New York City Seeks to Unravel the Secret Mystery of Hospital Costs

New Yorkers in need of medical treatment often choose their hospitals based on a variety of factors: reputation, their practitioners’ affiliation or maybe location.

But there is one variable that seldom enters the mix: how much hospitals charge for the same service.

The lack of transparency has bedeviled patients across the country, sometimes arising in well-publicized stories about overinflated bills for relatively straightforward hospital visits — an issue that is particularly troubling for people without insurance.

On Thursday, the New York City Council intends to rectify the issue by passing a bill that will allow New Yorkers to compare the prices of procedures at different hospitals online.

The bill would create the nation’s first city “health care accountability office” to analyze hospital costs and to provide information about prices online.

“There is no other area where, as a consumer, you’re procuring a service and you have no idea what you’re going to be charged,” said Councilwoman Julie Menin of Manhattan, who sponsored the bill. “This is a simple, straightforward consumer protection measure.”

The bill has the support of a majority of the City Council, with 42 co-sponsors out of 51 members. Mayor Eric Adams, a Democrat in his second year in office, said in a statement that he supports the bill.

“This bill will make it easier for New Yorkers to find information on hospital pricing, and we’re grateful to our partners in labor and the Council for pushing this forward,” Kate Smart, a spokeswoman for the mayor, said.

The Greater New York Hospital Association, the state’s most powerful hospital and health system trade association, strongly opposes the bill, arguing that hospitals were already working to comply with federal regulations instituted in 2021 requiring them to publish a complete list of the prices they negotiate with private insurers.

But many hospitals ignored the requirement. A study by a nonprofit patient rights’ group found that only about 24 percent of the 2,000 hospitals it surveyed were complying. In New York City, the rate was even lower at roughly 6 percent.

David Rich, an executive vice president at the Greater New York Hospital Association, suggested at a Council hearing in February that the bill unfairly targeted hospitals instead of insurance companies.

“It virtually ignores the behemoth national for-profit health insurance companies that make enormous profits in New York’s health care economy and ship those profits out of New York to their parent organizations and shareholders,” he said.

Costs in New York can vary widely. A cesarean section delivery at Montefiore Hospital in the Bronx — which lists the cost of procedures on their website — typically costs roughly $55,000, while the same procedure costs about $18,000 at New York City-run hospitals, according to a recent survey.

Data from hospitals across the nation that have complied with federal regulations show why powerful industries wanted cost information to remain hidden from the public. Hospitals are charging patients vastly different amounts for the same basic services, including an X-ray or a pregnancy test.

Other states have approved price transparency measures for hospitals. An effort in California contributed to cheaper costs for knee and hip replacements. In 2007, New Hampshire started a website that showed the cost of procedures, including magnetic resonance imaging scans.

In New York, about one million people are uninsured, even after the implementation of the Affordable Care Act. It is even more important for those residents to understand how much a procedure will cost in advance, Ms. Menin said.

“If you’re uninsured, this bill is a game-changer,” she said.

The price estimates for hospital procedures came from a report by the powerful 32BJ union health fund, whose leaders support the bill.

The new health care accountability office would list the prices of common hospital procedures on its website in a “simplified and publicly accessible format” that would allow consumers to compare prices.

Michael D’Anvers, 40, who lives in Brooklyn and works on accessibility issues, recalled his frustration at being charged $430 for a 15-minute virtual visit with a doctor at the Mount Sinai Health System in 2021, to discuss the neck pain he suffered while working from home. The bill was reduced to $220, but he said he was still upset.

“They should be upfront about their costs,” he said. “If I knew it was going to be that much, I would have found another way to get a referral to a pain specialist.”

Sometimes the issue is less about being overcharged, and more about the seemingly haphazard calculation that determines how much a patient is eventually asked to pay after making an on-site co-payment.

Michelle D. Winfield, 76, a retired teacher who lives in Manhattan, said that after receiving an electrocardiogram during a routine physical at a New York University health facility in Manhattan this year, she was surprised when she later got a bill for another $18.56.

“It’s not the amount — it could have been $500,” she said. “It’s about transparency. It should have been told to me that there was a cost and I could determine whether I wanted to do it.”