What’s one of first things you do when you make a purchase? If you’re like me, you look at the price. Why is purchasing healthcare different? Is it because we’ve become insulated from the cost of care with flat-dollar copays? Is it because once we’ve met out out-of-pocket maximum, we have little personal incentive to shop for the cost effective care? Or is it because shopping for healthcare can be confusing because of the lack of transparency of the “negotiated” rates between the medical provider and insurance carrier?
One idea is to ask your doctor or insurance company how much a medical procedure will cost prior to getting the service. But, determining your actual cost in advance for a procedure can be frustrating; not to mention receiving an invoice for a medical service and getting sticker shock after the fact.
Insurance carriers have health cost estimators available which can assist for common procedures. Additionally, there are vendors that can help you shop for quality healthcare and provide you with the cost of care. But wouldn’t it be nice to know the actual cost of care from your healthcare provider in advance of the service?
The Trump Administration released an Executive Order on June 24th 2019 focused on improving healthcare price transparency. This order calls for the Secretary of Health and Human Services to propose regulations requiring hospitals to provide charges based on negotiated charges for common services. Having price transparency from the provider in advance of your medical procedure would provide insight to the patient. It would enable the member to “shop” the cost of care and know the price in advance of the service being rendered.
There will likely be pushback and legal challenges to any proposed transparency regulations. Insurance companies and healthcare providers may choose not to publish their negotiated rates and protect their competitive advantage. However, it’s time for patients to become engaged with our own healthcare. As consumers of healthcare, we need to be part of the solution and providing detailed pricing will help us make educated decisions.