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GAO to HHS: Open the Curtains on Health Care Prices

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Consumers in most areas still have a hard time finding out how much their medical care really will cost.

Linda Kohn, a director at the U.S. Government Accountability Office (GAO), makes that case in a new GAO health care price transparency report.

GAO investigators looked at 8 public and private health care price information services and also tried calling doctors’ offices themselves to find out how much various services would cost.

The investigators found that the representatives in many offices refused to give prices for procedures until patients came in for a screening, and that only two of the price information services – one run by a unit of Aetna Inc., Hartford (NYSE:AET), and the other by the Anthem unit of WellPoint Inc., Indianapolis (NYSE:WLP) – could tell patients what the patient’s actual price would be, after taking plan discounts into effect.

Aetna gives discounted prices for 40 bundles of hospital services and 460 bundles of physician office services; Anthem gives prices for 59 inpatient, outpatient and physician office bundles.

Many other programs simply gave the average or median price of care for specific services or bundles of services.

“This lack of health care price transparency presents a serious challenge for consumers who are increasingly being asked to pay a greater share of their health care costs,” Kohn writes.

Health care providers and provider groups often say that providing price information could raise antitrust concerns, but Kohn notes that federal antitrust regulators have endorsed the idea of providers giving price information to an independent entity that does not let users identify the prices charged by an individual provider.

Some providers say insurers should give consumers information about discounted prices, but many insurers lack data systems that can calculate discounted prices for patients before the patients actually get care, Kohn says.

“As a result, insurers may have difficulty maintaining real-time data on how much their members have paid towards their deductibles, which could affect an estimate of the complete cost,” Kohn says.