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Starting today, patients will have a lot more clarity into what their insurers pay

July 1, 2022, 3:57 PM UTC
A caregiver walking with an elderly woman.
Halfpoint Images—Getty Images

Consumers who are curious if they’re getting the best deal from their insurance company have a lot more information at their fingertips, starting today.

New transparency rules from the Centers for Medicare and Medicaid Services went into effect on July 1, requiring insurers to post virtually every price they’ve negotiated with doctors, hospitals, health care facilities, and more. Prescription drug prices are not included in the rules, except for those directly dispensed by doctors’ offices or hospitals.

The data could initially be overwhelming for consumers, but experts say that it shouldn’t be long before entrepreneurs or others incorporate it all into a user-friendly interface that will, for instance, let consumers estimate what their expenses might be for a visit. And perhaps more important, do price comparisons.

“If you’re 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,” Chris Severn, CEO of Turquoise Health told NPR.

The information will also highlight the negotiating strength of health insurance companies. Is Blue Cross Blue Shield, for example, able to persuade doctors to offer a better price than UnitedHealthcare?

The insurance data dump comes after last year’s requirement that hospitals publicly post their negotiated rates. Officials have broadened the requirements for insurance companies, though, to increase transparency after some hospitals were slow to comply or continued to hide information.

Companies that fail to post the information face fines of up to $100 per day per violation, which could quickly add up to millions of dollars. Additional transparency requirements are set to go into effect over the next two years.

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