Hospital Cost Study

Albuquerque, N.M. – Have you ever been to the doctor or the hospital and been shocked by the bill? You’re not alone. A new report says the majority of hospitals in New Mexico aren’t complying with the federal hospital price transparency rule, which gives patients an up-front cost before they go in.

A report from the national non-profit Patient Rights Advocate found just 21.1% of 2,000 hospitals it looked at are in compliance with the federal hospital price transparency rule.

“We need to do better in giving patients access to complete dollars and cents prices up front so they can shop for the best quality of care at prices they know they can afford,” Ilaria Santangelo with Patient Rights Advocate said.

The rule went into effect back in 2021 but since then there’s been some changes.

“Hospitals now have to put their pricing data in a standard file format. I think there’s a lot of growing pains,” Santangelo said.

In New Mexico, that compliance drops down to 13% with just 2 out of 15 hospitals following regulation. But Ilaria Santangelo explained in most cases, it’s a simple fix.

“Hospitals can come into full compliance by looking at our report and seeing what aspects of their machine readable files they need to fix,” Santangelo said.

PRA used the hospitals websites and compliance regulation, set by the Centers for Medicaid and Medicare Services or CMS for its report. KOB4 reached out to Albuquerque’s main hospitals: Presbyterian, University of New Mexico Hospital and Lovelace. All three sent back statements saying they’re in compliance with CMS standards. The full statements are below.

But for a patient, pricing can still get confusing. KOB4 spoke to a patient, who wanted to remain anonymous.

“I’ve never had to deal with so many medical bills,” the patient continued. “Three years ago, I was diagnosed with stage one cancer, and then a year later, I had stage four. You really have to prepare yourself mentally and emotionally.”

She explained she was paying the same amount for her treatment until one day the bill more than doubled.

“I got a bill for $1500 and then a couple of months later, the bill came to $4000. So that’s the last thing you need when you’re going through this journey, this battle. The last thing you need is financial stress,” she said.

After spending hours talking with her insurance company and the hospital, she was able to get her bill back down.

“They changed the coding, and so the insurance company just denied it, so I had to work with the hospital to ask them if they could change the coding,” she continued. “That’s very frustrating. I mean, I’m someone that looks over things but I can’t imagine that every patient… Some patients, probably just think, ‘Hey, I just got to pay it.'”

She tells KOB4 she hopes her story will encourage others to question their bills when they think something is off.

University of New Mexico Hospital Statement:

“Our Machine Readable File passes the Centers for Medicare & Medicaid Services (CMS) Validator tool and is in compliance with all CMS requirements.” 

– Brianna Mortensen, UNM Hospital Spokesperson 

Presbyterian Healthcare Services Statement:

At Presbyterian we are committed to transparency in healthcare, including helping patients understand the charges they receive for their care. We are honored to have been named among healthcare systems with the highest price transparency scores.

The Centers for Medicaid and Medicare Services (CMS) regulates how hospitals and clinics charge Medicare patients and for which services. We continuously review our approach to ensure that we are fully compliant with all CMS requirements.  As recently as fall 2024, we received confirmation from CMS that we are compliant. The methodology used by this report appears incorrect and does not align with CMS’ requirements.

– Spokesperson, Presbyterian Healthcare Services

Lovelace Health System Statement:

Patient satisfaction and experience are a top priority for each of our facilities, including access to patient financial services and assistance with understanding potential costs. Reports like this often use outdated information and are not performed by state or federal agencies. Lovelace Health System is compliant with the current federal hospital price transparency rule and has worked to ensure we provide patient cost estimate tools. Our standard charge file for each facility is available online and through patient financial services.

– Whitney Alcantar, Communications Manager for Lovelace Health System