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Health Leaders To Talk Hospital Prices, Reimbursement Discrepancies This Week

Health industry leaders and employees will come together this week to discuss a recent report that highlights the large discrepancies between what private insurers pay hospitals and what Medicare pays.

Nonprofit research group RAND Corporation analyzed hospital claims in the U.S. from 2015-2017. The report released in May shows that on average, private insurance companies paid almost two and a half times more in hospital bills than Medicare.

The Kentuckiana Health Collaborative is holding a forum to discuss the findings on Tuesday at the University of Louisville Shelby Campus from 7:30 to 10 a.m. KHC Data Scientist Stephanie Clouser said authors of the RAND study will be at the forum to answer questions.

“If you're paying more than two-and-a-half times what the largest insurer in the country is paying, you [would] think that's not very fair,” Clouser said. “I think that's one of the questions, 'What is fair?' Is 100 percent being the same as Medicare what's fair? Is paying twice as much as Medicare fair? That's one of the questions that is brought up in the study that hopefully we can explore some more.”

Medicare, a government program for people over age 65 and people with disabilities, is the largest insurer in the U.S.Studieshaveshown Medicare is better at keeping health prices down than private insurers.  

People who have insurance through an employer are likely shouldering some of the higher costs in the form of co-pays, deductibles and other out-of-pocket costs.

The RANDstudy showed that Kentuckians with private insurance actually had a lower-than-average pricing of 1.86 times more than those with Medicare. In Indiana however, hospital prices for privately insured patients were a little over three times what Medicare pays, according to the study.

Some hospitals in Kentucky charged private insurance much more than Medicare, per the study. The University of Kentucky Hospital in Lexington charged a little over five times more for patients with private insurance than patients with Medicare. And Baptist Health LaGrange charged 3.21 times more for private insurance patients than for Medicare patients.

The cost to attend the forum is complimentary for KHC members and $35 for non-members.

Lisa Gillespie is WFPL's Health and Innovation Reporter.

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