How to figure out how much you'll pay at hospital BEFORE you visit

SAN ANTONIO – If you've ever had a medical procedure done, you know how tricky it can be to figure out how much you're going to pay. Now, there's a new federal law that requires hospitals to post prices for their services online.

The law was created to increase transparency and educate patients, but the pricing lists are long and full of medical jargon.

When you go to the online pricing section of the majority of hospitals, you are usually met with a couple hundred pages of an Excel spreadsheet. For example, if you go to University Hospital's pricing list, it's 223 pages, and it can be difficult to understand for the average person.

Ramona Lampley, a law professor at St. Mary's University School of Law, said the new law is a step forward in medical pricing transparency, but it's not where you are going to go to find out how much you will end up paying.

"I wouldn't go to the charge master to ask for the price," Lampley said. "I wouldn't even start there."

Lampley broke it down into four steps:

First, she said, you should call the hospital billing department with the exact procedure or surgery your doctor will perform to get an estimate. 

"Texas does require a hospital to give you an estimate for the charges when you know you are going to have a procedure and you request it," Lampley said.

Lampley said you should then take that price and compare it with other area hospitals on Texas PricePoint, a more consumer-friendly website.

The nonprofit Texas Hospital Association runs the website, which lets patients compare prices at 35 hospitals or health centers in Bexar County.

"You can go in, type in your procedure and it will ask you a couple of questions, and then it will give you what the average cost should be," Lampley said.

The third step is call your insurance company to see how much it will pay. Lampley said this way, before you go into your surgery, you'll have an estimate of how much you'll pay out of pocket.

And lastly, she said, after your surgery, always ask the hospital for an itemized bill. You are also protected by Texas law to ask for one.

Lampley said an itemized bill lets the patient see their exact charges.

"The hospital happens to charge, say, $15 for Tylenol, which should be, say, $4," Lampley said. "You know when you start looking at the itemized bill, it really hits home how high the health costs are."

Lampley said patients should go over their itemized bill, and if they see something that's off, they should call the hospital to dispute it. 

About the Authors:

Sarah Acosta is a weekend Good Morning San Antonio anchor and a general assignments reporter at KSAT12. She joined the news team in April 2018 as a morning reporter for GMSA and is a native South Texan.