Price transparency

Have You Heard of The Hospital Price Transparency Rule?

Have you ever tried to find the price of a healthcare service?

Imagine you need to see a doctor or surgery and would like to know the cost upfront to avoid receiving a surprise medical bill – it’s usually really difficult to find the price of care before your appointment. Until January 1, 2021, finding the cost of care prior to receiving it was almost impossible.

Thanks to the Hospital Price Transparency Rule that went into effect last year, we are now able to help you clear up some of the confusion and mystery that often exists when shopping for healthcare. Handl Health has created a cost estimator to help you find the prices of healthcare services, compare the cost of care and empower you to make an educated decision that is best for your physical and financial health.

What is the Hospital Price Transparency Rule?

On New Year’s Day of 2021 hospitals were required to publish prices for the most common services they provide, for the first time in American history. The Price Transparency Rule is an effort to offer you, the consumer or patient, public access to these prices, allowing you to compare and shop for the care you need. Although the legislation requests that this pricing information is consumer-friendly and machine-readable, it is often difficult to find and decipher. That’s why Handl Health made our free easy-to-use tool currently with 400 facilities (and counting!) nationwide in our database of information. You can use our cost estimator to get a personalized quote for the service you’re looking for in 5 minutes or less!

Hospital Price Transparency Rule phases

The Price Transparency Rule is a historic act of legislation that will be expanded in three phases. Currently, the legislation requires hospitals to provide information and pricing for 300 common medical services.

Phase 1 began January 1, 2021, and is currently enforced. It requires hospitals to provide information and pricing for 300 common medical services, 70 of which were chosen by Centers for Medicare and Medicaid Services, while the other 230 could be chosen by the providers themselves.

Phase 2 is going into effect and will be enforced beginning January 1, 2023. It requires hospitals to provide information and pricing for 500 common medical services.

Phase 3 will go into effect in 2023 and will be enforced beginning January 1, 2024. It requires that a hospital provide information and pricing for all medical services that are offered at that facility.

The information required to be posted by the hospitals for each service will include details on the price charged, the price negotiated and contracted, as well as consumer cost-sharing information. Getting this information before you receive care allows you to compare prices and choose care at the best cost for you.

Who has to comply with the Hospital Price Transparency Rule?

Hospitals are not the only ones that must comply with price transparency regulations. As of January 1, 2022, insurers of individual and group plans, as well as self-funded employer plans, must now provide pricing for the healthcare services provided (for non-grandfathered plans). Hopefully, this will create further access to the accurate pricing that many patients, maybe you included, are craving. In an article that details this information, it was noted that “78% of surveyed consumers stated that they’d like to know the cost of care before obtaining it.”

Lack of hospital compliance

Three months after the implementation of the Price Transparency Rule, the Healthcare Cost Institute surveyed 222 hospitals across ten states to find out if hospitals were in compliance with the new legislation. The study found that only half of the 222 hospitals posted prices at all and only a third did so in a way that met regulation requirements.

According to the data gathered by Handl Health, there is a compliance rate ranging from 60% to 100% in the areas we have collected from, with an average of approximately 80% across 400 facilities. Since we launched, we have witnessed a noticeable improvement in compliance, especially over the past few months. We have also noticed that many facilities have an all-or-nothing approach to their data, either sharing information for all of their services or for none at all.

Lack of compliance is an issue that is now being addressed by the upcoming phases that will expand the Price Transparency Rule. Beginning July 1, 2022 enforcement will be elevated with the hopes that more hospitals will take the initiative to comply with the requirements. Enforcement can begin with a warning to the hospital giving 90 days to reach compliance. After 90 days, a second warning may be issued that could result in a fine of $300 to $5500 per day of non-compliance.

Who does the Hospital Price Transparency Rule help?

The Price Transparency Rule is not only a huge win for patients, but it also benefits hospitals and providers. There has been a significant change in the accuracy of the patient’s billing estimate compared to their final bill for healthcare services from November 2020 to June 2021. More than 50% of people surveyed expressed that the estimate and bill differed dramatically in November, but only 14% said the same in June, according to Experian’s State of Patient Access Survey.

Although improvement towards price transparency has been made there is still more opportunity for change. When a patient is able to accurately estimate the cost of their healthcare service, they are more likely to be able to pay their final bill when it arrives, leading to benefits for all.

A surprise medical bill is frustrating at best but often devastating. The founders of Handl actually formed the company because of an occurrence such as this, leading to the creation of our cost estimator tool to help combat surprise billing. Legislation is also taking action that supports our efforts.

On January 1, 2022, the No Surprises Act was passed to ban surprise medical bills for anyone with individual, employer or Marketplace insurance. If you do not have insurance you’ll receive a “good faith” estimate of what your care will cost. There are also efforts to create a better resolution process for billing disputes between plans and providers, which may also help you if you have a dispute or have to navigate a process for self-pay as an individual.

Between the Price Transparency Rule and the No Surprises Act, there is hope that shopping for healthcare services will become easier and more accessible for the patient. Thankfully you can always turn to Handl Health to help you compare and contrast pricing for the healthcare services you need. So the next time a medical concern arises, you will be able to concentrate on getting the care you need without a headache or a surprise medical bill.

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