Newly required cost transparency empowers patients and their families
Hospitals and other medical providers are being forced to display prices charged to patients for certain medical procedures, thanks to tough new federal enforcement federal guidelines to punish violators of the price transparency rules that rolled out in 2021.
Even as a new law, the No Surprises Act (NSA) will begin protecting patients against unfair out-of-network health care bills. The No Surprises Act establishes new federal protections against surprise medical bills that take effect in 2022. Surprise medical bills arise when insured consumers inadvertently receive care from out-of-network hospitals, doctors, or other providers they did not choose. Peterson-KFF and other studies find this happens in about 1 in 5 emergency room visits. In addition between 9% and 16% of in-network hospitalizations for non-emergency care include surprise bills from out-of-network providers (such as anesthesiologists) whom the patient did not choose. Surprise medical bills pose financial burdens on consumers when health plans deny out-of-network claims or apply higher out-of-network cost sharing; consumers also face “balance billing” from out-of-network providers that have not contracted to accept discounted payment rates from the health plan. The federal government estimates the NSA will apply to about 10 million out-of-network surprise medical bills a year.
The NSA will protect consumers from surprise medical bills by:
requiring private health plans to cover these out-of-network claims and apply in-network cost sharing. The law applies to both job-based and non-group plans, including grandfathered plans.
prohibiting doctors, hospitals, and other covered providers from billing patients more than in-network cost sharing amount for surprise medical bills.
Unfortunately, many hospitals still remain stubbornly non-compliant with the Hospital Price Transparency Rule implemented in January 2021, as they continue to hide pricing that gouges patients’ pocketbooks. A new analysis found only 5.6% of hospitals were fully compliant with a major price transparency rule, with most failures centered on not posting payer-negotiated prices. Another problem has been price estimator tools that don’t enable meaningful accessible comparison of discounted cash prices, researchers said.
A recent 2022 survey finds that only 1 in 10 patients know hospitals are now required to post their prices online. PatientRightsAdvocate.org wants CMS to scrap the requirement for a price estimator tool and instead require hospitals to provide “guaranteed price quotes.”
The new transparency regulation is more important than ever. Over a recent six-year period, medical costs have doubled.
While the new transparency law concerning medical costs is helpful, it is not always easily accessible or usable to the patients’ advantage.
“Despite government regulations, many hospitals still have inconsistent and hidden pricing,” said Katy Talento, executive director for the Alliance of Health Care Sharing Ministries (www.ahcsm.org). “Many people believe that patients just have to accept this opaque system where you find the price after the fact. But the truth is, hospitals are required to comply, and consumers can report their hospitals to the federal government for defying the law. What’s more, even if a hospital is posting its prices, that doesn’t have to be the end of the conversation—uninsured patients can negotiate discounted rates.
Sources:
https://www.fiercehealthcare.com/hospitals/report-
https://www.ahcsm.org/
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