NYC Hospitals charge wildly different prices for same care
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A groundbreaking analysis by NYC’s Health Department examining hospital pricing has significant data gaps due to the city’s primary public employee insurer withholding crucial information, according to officials.
The extensive 263-page document, released without fanfare on Friday through the Office of Healthcare Accountability, reveals dramatic inconsistencies in hospital charges. The analysis concentrated on payments through the city’s Anthem Blue Cross healthcare program, excluding private insurance plans.
According to the findings, the city’s GHI-Comprehensive Benefits Plan via Anthem paid an average of $45,150 for inpatient care at New York’s leading hospital systems during the previous fiscal year.
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The data shows New York-Presbyterian and Montefiore Medical Center commanded the highest inpatient treatment fees at $92,727 and $83,573 respectively, while Stony Brook University Hospital charged the lowest at $36,876.
Municipal employee hospital care cost the city $3.3 billion in the fiscal year ending June 30, with three hospital systems – Northwell Health, New York-Presbyterian, and NYU Langone Health – receiving half the total, collecting $759 million, $485 million, and $443 million respectively.
The analysis revealed New York-Presbyterian’s dominance in pricing, leading costs in 11 of 12 inpatient procedures and 14 of 27 outpatient services examined.
Procedure costs varied dramatically across hospital systems, with colonoscopies ranging from $940 to $12,000 and C-section deliveries spanning from $7,000 to $58,000.
The report criticizes Anthem, which receives $3 billion annually to insure approximately 900,000 city employees, for refusing to provide complete hospital healthcare costs and other essential data to the OFA for determining price justification.
Anthem defended its position by citing confidentiality agreements with hospitals predating a 2021 federal mandate for public hospital price disclosure.
“It’s a slap in the face to the City of New York when federal rules require hospital pricing be made public, but Anthem won’t comply with city law due to so-called ‘preexisting agreements,'” said Councilwoman Julie Menin (D-Manhattan), who authored the legislation establishing the healthcare watchdog office in 2023. “This health care industry cat-and-mouse game is costing the city billions, and we need full transparency now.”
“It’s so distressing to see these prices,” she added. “It’s extremely high and is why we need price transparency. Why should New York City be paying so much for health care? It’s sickening and unsustainable.”
Prior analyses by 32BJ SEIU suggested potential annual taxpayer savings of $2 billion through comprehensive auditing of municipal worker healthcare costs and implementing cost-reduction strategies.
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“It’s clear that hospitals and insurers are still exerting their influence to block sharing certain data the city needs to reverse the trend of exorbitant health care costs,” said Manny Pastreich, 32BJ’s president.
The OFA, operating with 15 staff members and a $2 million budget, was established to enhance pricing transparency between private and city-operated medical facilities.
“Health insurance companies and New York City hospitals must remove arbitrary barriers to data access that would otherwise support transparent and equitable pricing of medical services,” said Henry Garrido, executive director of District Council 37, the city’s largest municipal employee union.
“We must utilize every tool at our disposal to fight these unfair practices, including ensuring the Office of Healthcare Accountability is adequately staffed to fulfill its primary purpose of tackling disparity pricing that exploits the vulnerabilities of New Yorkers in need of care.”
Anthem representatives were unavailable for comment.
