UPDATE: Health plans now required to post the prices they pay for health care and why it matters.

 | 
Patricia Kelmar
Director, Health Care Campaigns

Author: Patricia Kelmar

Director, Health Care Campaigns

 

Started on staff: 1986-1991; 2020
B.A., magna cum laude, Boston College; J.D., high honors, George Washington University Law School

Patricia directs the health care campaign work for U.S. PIRG and provides support to our state offices for state-based health initiatives. Her prior roles include senior director of health policy with the National Consumers League, senior policy advisor at NJ Health Care Quality Institute, and consumer advocate at NJPIRG. She serves on the board of the Patient and Caregiver Engagement Advisory Group for the National Quality Forum. Patricia enjoys walks along the Potomac and sharing her love of books with her friends and family around the world.

Beginning July 1, health insurers must share how much they pay hospitals and physicians, as required by a Trump administration rule. We expect to see similar findings that a Wall Street Journal investigation showed: health plans are paying very different prices for the same health treatment, even within one city. Why does this matter for Americans?

If our health plan hasn’t managed to negotiate a good rate for services, not only will we pay more in annual premiums, but we’ll also pay more out-of-pocket for any co-insurance we owe.  Because insurers are now required to disclose their negotiated rates for doctors and hospitals, employers should have the information to design health plan networks that help keep costs down. Insurers that don’t post their prices could face penalties of $100/day per health plan enrollee which could add up to millions of dollars in just one week. 

With improved disclosure of wide variation in prices, we can challenge hospitals and doctors to prove why they deserve higher payment. Is their quality any better? Employers should start asking their health insurance plan administrators why they should keep an overpriced hospital or provider in their network if it is going to result in higher costs for their employees. 

And this disclosure will also help patients planning care and treatment. Starting in the new year, health plans must provide online tools so consumers shop around by finding out their costs for 500 “shoppable” planned procedures.

More good should come from this continuing move toward greater health price transparency. Learn more about PIRG’s high-value health care work.  

Photo by Alvaro Reyes on Unsplash

Patricia Kelmar
Director, Health Care Campaigns

Author: Patricia Kelmar

Director, Health Care Campaigns

 

Started on staff: 1986-1991; 2020
B.A., magna cum laude, Boston College; J.D., high honors, George Washington University Law School

Patricia directs the health care campaign work for U.S. PIRG and provides support to our state offices for state-based health initiatives. Her prior roles include senior director of health policy with the National Consumers League, senior policy advisor at NJ Health Care Quality Institute, and consumer advocate at NJPIRG. She serves on the board of the Patient and Caregiver Engagement Advisory Group for the National Quality Forum. Patricia enjoys walks along the Potomac and sharing her love of books with her friends and family around the world.