Insurance companies negotiate with hospitals and doctors the price of every treatment, procedure and medical service. That price differs from hospital to hospital — even health plan to health plan. Vincent Wartner/Science Source hide caption
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Insurance companies negotiate with hospitals and doctors the price of every treatment, procedure and medical service. That price differs from hospital to hospital — even health plan to health plan.
As Americans begin shopping again for health insurance under the Affordable Care Act on Saturday, they'll be wrestling with premiums, deductibles, out-of-pocket costs and other vague and confusing insurance-speak.
Believe it or not, that's the easy part compared with figuring out what health care actually costs.
Sal Morales found an Obamacare health plan this year that costs him $145 per month — versus the $560 he'd been paying. Courtesy of The Miami Herald hide caption
toggle caption Courtesy of The Miami Herald 
Sal Morales found an Obamacare health plan this year that costs him $145 per month — versus the $560 he'd been paying.
Courtesy of The Miami Herald
Sal Morales of Miami bought insurance in March during the ACA's first enrollment period on the HealthCare.gov website.
It felt amazing, he says, to get that insurance card in the mail — "like if I got an American Express Platinum card. That's how I felt."
Morales was unemployed at the time. Money was tight and he knew he needed regular doctor visits to manage his high blood pressure. He diligently researched what he would get for his money before settling on a health insurance plan.
Sponsor MessageInstead of paying $560 a month for COBRA coverage, Morales discovered he could get an Obamacare plan for $145 per month.
"I have a network deductible of $500," Morales says. "My first three visits to a primary care physician — they're zero dollars. Then it's $5 out of my pocket."
Morales understands his end of the health care equation, but what he sees doesn't necessarily reflect the amount that hospitals and doctors receive to care for him, says Bruce Rueben, president of the Florida Hospital Association.
"That gentleman knows what it costs him, but he may not know what the actual cost of his health care is," Rueben says.
Here's how Rueben breaks it down: "There's one party — the hospital who provides the service. There's a second party — the patient, who receives the service. And there's a third party — the insurance, who pays for the service."
That third part is where health care pricing gets really squirrelly.
I am completely sympathetic that it's very confusing. There are at least six different prices for a hospital day. And then there's the cost of actually delivering the service — which, for most of these things, even hospitals don't know.
Dr. Ezekiel Emanuel, health policy specialist, University of Pennsylvania
Every hospital has its own master list of charges for different services. Those charges are different from hospital to hospital.
But insurance companies don't pay those listed charges. The listed charges are almost fiction. Instead, each insurer negotiates for lower prices with each hospital and doctor on every plan. The negotiated prices even can vary within an insurance company depending on which plan a patient has.
All of this means there are about as many price tags for that hypertension checkup as there are insurers and providers.
"For an individual consumer, I am completely sympathetic that it's very confusing," says Dr. Ezekiel Emanuel, who was an adviser to the president during the drafting of the health law and is now a health policy specialist at the University of Pennsylvania. "There are at least six different prices for a hospital day. And then there's the cost of actually delivering the service, which — for most of these things, even hospitals don't know what that is. So when you say, 'What's the price?' it's almost a meaningless question, because there [are] all these different prices."
