A new proposed rule would require employer-sponsored group health plans to provide plan enrollees with estimates of their out-of-pocket expenses for services from different healthcare providers.
The proposal, to be published in the Federal Register Nov. 27, aims to advance actions the White House administration has taken to increase price transparency by giving patients tools to access pricing information through their health plans.
The proposed rule would require the healthcare provider to make available to participants, beneficiaries and enrollees personalized out-of-pocket cost information for all covered healthcare items and services through an internet-based, self-service tool, or in paper form upon request.
These new proposed rules would go a long way to improving transparency, says Michael Thompson, president and CEO of the National Alliance of Healthcare Purchaser Coalitions.
“This will lift a veil of secrecy on healthcare costs, especially for those paying the bills—employers and their employees,” he says. “Transparency of both cost and quality is essential if we are going to move toward a value-based healthcare system.”
Echoing in agreement, Steve Wojcik, vice president of public policy at the National Business Group on Health, says the group is all for, and has been trying, to get employees their out-of-pocket costs as clearly and early as possible in advance of what they need.
“This is something many employers have hired third-party vendors or have worked with their health-plan administers to provide to employees,” he adds.
However, he cautions, there is a part of this rule that would also require disclosures of the in-network negotiated rates with their network providers and historical payments of allowed amounts to out-of-network providers.
“We have questions, and we’re not convinced it’s going to work as intended,” he says.
When you have a concentrated market on the provider side, hospital systems and physician practices—by publicly disclosing all the rates among all the plans—they can go back and say, “We should get that rate, too,” thereby backfiring and raising prices, Wojcik warns.
Comments on the proposed rule are due by Jan. 14, 2020.