Coloradans can now compare hospital prices for specific procedures, insurance plans

If you have a medical procedure on the horizon in Colorado, there’s a new way to shop around for the best price.

Gov. Jared Polis on Tuesday announced a new website — ColoradoHospitalPrices.com — where people can look up various procedures performed at a hospital and see a list of prices based on insurance carrier. The tool, then, potentially allows people with upcoming medical care to shop around and see which hospitals available in their insurance network can offer the lowest price.

At a news conference, Polis said he hopes the website is the first step in an effort to apply market pressure to hospitals to reduce their prices. With health insurance premium prices set to rise for many next year, lowering what patients — and insurers — pay for health care is vital to reducing overall health care spending

“One of the key failings of the market is the lack of pricing transparency that doesn’t allow for the competition to work as it does in any normal market, to bring down costs,” he said.

The website was launched in partnership with the national organization PatientRightsAdvocate.org. Colorado’s website is the first of what the organization hopes will be a nationwide network of price transparency tools for patients.

The new website also adds to the list of local tools in Colorado that give patients the ability to search for hospital prices based on their insurance carrier — that last part is crucial because the prices that different insurers pay at the same hospital for the same procedure can vary widely, while not all hospitals will be covered under a specific insurance plan.

Just last month, the state Department of Health Care Policy and Financing launched its price-lookup site, which relies on the same data as the website announced Tuesday but offers a different search experience. The data comes from prices that hospitals are required to report under state and federal law. Polis said the connection to a national network of price-transparency sites made it worthwhile to launch a second website.

“The more ways to make it easier for people to access that information, the better,” he said.

The Center for Improving Value in Health Care, a nonprofit that administers a state database for insurance claims information in Colorado, also has a shop-for-care tool. Unlike the other two websites, the CIVHC tool allows users to see quality and patient-experience scores for particular hospitals.

But all of these tools — as well as various other efforts to get hospitals to reveal their prices — come with challenges that may limit their value to consumers.

Hospital prices are not a basic menu. There are thousands of billing codes for various procedures, and some procedures could be billed under different codes, depending on the hospital’s operating standards. For instance, there are over 70 different billing codes for an X-ray, depending on the body part being scanned and the number of views needed.

Insurance companies, too, offer multiple plans, which may have different negotiated prices. So it’s not enough to know your carrier — you have to know the specific plan name, too.

And, on top of that, different hospitals may use different names for things. As a portion of an instructional video Polis showed Tuesday explaining how to use the new website put it: “Remember the descriptions may be different as you shop across hospitals, because descriptions vary according to the hospital. Now look for your payer from the list. Payer names can also vary according to the hospital.”

Even more confusing, the prices presented for a specific procedure may not be the “all-in” cost. In other words, there may be other charges for scans, anesthesia, medications and services not included in the procedure price.

Depending on the hospital and how they staff their doctors, patients may also receive a separate bill for physician charges that are not included in the hospital’s posted procedure price.

Polis acknowledged the complexities but said it’s important to start somewhere in making Health care prices more transparent.

“It starts with saying, ‘Hey, why is my lung X-ray $600 at this hospital and $1,500 at this other hospital? The plan I have is paying twice as much as another plan,’” Polis said. “That’s the kind of pressure we need to bring down rates.”

Polis said insurance companies may also use the sites to see what their competitors are being charged and then use that as leverage in future negotiations with hospitals.

Cynthia Fisher, the founder of PatientRightsAdvocate.org, echoed Polis, saying the website is a first step toward “the great reveal of the absurdity of price variation that’s going on across Colorado and across the country.”