Radiology outpatients’ awareness of their out-of-pocket estimates and hospital price estimator tools in the United States

• 10.7 % of radiology outpatients were aware of their out-of-pocket cost estimates. • Only 16.8 % knew of the imaging centers’ price estimator tool. • Patients with financial hardship were more worried about OOPC, but less likely to know their estimates. • Limited OOPC awareness highlights persistent challenges in achieving price transparency goals. • Targeted interventions to increase awareness and enhance healthcare decision-making are needed. Price transparency mandates by the Centers for Medicare and Medicaid Services (CMS) were implemented in 2021 for hospitals and 2023 for health plans. We assessed U.S. patients’ awareness of their estimated out-of-pocket cost (OOPC) and hospital price-estimator tool among outpatients undergoing advanced imaging. English-, Spanish-, and Vietnamese-speaking adults receiving a CT, PET/CT, or MRI at a tertiary academic center between 11/2022 and 03/2023 completed a 15-minute survey. We assessed awareness of OOPC estimates prior to imaging and the hospital price-estimator tool, and factors associated with such awareness using multivariable regression analysis. 423 patients were included (mean age: 57.1 ± 15.6; 57.4 % female; 55 % White; 21.8 % Hispanic; 18.9 % Asian). Only 10.7 % and 16.8 % were aware of their OOPC before receipt of imaging and center'shospital price-estimator tool, respectively. No patient used the hospital price estimator tool to obtain their OOPC estimate. Annual household income of $50,000 or more (OR: 30.25, 95 % CI: 1.78, 513.79), and having at least one comorbidity (OR: 4.59, 95 % CI: 1.42, 14.79) were associated with a higher probability of knowing OOPC prior to imaging. Patients who experienced financial hardship were less likely to be aware of their OOPC (OR: 0.29, CI: 0.10, 0.86). No significant factors were associated with awareness of hospital price estimator tool in full regression model. Our study highlights limited OOPC and price estimator tool awareness, two years post-CMS mandate, with specific demographics more likely to know their OOPC. Our findings emphasize the urgency for targeted interventions to increase price awareness and enhance healthcare decision-making.