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.