurance plans, 'it matters to have price competition,' she adds.
It also matters because nearly two-thirds of Americans delay care each year for fear of financial ruin.
President Trump mandated in 2021 that hospitals and insurers make prices public for 300 shippable medical services. However, it isn't happening.
Changes under the Biden Administration rolled back key price transparency requirements, allowing hospitals to post estimates rather than actual prices. Trump's new order, signed in February, said that hospitals and health plans 'were not adequately held to account when their price transparency data was incomplete or not even posted at all.' The president wants to create rules that will boost enforcement to increase hospital compliance and force hospitals and health insurance companies to make it easier for patients to compare the actual prices of procedures and prescription drugs.
Florida Attorney General James Uthmeier's investigation aligns with Trump's recent efforts. It draws on Florida law, which states that unfair and deceptive acts and practices are 'unlawful,' including the omission of material information, such as prices.
On the website of every hospital in Florida, a 'price transparency' link at the bottom will guide you to a tab that provides information on costs for services. The amount of information and the ease of accessing it vary. Many price lists are so incomplete or difficult to navigate that it is nearly impossible to figure out an actual price, conduct a rigorous comparison between hospitals, or fully compare the rates negotiated by two major insurers at the same hospital. Often, a link on the page requires a visitor to download pricing spreadsheets that are voluminous, complex, and difficult to understand.
A December 2024 report by PatientRightsAdvocate.org found that most hospitals in Florida are not complying with the federal rule requiring them to publish their discounted cash prices and all negotiated rates by insurance plan for all services.
The organization found only 29% of hospitals in Florida are fully compliant with the federal price transparency rule — that's only 39 of 135 Florida hospitals reviewed.
And only 3% of the 135 Florida hospitals reviewed provided sufficient pricing data to consumers. The report revealed wide price variations for the same service, even within the same hospital system. It found hospitals posted files that did not include all payer and plan names, or files that did not include accurate minimum and maximum negotiated charges
'By keeping their prices hidden, hospitals continue to block consumers from their right to compare prices and protect themselves from overcharges,' Fisher said. 'Over 92% of healthcare is planned. Scheduled. We, by law, are supposed to have prices before we receive care.'
Ilaria Santangelo, director of research at PatientRightsAdvocate, said that Florida's insufficient transparency mirrors a national lack of transparency. Of 2,000 hospitals in the U.S. reviewed by the organization, only 335 hospitals (16.8%) were found to be sufficient in their disclosure of dollars-and-cents prices.
'The rest of them posted unaccountable, incalculable prices,' Santangelo said. 'What good is a pricing file that doesn't contain prices?'
To help patients navigate healthcare costs, Florida offers the Health Price Finder tool. You can search by procedure name, select locations (county, city, zip), and see a comparison of average or typical charges. The finder, though, provides cost estimates and averages that may vary from actual charges.
'An estimate can be off by thousands or tens of thousands of dollars,' Santangelo said. 'Averages are not real prices. What happens when you are charged an above-average price? How do you dispute that?'
Matt Ungs, founder of Patient Fairness, said he regularly receives calls from Floridians outraged by hospital bills exceeding six figures.
'(Hospitals) are relying on people to shrug and pay the bill, but the more people who push back, the more likely hospitals will change their conduct,' said Ungs, whose company disputes medical bills for clients.
A Central Florida woman who received an outrageous bill made national headlines a few years ago, drawing empathetic responses.
In December 2021, Bisi Bennett ended up with a hospital bill for more than a half-million dollars after giving birth — despite having health insurance. Her son was born prematurely at Advent Health Orlando and rushed to the NICU, where he had a two-month stay. During that time, Bennett's employer changed health plans. The hospital billed her $550,000. After numerous calls to straighten it out, she was sent the same bill again, with a payment plan of nearly $46,000 a month. After a media inquiry, the hospital lowered the bill to just $300 total.
Fisher said her organization wants to protect patients from overcharges and force hospitals to follow federal and state law.
Under the Florida No Surprises Act, patients have the right to a Good Faith Estimate, which is an estimate of the cost of services. It offers protection from unexpected, or surprise, bills when a person receives care from out-of-network providers at in-network facilities.
Ungs said while estimates are helpful, knowing the exact cost in advance is more useful. 'Patients have a right to real prices, and they need to start demanding them. You can only fight an overcharged bill with an actual price, not an estimate.'
On May 30, Florida's attorney general released a video on X in which he addresses Floridians about Trump's actions to enforce price transparency. 'My office is going to help the President deliver on his mandate,' Uthmeier said. Subpoenas are part of an investigation 'related to patient charges, disclosures, billing practices, price transparency, and surprise billing protections,' he said.
The hospital systems targeted by Uthmeier's subpoenas include AdventHealth, with more than 30 hospitals in Florida, and Southern Baptist of Florida in Jacksonville, with about a dozen hospitals in the state, according to Fox Business. Neither health system responded to requests for comment or to answer questions about the subpoenas or their efforts for price transparency.
Southern Baptist of Florida's website appears more transparent than many others in the state. It provides a tool to estimate costs, even for those who are not existing patients. It can be searched by insurance plan or cash. The tool offers a good example of why a patient would want to shop around: For a procedure such as a colonoscopy, cash prices differ between hospitals within the Southern Baptist system — a colonoscopy at Baptist Clay is $5,121 and at Baptist Jacksonville, $5,546.
Uthmeier would not provide any confirmation or elaboration on which Florida hospitals received subpoenas, whether those hospitals will receive fines, or how he plans to enforce price transparency rules. Numerous requests from the South Florida Sun Sentinel for more details went unanswered and a request for an interview was denied.
Jaime Caldwell, president of the South Florida Hospital and Healthcare Association, said local hospitals have devoted time and resources to make price tools consumer-friendly. They have had much to overcome and still have more work to do, he said.
'Hospitals need to better integrate their IT systems to make the required data more readily available … these improvements are happening,' he said. 'It's a long road and hospitals have made the journey toward providing their patients with the financial information that they want to make an informed decision.'
A spokeswoman for the Cleveland Clinic of Florida offered this written response about price transparency: 'For patients to understand their potential financial obligation for care, it is recommended to first check with their insurance provider, who has access to all of the detailed information about their personal coverage. Estimates for care are available to patients when scheduling surgical and diagnostic services and upon request for all other services.'
It was noted that patients can access their own estimates for 300 services through their MyChart account or the Cleveland Clinic's website.
'Our financial advocates are also available to help patients understand and calculate their potential financial obligations before they receive care,' the spokeswoman said.
After Uthmeier announced his investigation into hospital price transparency, Mary Mayhew, president/CEO of the Florida Hospital Association, provided the South Florida Sun Sentinel a written response:
'Florida hospitals have invested time and resources to develop responsive, easy-to-use tools to deliver meaningful, consumer-friendly pricing information: providing patients with straightforward, personalized, and actionable information based on their specific insurance coverage and financial circumstances,' she said. 'Florida hospitals are deeply committed to preserving and enhancing the health and well-being of the communities they serve, and working collaboratively with local and state leaders to advance this shared vision of an affordable, accessible, efficient and high quality health care system.'
The push for price transparency comes as roughly 100 million Americans are currently in debt due to medical costs, representing the nation's leading cause of personal bankruptcy, according to KFF Health News.
Patient rights advocates said no one should pay a hospital bill without an itemized list of costs. In Florida, under the Patient's Bill of Rights, you can obtain that list, but you must request it.
Price variations within a hospital system for the same care are not uncommon. Vivian Ho, an economics professor at Rice University, found at Memorial Regional in Hollywood, colonoscopies range from $550 to $6,400 depending on the insurer.
Advocates also recommend printing out pricing information available on a hospital website, if available, and bringing it with you during registration.
Ungs said with research and persistence, Floridians can make price transparency work for them.
To dispute a bill, he suggests getting the list of Florida hospitals that are noncompliant from PatientRightsAdvocate.org. 'If a provider is non-compliant, that can be a reason to dispute the bill,' he said. A provision of a Florida law that went into effect last year requires hospitals to have an internal grievance process for patients to dispute charges.
'Patients need to stick up for themselves,' he said. 'Don't give hospitals a pass because they are using complex billing systems that they choose to use.'
He recommends writing a letter to the hospital, and continuing to write to the hospital until you get a result.
'Perseverance is a big factor in success with this,' he said. 'Patients have to stick with it. Those who do tend to get action.'
South Florida Sun Sentinel health writer Cindy Goodman can be reached at [e-mail] or at 954-304-5908.