These prices are fairy tales. It's a figure next to no one will actually ever pay. Insurers pay less. If you ask for a discount you will pay less.
Negotiated prices with insurers is included in the provided list.
NewYork-Presbyterian Hospital Price List
11–20 of 20 posts
Re: NewYork-Presbyterian Hospital Price List
#12People are getting way too excited about this. The real costs we are missing is the prices insurers pay for procedures by billing code and provider.
If you would have opened it, you would have seen that the spreadsheet has exactly what you're asking for... reimbursement rates by DRG/CPT code and insurer. You're right that in many cases the rates paid by different insurers vary significantly.
Re: NewYork-Presbyterian Hospital Price List
#13The file says "Confidential Proprietary Information" just above the price list. What does that mean in this context? They are making it publically available on their website, and one of the intents of the new bill was to make this information machine readable so developers could build upon it.
In all honesty, it's probably a line they forgot to remove. This document looks like it's in response to new executive action around price transparency.
Re: NewYork-Presbyterian Hospital Price List
#14> List of Shoppable Services > Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc These aren’t shoppable services...
Well, the latter might not be as shoppable (you know, because it's time sensitive), but joint replacements certainly can be.
Re: NewYork-Presbyterian Hospital Price List
#15These prices are fairy tales. It's a figure next to no one will actually ever pay. Insurers pay less. If you ask for a discount you will pay less.
> These prices are fairy tales. It's a figure next to no one will actually ever pay. Insurers pay less. If you ask for a discount you will pay less.
Columns H through AI represent the negotiated insurance rates or agreed schedules. AJ represents the lowest negotiated charge for that service across all providers.
Interesting reading, really. Aetna largely seems to pay retail, whereas others like Cigna and Emblem are getting "decent" discounts. Also provides a good basis for negotiation if you're a cash payer. "I can pay your minimum negotiated charge for this, or I can dispute it during collection"
But even still, these prices are ridiculous even after negotiation and are indicative of a broken system. For what it's worth, hospitals aren't charging these fees because they're profiting; many of them are struggling to stay in the black.
(I used to run appsec at a healthcare best practice and advisory firm. A lot of my background on this was absorbed through osmosis, though I can't say I'm an expert)
Re: NewYork-Presbyterian Hospital Price List
#16People are getting way too excited about this. The real costs we are missing is the prices insurers pay for procedures by billing code and provider.
If you would have opened it, you would have seen that the spreadsheet has exactly what you're asking for... reimbursement rates by DRG/CPT code and insurer. You're right that in many cases the rates paid by different insurers vary significantly.
No it doesn't. That's the charges hospitals charge for patients under those plans
What I am asking for is completely different.
I want to know what insurers pay out by procedure code by provider. There's a reason why insurers lobbied against providing this information under this law.
Re: NewYork-Presbyterian Hospital Price List
#17People are getting way too excited about this. The real costs we are missing is the prices insurers pay for procedures by billing code and provider.
The spreadsheet provided at the link includes exactly that information.
Nope it's only what hospitals charge to different insurers.
That's different from what insurers pay out by procedure to providers.
Common misconception.
Re: NewYork-Presbyterian Hospital Price List
#18These files are more widely available than people think. For California for example, an agency called OSHPD makes available a set of documents called “charge masters” which have similar information.
This appears to be a little different bc it looks like they are listing an insurer-specific (e.g., an Aetna negotiated price). That would be very very unusual.
However the caveat on the linked page suggests that maybe that data isn’t what it appears to be.
Regardless, this kind of price transparency (even if the negotiated prices are available) is not obviously something which is going to bring prices down.
Re: NewYork-Presbyterian Hospital Price List
#19Interesting to see this data released, but I'm a little dubious.
According to the spreadsheet, Aetna is always paying 100% of list, and SEIU 1199 is always paying exactly 50%.
Most of the other private providers are listed with almost-flat discounts (85% for CHP, 71% for Empire, 60% for Healthfirst) with a handful of operations at other price points. Cigna has a little more variety but is mostly listed at 51%.
Only Emblem shows real variety across the board, with prices listed from 21.9% to 174%. It also has the lowest mean/median, at 45% and 34% respectively.
I know from personal experience that Aetna does have negotiated rates with NYP, and the flat discounts for all providers other than Emblem are also suspicious.
Re: NewYork-Presbyterian Hospital Price List
#20Earlier quoted context omitted.
The spreadsheet provided at the link includes exactly that information.
Nope it's only what hospitals charge to different insurers. That's different from what insurers pay out by procedure to providers. Common misconception.
You have made this comment twice and I'm not sure I understand from it what you are looking for that is different from the information provided.
The only thing I can think of is you are looking for the split of the negotiated amount paid by the insurer vs the patient. This of course can vary based upon the particular level of coverage the patient has with the insurer.