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HHS Finalizes Rule on Insurer Price Transparency

WASHINGTON — Private health insurers will have to start posting their prices publicly within the next several years according to a final rule issued Thursday by the Department of Health and Human Services (HHS).

“This shadowy system” of healthcare pricing “has to change; the patient has to be in control,” HHS Secretary Alex Azar said on a phone call with reporters. “That means giving them the right to know what they’re going to owe for a healthcare service before they ever get it.” Right now, however, “patients don’t have the information they need to shop around and get a good deal … and have an informed conversation with their doctor about what makes sense for them.”

The final rule — which was issued by HHS together with the Labor and Treasury departments — would require almost all private health insurance plans to give the 200 million Americans they cover real-time access to information about negotiated prices and cost-sharing, beginning with a list of the 500 most “shoppable” services in 2023, Azar said. This list would be expanded to include all healthcare services in 2024. “This is information that patients typically receive after they get those services, through an EOB [Explanation of Benefits] form,” but now they could get it ahead of time.

Through a shopping tool available through their plan or insurance company, consumers will be able to see the negotiated rate between their doctor and their plan or insurer, as well as the most accurate out-of-pocket cost estimate possible based on their health plan for procedures, drugs, durable medical equipment, and any other item or service they may need, HHS said in a press release. “Consumers will also have access to accurate price and plan information that allows them to shop and compare costs between individual doctors before receiving care, so they can choose a healthcare provider that offers the most value and best suits their medical needs.”

In 2022, a year before the real-time access provision takes effect, insurers will be required to publish their negotiated rates in data files that will be searchable by patients, employers, researchers, and app developers who could then develop tools to help patients choose their providers. “The vast majority of patients don’t have easy access to this information today,” said Azar.

“In one study when prices for imaging were made transparent, the prices dropped almost 20%,” he said. “You should have the right to know what a healthcare service is going to cost, and the right to know what it’s going to cost you out-of-pocket. That’s what today’s rule will do.”

For each insurer, three data files will be available: one with prices for in-network providers and services, one with prices for out-of-network providers and services, and another for in-network prices for all prescription drugs.

HHS giving insurers a lot of time to comply with the new rule “reflects that there’s a lot of work involved, but that work is only necessary because entrenched special interests in the healthcare system have for

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