The Federal Trade Commission of the United States (FTC) has turned its attention to healthcare pricing by sending letters to 24 of the largest health service companies in the country, reminding them that patients should receive cost information that is clear, comprehensive, accurate, and provided in a timely manner.
The warning, announced on October 5 by FTC President Andrew N. Ferguson, focuses particularly on routine procedures and non-urgent medical care that can be scheduled in advance.
The federal agency stated that hiding the price of a service, providing incomplete information, or presenting a figure that later excludes relevant charges could constitute a misleading or unfair practice under Section 5 of the FTC Act.
The FTC explained in its official statement that a patient may reasonably interpret a figure presented as the cost of their care as the total price, when in fact additional medical fees, facility charges, or other items that were not included may later appear.
The FTC did not publicly identify the 24 companies that received the letters, and the announced action does not constitute a penalty or a determination that these companies have violated the law. The stated goal is for them to review their transparency policies and address any potential deficiencies.
A price that does not include all charges can also be misleading
One of the central points of the warning is that it is not enough to show a figure before a procedure.
According to the FTC, price information can be misleading if it omits important components of the expected cost. Among the examples mentioned by the agency are the physician's fees and the charges from the facility where the procedure is performed.
This may be especially relevant in outpatient surgery, an MRI, a colonoscopy, certain diagnostic tests, or any other scheduled procedure involving multiple providers.
The hospital can bill for the use of its facilities while the surgeon, anesthesiologist, radiologist, pathologist, or other professionals submit separate charges.
What is advisable to ask before agreeing to a procedure?
In the case of a scheduled medical service, the patient can reduce the risk of financial surprises by inquiring in writing about the expected cost and exactly what it includes.
What is the estimated total cost of the procedure?
Does it include the charge from the hospital or medical center?
Are the doctor's fees included?
Will there be separate charges for anesthesia, radiology, laboratory, or pathology?
Are all the professionals who will participate part of the insurance network?
What is the price for someone who pays directly without insurance?
What would the patient's responsibility approximately be after insurance?
Can the detailed estimate be provided in writing?
For those with insurance, it is also helpful to consult the cost estimation tool provided by your insurer and compare that information with what is supplied directly by the hospital or provider.
Hospitals already have federal transparency obligations
The FTC's actions complement the regulations enforced by the Centers for Medicare and Medicaid Services (CMS).
Federal regulations on CMS hospital price transparency require most hospitals in the United States to publish information about their standard rates online.
In addition to the complete price list, hospitals must provide accessible information to consumers about at least 300 services that can be scheduled in advance, or about all the services they offer if they have fewer than that number.
The FTC, however, made it clear that complying with CMS rules does not automatically provide protection under the FTC Act. A company could satisfy certain technical publishing requirements and still face scrutiny if the information provided to the consumer is found to be misleading, incomplete, or inaccurate.
If you don't have insurance, you can request a good faith estimate
There are additional protections for those who do not have health insurance or choose not to use it to pay for a service.
CMS establishes that, in general, when a medical appointment is scheduled at least three business days in advance, these patients can request a good faith estimate of the expected charges.
The document should outline the anticipated services and may include items such as hospital or facility fees. CMS recommends keeping that estimate to compare it later with the final bill.
If a provider or center charges at least $400 more than their corresponding good faith estimate, the patient may be eligible, if they meet the other established requirements, to initiate the federal dispute resolution process. The general timeframe to start this process is 120 days from the date of the initial bill.
These protections do not mean that every difference between an estimate and a bill can be automatically claimed, nor do they operate in the same way for a medical emergency.
An additional tool for those living in Florida
Florida residents also have a state tool to compare costs before certain procedures.
The Agency for Health Care Administration of Florida (AHCA) maintains the Florida Health Price Finder, which allows users to consult and compare healthcare costs using insurance claims data.
The information serves as a reference and does not necessarily represent the exact amount that each patient will end up paying, as the final cost depends, among other factors, on insurance, deductibles, copayments, coinsurance, involved providers, and the services actually used.
Federal pressure on hospital prices has been increasing
The new warning from the FTC does not emerge in isolation.
That process was primarily related to the enforcement of CMS regulations. The FTC's intervention now opens another front: it is not only important for price information to exist, but also that what is communicated to the consumer is neither incomplete nor misleading.
On the same day, October 5, CMS, along with the Departments of Labor and the Treasury, also announced new rules to enhance the accuracy, accessibility, and comparability of the price data published by health plans and insurers.
The combination of these measures increases the pressure on hospitals, healthcare companies, and insurers to ensure that patients have a better understanding of how much they might end up paying before agreeing to scheduled medical care.
For the consumer, the practical recommendation is simple: when faced with a procedure that can be planned, do not settle for just a verbal figure. It is advisable to ask what is included, request the information in writing, verify any possible separate invoices, and compare the available data before receiving the service.
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