A gold dollar symbol over a stethoscope

‘Secret shopper’ study finds errors, discrepancies in inquiries about hospital prices

Discrepancies in online vs. phone prices were common, despite federal regulations


Although hospitals are required by law to publicly post prices for their services, it remains difficult for the public to get reliable information on what those services will cost.

That’s the overall finding of a paper published Sept. 18 in in the Journal of the American Medical Association: Internal Medicine based on research out of the University of Texas Medical Branch.

In a cross-sectional study of 60 U.S. hospitals, there was a significant difference in prices that hospitals posted online and the prices hospitals gave over the phone to “secret shoppers,” calling for prices for vaginal childbirth and brain MRI.

The study found that online prices hospitals are required to post were missing for 47% of hospitals for childbirth and 10% for MRI, according to UTMB medical student Merina Thomas, the lead author of the paper.

“Among those hospitals where prices were available online, the online price often did not match the prices provided over the phone,” Thomas said. “As an example, a hospital might have an online price for an MRI of $2,000 but give a phone price of $5,000 or an online childbirth price of $20,000 but a phone price of $10,000.”

Also, online prices often seemed to be wildly inaccurate and unlikely—for example, a hospital with an online price for an MRI of $166,000 and an online price for childbirth of $0.

“We found that in a number of cases when we called a hospital, staff were unable to provide a price even though the price was available on the hospital’s very own web site,” Thomas said. “And we found that for both childbirth and MRI the online price and the phone price often were significantly different within the same hospital.” 

In 2021, the Centers for Medicare and Medicaid Services implemented a rule requiring all U.S. hospitals to publicly post their prices in an effort to increase price transparency. The Hospital Price Transparency Rule allows for fines of up to $2 million for hospitals failing to post prices, but there’s no formal mechanism for CMS to audit or penalize hospitals with erroneous or misleading price data.

The study came about when Dr. Peter Cram, chair of the Department of Internal Medicine at UTMB, listened to an interview with Shark Tank investor Mark Cuban in 2022. 

“They were talking about how difficult it was for Mark Cuban to get a price for his colonoscopy,” Cram said. “I subsequently had an email exchange with Mark about the new U.S. price transparency regulation. 

“Mark made the point that just because hospitals had posted prices to their websites didn’t mean they would actually offer those prices to a patient,” he said. “I had this eureka moment to call hospitals and see if they would honor the prices they posted to their websites.”

Overall, Cram said, the study found:

  • Data suggests that most patients can find lower-priced hospitals in their city or neighborhood, so it is worth shopping around.
  • Hospitals often gave very different prices over the phone than what they provided online and sometimes seemed unaware that they even had posted their prices online. 
  • Some of the online price data was missing or seemed to be in error.

“There were multiple hospitals with online prices that were greater than $20,000 (for vaginal childbirth), but telephone prices of less than $10,000,” the report reads. “For brain MRI, two hospitals provided telephone prices of more than $5,000 when their online prices were approximately $2,000.”

The findings demonstrate hospitals’ continued problems in communicating their prices, as well as continued financial challenges for uninsured patients or those who want to comparison shop for health care.

“Transparency is critical to changing the trajectory of health care costs in this country,” said Cuban, a co-author of the study. “Our paper shows that while some progress has been made in hospital transparency, we still have a ways to go.”

The paper was authored by Thomas; Cram; Cuban; UTMB medical student James Flaherty; Dr. Jiefei Wang, assistant professor in the Department of Biostatistics & Data Sciences at UTMB; Dr. Morgan Henderson from The Hilltop Institute at the University of Maryland, Baltimore County; and Dr. Vivian Ho from The Baker Institute at Rice University.