Dr. Heather Falvo’s attempt to use Colorado’s hospital price transparency law succeeded in cutting her medical bill in half.
Others may not be so lucky, since publicly posted price information may be unusable to a layperson while still complying with the law.
Falvo, who divides her time between Denver and Texas, needed an echocardiogram to check on some heart palpitations she had been feeling. She expected it would cost something close to the $200 Medicare would pay for an ultrasound of the heart.
But when the bill came, it showed HCA HealthOne Swedish billed her insurance more than $8,500, and that she would have to pay about $3,600.
Falvo said no one in the Englewood hospital’s billing department could explain why the price was so high. She was looking online for the medical center’s patient advocate when she stumbled on something that would help: Swedish’s price transparency files.
A quick search led her to a Colorado law that forbade hospitals from sending patients to collections or suing them if the hospital hadn’t posted relevant price information.
The files were in a form that Falvo couldn’t open, which seemed like a violation of the state’s price transparency law to her — though the law doesn’t specify a format. She paid half the bill and wrote Swedish a letter saying she believed they had violated the transparency law — and that she didn’t plan to pay the rest.
Richard Grissom, spokesman for Swedish, said the hospital “strongly supports” efforts to give patients price information and encourages them to use its estimator tool. He said he couldn’t comment on a particular patient’s situation.
“Our pricing is competitive and varies based on a number of factors, including the health status of the patient, the expertise of physicians and the technology and equipment used in providing care,” he said in a statement. “The move toward higher-deductible insurance plans has put a strain on many of our patients, but we understand their choice to pay a lower monthly premium, and we also understand their frustration with the larger out-of-pocket expenses they may experience as a result.”
Colorado’s 2022 transparency law requires hospitals to post a list of prices for “shoppable” services and a machine-readable file listing all prices, in line with federal price transparency rules. It put the onus on patients to sue the hospital if they experienced coercive tactics, though a separate bill a year later gave the Colorado Attorney General’s Office the right to sue hospitals for violations.
The attorney general hasn’t taken any public action against hospitals related to price transparency. No one has tracked whether patients have sued because the hospital where they got care hadn’t posted prices.
A November report from PatientRightsAdvocate.org found 21 out of 35 Colorado hospitals appeared to comply with federal price transparency rules, but only three posted prices in a form that consumers could easily use.
The Centers for Medicare and Medicaid Services allow hospitals to report a percentage of other prices or a formula rather than a flat dollar amount, so facilities that comply may still not offer useful information, said Ilaria Santangelo, director of research at PatientRightsAdvocate.org.
Allowing hospitals to hide real prices means consumers have no way of knowing what they should pay, she said.
“We are only able to prove overcharges with real prices,” she said.
Colorado hospitals support price transparency and have worked hard to comply with federal law, said Cara Welch, spokeswoman for the Colorado Hospital Association. Only CMS can determine if hospitals are in compliance, and they haven’t fined any Colorado institutions for falling short, she said.
“We strongly believe that patients should understand their insurance benefits and have access to price information in order to make informed decisions about their health care,” she said in a statement.
Since 2022, CMS has fined 24 hospitals nationwide, including seven in the current year.
The report showed HCA HealthOne Swedish as in compliance, because federal rules for the machine-readable file don’t require it to be in a form that people without coding experience can use.
A letter that Falvo received said the hospital didn’t find any billing errors or problems with the price transparency postings, but opted to write off the rest of the bill “in recognition of the difficulties you face.”
Falvo said she thought a bill of about $1,700 for an echocardiogram was still excessive, and that she doesn’t believe people with less experience understanding medical bills would have received even that discount. She works for an insurance company, examining bills other doctors submit.
“I’m a physician, I work in the business and I couldn’t figure out what happened or how to resolve it,” she said.
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