Price Transparency in Health Care Is Here. Sort of.
The data requires structuring.
It’s a good step. From a practical standpoint, however, we’re not all of the way there.
Forbes reports: “The Transparency in Coverage Final Rule (1), issued by the Centers for Medicare and Medicaid Services (CMS), requires health insurers to disclose pricing for covered services and items. Insurers must include the rates they have negotiated with participating providers for all covered services and items, as well as the allowed and billed amounts for out-of-network providers.” (2)
CMS says: “Health plan price transparency helps consumers know the cost of a covered item or service before receiving care. Beginning July 1, 2022, most group health plans and issuers of group or individual health insurance will begin posting pricing information for covered items and services.” (3)
Ah! No more walking blindly into the thickets and thorns of health care pricing? Perhaps we’ll be able to know how much a given treatment will cost before we walk through the door? Or perhaps we’ll even be able to shop around in advance for the best price on a given medical procedure?
Not quite. Not readily. Not yet.
The enormity of the data that is becoming available will require some structuring (and massaging?) before it makes it to your smartphone for easy and practical use. CMS explains: “This pricing information can be used by third parties, such as researchers and app developers to help consumers better understand the costs associated with their health care.” (3)
(So c’mon, app developers!)
CMS concludes: “More requirements will go into effect starting on January 1, 2023, and January 1, 2024 which will provide additional access to pricing information and enhance consumers' ability to shop for the health care that best meet their needs.” (3)
Sources:
(1) https://www.cms.gov/newsroom/fact-sheets/transparency-coverage-final-rule-fact-sheet-cms-9915-f
(3) https://www.cms.gov/healthplan-price-transparency
Background:
To the contrary: https://www.medpagetoday.com/opinion/second-opinions/99542