To pro­mote com­pe­ti­tion and push down health­care costs, the Trump admin­is­tra­tion issued new rules in Novem­ber to require insur­ers and hos­pi­tals to dis­close upfront the actu­al prices for com­mon tests and pro­ce­dures.  Not sur­pris­ing­ly, there is an almost open revolt from the health­care indus­try.  The rules for hos­pi­tals take effect in 2021 – it is not out­lined when this applies to health insur­ance com­pa­nies.  It is expect­ed this will go to court, but in the meantime:

Hos­pi­tals must pub­lish in a con­sumer-friend­ly man­ner nego­ti­at­ed rates for the 300 most com­mon ser­vices that can be sched­uled in advance and pub­lish all charges in a for­mat that can be read on the web.  For health insur­ance com­pa­nies, it is required that they cre­ate an online tool so pol­i­cy­hold­ers may get a real-time per­son­al­ized esti­mate of their out-of-pock­et costs, and a pub­lic dis­clo­sure of nego­ti­at­ed rates for their in-net­work providers.

Charge lists will include:

  • Gross charge
  • Pay­er spe­cif­ic nego­ti­at­ed charge
  • Dis­count­ed cash price
  • De-iden­ti­fied min­i­mum nego­ti­at­ed charge (low­est of all prices the hos­pi­tal has)
  • De-iden­ti­fied max­i­mum nego­ti­at­ed charge

The for­mal title is “The 2020 Out­pa­tient prospec­tive pay­ment sys­tem and ambu­la­to­ry sur­gi­cal cen­ter price trans­paren­cy require­ments for hos­pi­tals to make stan­dard charges pub­lic final rule” and it is under CMS 1717-F2 issued 11/15/19.