June 23, 2022
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Biden administration delays new health insurance price transparency rules by at least 6 months

By on August 29, 2021 0


Going to the doctor or having surgery in the United States, even with health insurance, can feel like stepping into a financial black hole. How much of the bill your health insurer will pay and which will be your responsibility may remain a mystery until the service has taken place and the bill arrives.

This will finally change. It will just take a little longer than expected.

Games of a final Transparency in the coverage rule issued by the Trump administration in October 2020 were scheduled to take effect on January 1, 2022, with phased implementation until 2024.

But healthcare consumers will have to wait a little longer for better price transparency from their insurers.

Earlier this month, the Biden administration announced it would not enforce certain provisions of the coverage transparency rules, delaying some implementation deadlines by six months and others indefinitely.

The new rule requires most health insurers to provide personalized information on consumers’ reimbursable charges for covered services through a self-service online tool. A first set of 500 “purchasable services” is expected to be available to consumers in 2023, with the rest to follow in 2024.

The explicit goal of making this information available is to encourage consumers to seek out lower-cost health care services and providers, despite studies showing that the use of price transparency tools does not necessarily lead to an overall reduction in health costs.

Insurers will also need to publish the underlying negotiated rates paid to health care providers, historical information on fees and payments from out-of-network providers, as well as negotiated rates and historical prices of covered prescription drugs. This detailed data must be provided in a machine-readable form in order to enable data analysis and foster private sector innovation to drive consumer purchasing behavior.

Mutuals will now have until July 1, 2022 to publish these files, according to a news advice issued jointly by the US Departments of Labor, Health, and Human Services, and the Treasury.

The Administration will also indefinitely delay the application of certain provisions, in particular the obligation for insurers to publish the costs of prescription drugs.

Application of other transparency requirements from 2021 Law without surprise will also be delayed. For example, disclosure rules that require insurers to provide consumers with good faith estimates of their expected costs and related details will not be enforced as of January 1, 2022, when they officially come into effect.

While the implementation of hospital price transparency rules is any guide, consumers might not get the cost clarity they need even after the new health insurance requirements are implemented.

The Final rule of transparency of hospital prices entered into force in early 2021, forcing hospitals to publish their negotiated rates with insurers as well as expected spot prices for 300 common services. Like the new rules for health insurers, hospitals must provide online consumer transparency tools and machine-readable files for research and analysis.

But the implementation of hospital transparency rules has not necessarily been smooth. A recent report showed that less than 6% of hospitals comply with the new transparency requirements. Most of the non-compliant hospitals had not posted all of the required negotiated prices or published the full list of reduced cash prices.

Despite the implementation challenges that insurers will no doubt face, evidence suggests consumers want price transparency.

According to a investigation conducted by HealthSparq earlier this year, 83% of consumers said they wanted to see their expenses reimbursed before obtaining health services. Of those interviewed who had used a price transparency tool provided by insurers, the vast majority said they felt they could make more informed healthcare decisions and better understand their coverage and benefits. assurance.

The stakes linked to the non-application of price transparency can be significant.

Without price information, 25% of those polled in the HealthSparq survey said they completely avoided health services and a preliminary investigation showed that 53% of consumers said they avoided healthcare because they didn’t know what it would cost them.