Recent U.S. policies require hospitals and health insurers to post payer-specific negotiated prices for services. Few studies, if any, have thoroughly investigated the accuracy of these payer-specific prices for individual hospitals. Our aim was to evaluate the concordance of prices using three datasets: 1) hospital price transparency, 2) payer price transparency data, and 3) Electronic Remittance Advice (ERA) claims data, reflecting actual payments. Evaluating transthoracic echocardiograms at 22 top-rated hospitals, we found high variability in prices and low concordance between datasets, as less than 30% of claim payments had a concordant price in the price transparency datasets. Deriving accurate price estimates for patients requires precise matching of the insurance plan, place of service, and fee type, all of which should be included in standardized reporting. This process highlights the complexity of insurance contracting, and it is not surprising that there is some disagreement in prices. Regardless, we are hopeful that highlighting variation and complexity in prices is a step towards a better system of healthcare payments in the United States.

R. Leland Van Horn is an employee of Preverity. R. Lawrence Van Horn is founder and CEO of Preverity. In addition, he has been Governance Committee Chair and Compensation Committee Member for Community Health Care Realty Trust (NYSE: CHCT). He is Board Chair for Savida Health and Advanced Behavioral Solutions. He is a member of the CEO Council for Council Capital and advisory boards for Harpeth Capital, Sidecar Health, and Abridge Health, and he is an operating partner with Whistler Capital Partners, LLC.

This study did not receive any funding

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All data produced in the present study are available upon reasonable request to the authors.