How Hospital Chargemaster Law Impacts Employer Health Plans

This New Year’s Eve hospital systems across the country watched the ball drop in NYC while also preparing their double-dutch secret pricing lists to post online. In industry parlance, this master pricing is known as a Chargemaster. This federal mandate falls under a requirement in the 2010 Affordable Care Act that calls for every service or procedure and it’s associated billing costs to be listed online. Until this week, hospital systems were not required to publish them.

As the following video illustrates, there is a big disparity among hospital systems as it relates to the cost for services performed. Additionally, cost, outcomes and quality metrics are equally as variable, even among hospitals with the same brand name on the building.


We applaud the Centers for Medicare & Medicaid Services efforts to improve price transparency in health care. It is a good first step to for our country to ask these ever growing giant retailers to first identify what services you provide to consumers (i.e. CPT codes) and then to associate a price. The price data point is immaterial, however, since the number has little relation to the contracted amount through your health plan’s network.

Our advice to plan sponsors seeking to help employees and dependents to navigate a complex system, engage a health care navigation firm to serve as a central point of contact for healthcare needs. Our company utilizes one of the leaders in the industry that has aggregated 6.3BB price points across 66 payer networks involving 73,000 procedures. They do more than present cost and quality options at the time of service for healthcare needs. I just changed primary care physicians (PCP) and have asked them to oversee the transfer of records to my new PCP. Other options involve utilizing quality / cost metrics to derive different decision towards premium care-givers through point of service or plan design.

The chargemaster price is essentially the sticker price of a car that no one really pays. This is why the free market system has created service providers like Carvana, KBB, Edmunds and TrueCar to help consumers along the way. Which healthcare navigation firm is right for your company? Our clinical consultants have already done the RFP and analysis work with thousands of employers across the country to help your firm select the right healthcare navigator and deploy it in a way to get meaningful results.