The truth is that, even for U.S. patients with a rough idea of how their health insurance is supposed to work, finding either the full discounted price or the patient’s share of the bill can be next to impossible.
Providers’ office managers use provider network agreement confidentiality provisions to justify refusing to give patients anything other than names, ranks and provider ID numbers.
If a plan provides a cost estimation tool, the estimate usually comes with many footnotes warning the patient that the estimate has no relationship with reality.
On the one hand, some states have found that health care pricing transparency laws have had little effect on health care costs.
See also: N.H. Prices Resist Sunshine
Some antitrust experts have suggested that price transparency requirements may backfire and help providers increase costs.
On the other hand, patients’ current lack of access to care price information is a slap in the patients’ face. Policymakers, providers, employers and insurers all want to blame as many of the patients’ bills on the patients as possible. But, even when patients might have some ability to shop based on price, they still have a terrible time getting the prices.
On the third hand, providers will blame carriers for the problem, and carriers will blame providers.
So, here’s a possible compromise solution: A federal board should require health insurance company executives to attest that they have eliminated any price confidentiality provisions from their provider network agreements.
The providers should attest that they have signed no price confidentiality agreements, that they have a system for calculating discounted prices for at least 100 common medical services for in-network patients at the point of service, and that they can provide a list of typical bundles of necessary services, along with discounted price estimates, for at least 10 common types of incoming patients.
If health insurance company executives or health care providers are unable to make such attestations, they should have to acquire and use bumper stickers declaring that they are health care transparency bozos.
They should be barred from saying anything about health system policy, except to their pet goldfish, until they meet price disclosure transparency standards. Unless they help with improving the price transparency situation, they’re just blowing smoke when they talk about making the system work better. No mammal should have to listen to them.
Have you followed us on Facebook?