Insurance Transparency is coming (slowly?)

[heybrother]

This July a requirement went into place essentially requiring insurance companies to post all manner of data about how they reimbursed hospitals, doctors etc. This process was theoretically similar to the process that was supposed to force hospitals to post their most common procedures and prices. That said, the hospital rule had no teeth and in general hospitals either ignored it, did a poor job at it, or made it not show up on search engines. The penalties for the insurance companies were much more substantial as it was somehow implemented based on number of plans and patients and what not so even small penalties over large numbers of people would rapidly translate into large amounts of money. For some of the major insurance companies - if you search for some variation of transparency and their name - many of them have posted enormous data files on their websites.

Aetna Transparency in Coverage: Machine-Readable Files

The Transparency in Coverage rule requires health plans and insurers to disclose pricing information via MRF by July 1, 2022. Aetna will publish this information on Aetna.com on July 1, 2022 for fully insured and Aetna Funding Advantage groups.

www.amwinsconnect.com

Transparency in Coverage Rule

In 2020, the Federal Government finalized “Transparency in Coverage” Rule, which requires health insurers and group health plans, including self-funded clients, to provide cost-sharing data to consumers.

www.uhc.com

Health Plan Price Transparency | CMS

www.cms.gov

New Healthcare Price Transparency Rule Took Effect July 1, But It May Not Help Much Yet

On July 1, 2022, the new Transparency in Coverage Final Rule went into effect. It could upend how Americans shop for healthcare services—and how much they pay.

www.forbes.com

Unless you are very good at manipulating massive amounts of data the machine readable files are apparently unusable hopefully someone / major newspapers etc will make a search engine like how the NYT/WSJ did for the Medicare payment data from a few years ago.

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[vm26]

This July a requirement went into place essentially requiring insurance companies to post all manner of data about how they reimbursed hospitals, doctors etc. This process was theoretically similar to the process that was supposed to force hospitals to post their most common procedures and prices. That said, the hospital rule had no teeth and in general hospitals either ignored it, did a poor job at it, or made it not show up on search engines. The penalties for the insurance companies were much more substantial as it was somehow implemented based on number of plans and patients and what not so even small penalties over large numbers of people would rapidly translate into large amounts of money. For some of the major insurance companies - if you search for some variation of transparency and their name - many of them have posted enormous data files on their websites.

Aetna Transparency in Coverage: Machine-Readable Files

The Transparency in Coverage rule requires health plans and insurers to disclose pricing information via MRF by July 1, 2022. Aetna will publish this information on Aetna.com on July 1, 2022 for fully insured and Aetna Funding Advantage groups.

www.amwinsconnect.com

Transparency in Coverage Rule

In 2020, the Federal Government finalized “Transparency in Coverage” Rule, which requires health insurers and group health plans, including self-funded clients, to provide cost-sharing data to consumers.

www.uhc.com

Health Plan Price Transparency | CMS

www.cms.gov

New Healthcare Price Transparency Rule Took Effect July 1, But It May Not Help Much Yet

On July 1, 2022, the new Transparency in Coverage Final Rule went into effect. It could upend how Americans shop for healthcare services—and how much they pay.

www.forbes.com

Unless you are very good at manipulating massive amounts of data the machine readable files are apparently unusable hopefully someone / major newspapers etc will make a search engine like how the NYT/WSJ did for the Medicare payment data from a few years ago.

Whatever penalties they sustain will be more than made-up for utilizing No-Suprise Act when renegotiating contracts in their favor

Coming to a contract negotiation near you: the No Surprises Act​

Insurers are using the federal ban on surprise out-of-network bills as a negotiating tactic with in-network providers, who see this as a harbinger of lower payments.

Coming to a contract negotiation near you: the No Surprises Act

Insurers are using the federal ban on surprise out-of-network bills as a negotiating tactic with in-network providers, who see this as a harbinger of lower payments.

www.modernhealthcare.com