Hidden costs: Breast reconstruction pricing remains murky
Study finds many Texas hospitals did not clearly publish costs despite a federal transparency law

It was meant to be a healthcare hack to help patients be savvy savers, but price transparency for hospital services, including breast reconstruction, made the process more convoluted and confusing for most, suggested the new study "Hospital Price Transparency Legislation and Published Costs of Breast Reconstruction" in the June edition of Plastic and Reconstructive Surgery (PRS).

"This is a complaint that patients have frequently, that the cost of (breast) reconstruction is completely obscured," said Steven Henry, MD, a breast reconstruction surgeon at the University of Texas at Austin Dell Medical School and lead author of the PRS study. "Even when they ask for the cost, the hospital doesn't give it to them. We know that is technically against the law and that these prices are supposed to be published. So, we looked into exactly how difficult it is for patients to find this information."

Posting prices for cost transparency

A federal law, the Great Healthcare Plan, was created in 2019 and required healthcare providers, including hospitals, to post their prices. It went into effect in 2021. Hospitals must disclose to the public standard charges for services, which include gross prices, insurer negotiated rates, minimum and maximum charges and cash prices. A new order increasing fines for noncompliance was issued in early 2025.

The law was meant to help protect patients from unpredictable healthcare bills. Dr. Henry developed the PRS study to assess the accessibility of prices for eight types of common breast reconstruction surgery at 32 large Texas hospitals.

"All of them are big hospitals with lots of resources," said Dr. Henry. "Hospitals that would certainly have the IT wherewithal to post these prices and that would be fully aware of the requirements to post them."

He said the study results were no surprise.

"What we found was that it's extremely difficult," said Dr. Henry.

Availability, but not accessibility

The first obstacle was finding pricing information. Some hospitals didn't list any at all. Others made the information available but not accessible.

"It would either be a spreadsheet that you might be able to read, but that would have a million rows," said Dr. Henry. "Literally, just an incomprehensible number of rows. Or it would be in some format that you wouldn't have the ability to open on your computer. It might be true that they're posting their prices on the internet, but it's in a format that the average consumer just wouldn't have the program to open. So, completely useless formatting was common."

Price variability

The next challenge was whether pricing was provided in a consumer-friendly format; it was unclear what the estimate included. All the elements of a procedure, including specific tests, length of stay, surgeon and anesthesiologist fees, facility fees or other care, vary because each patient's needs differ, leaving the final cost vague.

"There might be elements that are not included because the hospital might not actually own their own laboratory services," said Dr. Henry. "That might be a separate company that contracts with them, so the hospital might not be responsible for those prices, nor would they know those prices. There's just so many variables involved."

Prices also varied considerably depending on the insurer and the patient's healthcare plan.

"If a patient asks us, 'How much will this procedure cost?" said Dr. Henry. "Well, that's not always an easy thing to answer because you have to find out exactly what the (healthcare) plan is and what the contract is with that particular plan. There are hundreds of plans out there."

Opaque out-of-pocket costs

Out-of-pocket patients faced the most pricing chaos. Many times, those prices were not listed at all. They were wildly variable when listed.

"That's ironic, isn't it?" said Dr. Henry. "Those are the people who would be inclined to shop the most vigorously to find pricing answers."

Letter vs spirit of the law

The PRS study concluded that patients seeking a price estimate for an elective procedure, such as breast reconstruction, prior to surgery often faced opaque costs instead of true transparency. Even a call to the hospital provided more confusion than clarity.

"Patients want to know what their procedure's going to cost, and we're able to give them our cost from a surgeon's fee to the penny," said Dr. Henry. "But then they always ask,  'What's the hospital going to charge?' We can't answer that question, but they tell us that when they ask the hospital, the hospital tells them, 'Oh, we don't know. We can't know until after the procedure.'"

True pricing transparency could drive down healthcare costs, but clear, accurate and accessible information is mostly unavailable, giving patients financial uncertainty around breast reconstruction procedures. Dr. Henry continues to advocate for better price accuracy, despite the challenges.

He suggested hospitals could provide a reasonable range for procedures that takes into account the variability in services and insurance plans. Also, better enforcement of the law and standardized pricing could encourage more hospitals to put pricing information in more consumer-friendly formats.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.