This could be interesting, in terms of seeing what providers actually get paid for services used by patients paying with insurance, versus the list prices.
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Price opacity is one of main reasons why healthcare cost is so much higher in this country than anywhere else and continues to rise. As it has in other industries, making pricing more transparent will do more to help control spiraling healthcare cost than anything else other than governmental price control.
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Wow. I didnât know about this. This is very exciting.
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This is wonderful news.
I have been dealing with a billing snafu with our local hospital and medical and dental insurance for over 18 months. Nothing has been transparent, prices changed from what was originally quoted and had been pre-approved by insurance. We ended up having to pay our deductible twice last year due to coding mistakes and are still waiting for the refund. They mistakenly sent something to collections after repeatedly telling us to ignore the incorrect statements. When I logged in today several documents had been deleted, but luckily I had screenshots. I feel like I need to send them a bill for my time. It should be so much easier for people to know the real costs and compare. The hidden fees add up.
What took so long?
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I would call administration and negotiate a settlement or you will charge for your time. They will.
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More importantly, make sure your not being charged for a service not in your plan due to the hospital using an outside group. Some culprits are Emergency room docs and Anesthesia and sometimes lab work⊠Also see if your doctors are in the correct tier. With my plan after deductible if I go to a tier 1 hospital or doctor everything is covered 100%
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Itâs called the RAP doctors â radiologists, anesthesiologists, and pathologists. Theyâre the docs you never select on your own; they come with the hospital.
Thanks - They cleared everything owed after they messed up with the collections nightmare, but they have not reimbursed for the deductible portion paid that they owe us back. We had other medical expenses and had to keep paying the deductible a second time to other providers while waiting for the hospital to figure it out. We have a high deductible plan so it is thousands of dollars.
I could swear there was legislation passed prohibiting this practice not long ago.
In any event, if you go to the ED, and the doc is out of network, call your insurance provider and clearly state you were in the ED and had NO choice about the doctor and no chance to ask if they were in network. We had this happen twice, and our insurance paid the bill.
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I encourage everyone to read that article in the OP, we are a long way from being able to readily compare prices within and across insurers and self-insured employers.
Because this kind of public release of pricing data hasnât been tried widely in health care before, how it will affect future spending remains uncertain. If insurers are pushed back to the bargaining table or providers see where they stand relative to their peers, prices could drop. However, some providers could raise their prices if they see they are charging less than their peers.
Insurers (and self insured employers) will be able to see if they have better deals than another company, but often there are reasons for differently priced contracts, e.g, lower prices for insurers with more customers (higher volume), lower prices for insurers with strong market power, etc. And as pointed out, some hospitals, insurers, and employers might actually raise prices.
This is a good example of one way patients might be able to benefit:
âIf youâre going to get an X-ray, you will be able to see that you can do it for $250 at this hospital, $75 at the imaging center down the road, or your specialist can do it in office for $25,â he said.
I do wonder how many patients will take the time to do this. Another important unstated factor in that example is timingâŠyou might be able to access the more expensive option more quickly, and have to wait awhile for the less expensive option. For the patients who get that far, each will have a different way to calculate that x-Ray decision.
Greater price transparency is definitely a step in the right direction to be sure, and hopefully entrepreneurs will quickly create usable customer interfaces with the copious amounts of data.
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Some additional thoughts regarding the example of different x-ray costs at different sites/providers (from the article in the OP).
-only the relatively âbetterâ insurance plans are likely to have multiple choices as in this example.
-relatively more people in the healthcare system are incented to maximize revenues/profits than solely cut costs. So, in the X-ray example, when the practice manager of the physician office with the $25 x-ray sees how much more the hospital and standalone site are charging, they could very well immediately raise their price (if they have the latitude in their contracts to do so, if not, the next round of negotiations will be different). The practice manager would likely be rewarded for increasing revenues without increasing costs.
-Ditto for the standalone site once they see the price the hospital is charging.
-It is unlikely the hospital is going to cut their price to be closer to the standalone site or physician office, because the hospital has relatively higher operating costs, and offers greater access (basically 24/7), and likely has greater market power.
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I think theoretically I can do this now. I just remember years ago at open enrollment they said we could do it, so I tried. it was a pain to look it up. Maybe it was similar to trying to look up if a doctor is in network. Looking up the doctorâs name doesnât always work, nor the practice name. Sometimes they are lumped under a different name. I usually have to call the insurance company to figure it out. Fortunately, most everyone in my town takes ours. Itâs not a well known national company.
But the insurance company has a local rep for our employer who we can call if there are problems. Last summer, younger S went to urgent care (under a hospital group) for a rash. They didnât send the bill until a year later. And it didnât show the insurerâs allowable charge even though I had an EOB from the insurance company for what it should be. I called the hospital group and the lady said that they had that info from the insurance company, but that didnât mean thatâs what I was supposed to pay. Uh yeah it does. She said sheâd run it through again. Next month, same bill. Called our local rep and emailed her the bill and EOB and she took care of it.
Yes, the Federal No Surprises Act which went into effect January 1, 2022.
This is what ct.gov says about it and how it relates to CT.
No Surprises Act
More info on the No Surprises Act here
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So where do we go to get the data? Iâm confused.
You can be sure that the institutions which are required to release their data under the law will try to make them as confusing as possible. Itâs unlikely to be usable by consumers directly without some serious effort to clean up the data.
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Thank youâŠI thought so!
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While I agree that greater price transparency will help, price opacity is not the only problem plaguing the health care market.
One other major problem is that the user is generally not the same as the payer. This is true both for the medical care itself (a government or private insurance company is usually the payer) and the provision of insurance (the userâs employer is generally the main payer and also is the primary chooser). The three party situation is not the usual one in economic models where the user, chooser, and payer on the buy side are all the same person (or entity).
But then going to a system of self-pay to eliminate this three party situation would be difficult for many people, who find it hard to plan and save up for medical care that is often needed unexpectedly. People have a hard enough time saving up for longer term goals (retirement, kidsâ college, etc.), so saving up for something even more uncertain would likely be more difficult for them.
Only a few sectors of purely optional patient-pay medical services (e.g. cosmetic procedures) is there anything close to a typical economic market.
So how do I get the information about what price my insurer is paying?? Where do I go?