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Life Health > Health Insurance > Health Insurance

Transparency: A Must-Have for Health Care Payments

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After almost a year of dealing with the coronavirus pandemic, we still haven’t seen much relief. Stress remains high as the number of cases continues to rise and the economy hasn’t recovered. Families and hospital staff alike are struggling after nearly half a million Americans have been hospitalized due to COVID-19 complications.

Health care and health insurance costs are likely to rise even more as a result of the pandemic. On top of that, surprise medical billing can quickly add up to large amounts of debt; routine tests alone can result in thousands of dollars in uncovered charges. This is damaging not only for patients but for carriers, payers and the industry at large.

(Related: Health Plans Must Post Doctor Care Cost Estimators by 2023: Federal Regulators)

It’s time to reexamine how our health care system is failing consumers, starting with the lack of transparency for consumers. Greater transparency is the first step to helping patients take charge of their health care by allowing them to make more informed decisions.

Transparency is now a must-have for health care payments. Here’s why.

1. Quality and cost should drive provider selection.

The status quo in the health care industry isn’t working because consumers don’t have a single source of truth about provider cost and quality. When we purchase retail items, we have multiple tools available to compare prices and read reviews to ensure the best quality at the best cost. Why wouldn’t consumers have the same experience with health care?

While insurance sponsors might work to educate consumers on how to find an in-network provider, the process isn’t exactly easy. The member may be able to find a provider who takes their insurance, but many insurance carriers have a ‘Find a Provider’ tool that has some aspect of price or force ranking of providers. Given the lack of transparency, consumers aren’t able to select the right provider to fit their care needs and budget.

Consumers need data to make their decision on which provider to choose. Yes, part of that includes price transparency, but high price doesn’t always mean high quality. Human interaction is also crucial to a good doctor-patient relationship. Having a tool that displays in-network providers who are accepting patients, affordably priced and providing high quality is huge for empowering consumers in their health care journey.

2. COVID-19 has forced the rapid adoption of technology.

Even when we’re through the pandemic and can begin to spend more time together face-to-face, there will be no going back to the old ways. Consumers expect digital solutions to carry out basic tasks. Not only do they expect to interact with businesses digitally, but they also expect to be able to access the information they need in an easy, intuitive way.

Health care has been less-than-stellar about digitizing. Making more services available through channels people are used to using for other consumer channels will not only improve the user experience but will also demonstrate a commitment to greater transparency from your business.

For example, self-service portals for both agents and clients would make it easier for them to manage their insurance needs. Mobile apps for client services and claims could help them easily understand where they are in the payment process. Quick, responsive customer support available through multiple channels, including email and chatbots, will help consumers feel empowered about their health care choices. Healthcare is confusing enough already; helping your clients where you will make a big difference.

3. Transparency is becoming law.

Government agencies are making transparency less optional in health care by enacting new laws. Lawmakers made sure to include transparency in the Coronavirus Aid, Relief, and Economic Security (CARES) Act by requiring providers of diagnostic tests to make the cash price of a COVID-19 test publicly available on their website.

COVID-19 isn’t the only reason regulators are looking at transparency. Agencies have been enacting other laws designed to ensure that consumers know how much their health care costs before treatment, allowing them to make better-informed decisions.

As recently as October, the Centers for Medicare and Medicaid Services (CMS) issued a final rule on healthcare price transparency. Over the next few years, health plan providers will be required to:

  • Make available files with detailed pricing information related to negotiated rates for all covered items and in-network providers, historical payments to/billing from out-of-network providers, and in-network rates and historical net prices for covered prescription drugs (effective Jan. 1, 2022)
  • Make available through their website personalized out-of-pocket cost information for plan beneficiaries for 500 shoppable items and services (effective Jan. 1, 2023)
  • Complete the pricing information for the remaining procedures, drugs, durable medical equipment and any other item or service (effective Jan. 1, 2024)

CMS is also finalizing a requirement to make this information available through an Internet-based self-service tool, which will empower consumers to shop and compare costs between specific providers before receiving care. Insurance plans and issuers will also have to disclose on a public website their in-network negotiated rates, billed charges and allowed amounts paid for out-of-network providers, and the negotiated rate and historical net price for prescription drugs.

Transparency is no longer optional.

Instead of waiting for government regulation and consumer advocacy movements to force greater transparency in the health care industry, the time to act is now. Offering your clients increased transparency into pricing will not only help your business but will create a better ecosystem for us all.

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Terry RowinskiTerry Rowinski is president and chief executive officer of Health Payment Systems Inc.


© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.


© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.


© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.