Regulators in the Beaver State are trying to jump start efforts to help consumers determine how much medical care will cost.
Staff members of the Oregon Department of Consumer and Business Services are working with large businesses, insurers, hospitals and consumer groups to collect and publish data on the discounted rates that insurers actually pay for hospital care.
The department is developing the database of discounted prices because of concerns that few patients actually pay the full prices that hospitals put on bills.
“For an insured patient,” officials write, “the relevant charge data is the discounted rate that the patient’s insurance company has negotiated with each hospital.”
Department officials described the “actual cost of care” database project in a draft report on the Oregon health insurance market.
The sector of the private health insurance market regulated by the state is highly competitive, and most of the large carriers appear to be profitable, officials write in the report.
But carriers have been reporting healthy profits for only a few years, and the profits appear to be the result mainly of the normal ups and downs in the insurance underwriting cycle, officials write.
Officials make a number of recommendations in the report for improving the state health care system.
- Insurers should standardize how out-of-network charges are calculated, so that plan members would understand that they might be on the hook for costs over and above what the insurers define as reasonable charges.
- Insurers should give members estimates of out-of-pocket costs for specific services before the members seek care, so that members can consider cost when deciding what kind of care to get.
- The state should make insurers’ individual and small group rate filings public records, but they should give insurers a fair chance to show whether disclosing certain records would harm competition.
A copy of the Oregon report is on the Web at Document Link