Transparency for medical services will lower cost of health care and help Coloradans compare prices
WASHINGTON – U.S. Senators John Hickenlooper, Mike Braun, Bernie Sanders, Chuck Grassley, and Tina Smith introduced the bipartisan Health Care PRICE Transparency Act 2.0, which will make health care costs more transparent. Americans will better understand the upfront cost of health care services while having the opportunity to compare prices and get the best deal.
“Hospitals should disclose upfront what a stay will cost. Coloradans should be able to know and compare prices with other nearby facilities. Our bill puts patients in the driver’s seat to choose the care they need at a price they can see,” said Hickenlooper, member of the Senate Committee on Health, Education, Labor and Pensions.
“It’s wrong that the same procedure can be 20 times more expensive in one hospital than in another, and there’s no other industry where consumers are in the dark on the price of what they’re buying. Knowing what health care services cost will lower health care prices because Americans can shop around and get the best deal rather than relying on insurers to negotiate with providers which drives the price up for everything. The Health Care PRICE Transparency Act 2.0 will pull the curtain back and put the power back in the hands of the American people, introducing real market competition into the health care industry and bringing down prices,” said Braun.
“Patients should be able to compare and shop for health care services. However, the pricing information they need when visiting the hospital or working with insurance companies isn’t always available. By strengthening transparency and accountability requirements, our bill would help lower costs for patients through more competition and added sunlight in the health care industry,” said Grassley.
When Americans go to the hospital, they often don’t know what services will cost beforehand. This forces patients to rely on their insurance to pay as much as possible and negotiate rates with providers, and robs patients of the ability to shop around for a better deal. There’s also a lack of transparency in agreements between insurance and providers. There are many examples of employer-sponsored insurance plans reviewing the claims data for their employees and discovering egregious payment disparities and wasteful practices.
The Health Care PRICE Transparency Act 2.0 will finally introduce true transparency into health care pricing by requiring all negotiated rates and cash prices between plans and providers to be accessible. The bill requires actual prices for 300 shoppable services be published, with all services by 2025.
Specifically, the bill will:
- Impose data sharing standards.
- Require machine-readable files of all negotiated rates and cash prices between plans and providers, not estimates.
- Expand price transparency requirements to clinical diagnostic labs, imaging centers, and ambulatory surgical centers.
- Require pricing data standards including all billing codes for services.
- Require actual prices for 300 shoppable services with all services by 2025.
- Require attestation by executives that all prices are accurate and complete.
- Increase maximum annual penalties to $10,000,000 (includes specific minimum and maximum penalties according to number of hospital beds in the facility).
- Prevent preemption of state price transparency laws, except for ERISA group health plans. Codify the Transparency in Coverage rule.
- Provide group health plans the right to access, audit, and review claims encounter data.
For full text of the legislation, click HERE.