New Health Care Cost Transparency Rule Now in Effect

New Health Care Cost Transparency Rule Now in Effect

Last week a new federal rule that is supposed to give a clearer picture of what insurers and employers pay for health care went into effect. However, there are doubts about how successful it will prove to be.

Patients often have no idea what a procedure or service costs, and therefore, have little ability to comparison shop. As a result, they can be stuck with a higher bill than they expected.

Now, because of the new rule, insurers will have to list their negotiated rates with in-network providers, as well as out-of-network allowed amounts and billed charges for certain items and services. However, it is thought that it will take a while for the new rule to impact the average consumer.

As an example, while the idea of shopping for a CT scan online has obvious appeal, the fact is that we may not be able to do that yet because health care is full of unfulfilled, tech-driven promises. Some researchers also assert that consumers just aren't as inclined to shop for health care the way they would for a car or cell phone.

And while there is a lot of price data available, the law did not require payers and providers to work together to define what a total episode of care means.

Take for instance, a hip replacement. Does it include anesthesiology? Does it not? Is there any post-care or follow-up? Or no post-op? Even if [the payer and provider] both display hip replacement, they can display wildly different prices."

There has been no discussion of how this may or may not affect Medicare, but it is not inconceivable that if all the uncertainties can be answered and individuals are able to determine the costs of health care procedures, Medicare will look and see if and how this may affect the services it pays for.