Medical procedure prices vary by hospital

Posted at 11:58 PM, Sep 21, 2015
and last updated 2015-09-21 23:58:54-04

Ask Andrea Duenas the best part of motherhood.

“The love you get, you get paid in love,” she told the Contact 5 Investigators recently.

13 months later, you might just say this first time mom is drowning in love checks.

“She such a happy baby,” she said while playing with her daughter.

Duenas didn’t start “earning” her checks until she left Wellington Regional Medical Center, a hospital, the Contact 5 Investigators found, that can charge you big bucks for your little bundle.

“I didn't really think about it,” said Duenas who’s insurance paid most of the cost of her standard delivering bill.  Good thing, because we found starting charges for a standard labor and delivery at Wellington Regional are, on average, nearly 70 percent higher than other area hospitals.

“That's crazy, is there a reason for it,” asked Dueans.

Not really.  Hospital prices aren't regulated so while one area hospital can charge just under $6,000 for a standard delivery, another can charge close to $27,000, according to the state’s online hospital price comparison chart.

“It's so complicated there's no easy answer,” explained State Representative Gayle Harrell (R) of Stuart.

From hip replacements to pneumonia, we found prices for common procedures at area hospitals are all over the map.

It's a pricing problem that has infected the entire state.

Of America's 50 priciest hospitals, a recent study found 20 of them are in Florida, with Lawnwood Regional and Sebastian River Medical among the dozens found to mark up its prices more than ten times the actual cost of patient care.

Neither Sebastian River Medical or Lawnwood Regional would with the Contact 5 Investigators on camera about the price variances.

"What patients pay has more to do with the type of coverage they have than charges," wrote Rhonda Wilburn, spokesperson for Lawnwood Regional Medical Center in a statement to the Contact 5 Investigators.

"I definitely see the need for improvement," said Harell who admits Florida’s answer to helping to make hospital prices more transparent has not worked.  She should know, she helped implement the state's website aimed at making healthcare costs more transparent.  But the website only requires hospitals post charges not what consumers will actually pay once insurance kicks in.

When asked what good the website is, Harrell responded, “Well, it gives you a range that's about it, it gives you a range,” she chuckled.

In May, Governor Scott formed the Commission on Healthcare and Hospital Funding.  The group is focused on making hospital charges and costs more transparent

“It never crossed my mind to look at other hospitals,” said Duenas who didn’t realize medical procedure prices can vary so dramatically from hospital to hospital.

Wellington Regional Medical Center also wouldn't make anyone available on camera.  

Statement from Wellington Regional:

First and foremost, please be advised that a hospital’s payment for deliveries has nothing to do with its gross charges. Payments are determined by either predetermined contractual rates between hospitals and managed care companies or at governmental predetermined rates, i.e. Florida Medicaid.  Wellington’s average net revenue per case approximates $4,900 per delivery. The $4,900 then has to cover all costs for the patient’s stay and these costs account for the majority of the net revenue received.

The aforementioned paragraph addresses insured patients; however, we want you to know that we are very sensitive to those patients in our community who have no insurance and hence we offer competitive, self pay price for vaginal or c section deliveries, at a fraction of gross charges.

Lastly, on a periodic basis, we receive reports comparing our gross charges for high volume procedure codes such as room & board, CT scans, ED visits, etc., to other hospitals in the marketplace, and we have always been nearer the bottom of this comparison in terms of having low gross charges than our competitors.

Your best bet to finding out exactly what a hospital procedure will cost to ask the hospital directly.  Many have financial counselors who can give you a more accurate estimate once insurance kicks in.

Statement from Lawnwood Regional Medical Center:  

What patients pay has more to do with the type of coverage they have than charges. Government programs like Medicare and Medicaid determine how much they reimburse hospitals. Insurance plans negotiate their payments. Everyone else is eligible for our charity care program or they receive our uninsured discounts, which are similar to the discounts a private insurance plan gets.




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