08/30/2022
Have you ever tried to find the best primary care option within your budget, but had no luck when it came to finding price estimates? Have you ever been surprised by a hospital bill weeks after coming home from the emergency room? If so, you’re not alone. Nearly 1 in 5 patients who either go to the emergency room, have an elective surgery, or give birth receive surprise hospital bills, according to a recent ASPE report. On average, the cost of one of these surprise bills falls somewhere between $750 and $2,600.
With new transparency regulations, most group health plans and health insurance issuers are required to disclose price and cost-sharing information to their participants, beneficiaries, and enrollees of plans. We’re already seeing the benefits of cost transparency in the health insurance industry, from both a provider and consumer perspective.
New Regulations and Requirements
As of October 2020, the Department of Health and Human Services mandated that health insurance issuers and plans will be required to disclose in-network negotiated rates, billed charges, allow amount paid for out-of-network providers, and the negotiated and historical net rate for prescription drugs. While a seemingly large change from the perspective of the healthcare provider, the goal is to reduce the secrecy behind the pricing for consumers, allowing for more cost transparency.
In years following, Hospital Price Transparency and the No Surprises Act were created. The former requires accessible pricing information be shared online about services offered by every hospital in the United States, by either utilizing a machine-readable file with all items and services or incorporating shoppable services online for consumers to digest and gather details from. The No Surprises Act, includes a ban on surprise billing within the private insurance industry for almost all emergency care and a large portion of non-emergency care. Beginning in January of 2022, the No Surprises Act extended this cost transparency to those who are uninsured, or self-pay patients, and now requires these consumers be given a good faith estimate, including overviews of anticipated costs and details about their rights.
Provider Benefits of Cost Transparency
These regulations are already changing how both healthcare and insurance information is presented to consumers. But what lies behind these cost-transparency changes? And how can your insurance company prepare the pricing models, technology, and communications needed to implement and maintain a more transparent system? First and foremost, insurance companies will need to audit their current systems for price creation and display. Some questions to consider include:
- Does this system have the capability to reflect different pricing models in a public domain?
- Are you able to create varying levels of pricing depending on the consumer?
- Does your solution have the ground-level ability to produce and share different pricing models?
The system also needs to be able to keep-up with quickly changing regulations, as well as prioritize the consumer experience. Features of this system will benefit and improve customer experience, retention, and the ability to respond quickly to changing information. Consider what other features this system could offer:
- Will it be able to match your company’s branding?
- Are you able to easily edit pricing that is reflected on the website?
- Does the system have an easily accessible user interface?
Building a customer-friendly digital platform to comply with transparent pricing isn’t free or an easy project. However, insurance providers who recognize this as an opportunity to improve their customer relationships can position themselves to keep–and win–business. When customers have easy access to transparency across the board and insurance providers are investing in the customer experience, it can be met with more customer acquisitions, better customer engagement, reduced cost of service and marketing, and increased customer loyalty and retention. Ultimately this can result in more business for the providers who make the most out of cost transparency.
At Sendero, we have helped countless companies implement systems and processes to support your most challenging business problems, while maintaining best practices and navigating a shifting financial landscape.
If you are a company or provider looking to implement a new system or make changes to your current functionalities amidst the cost-transparency regulations, fill out the form below to connect with one of our consultants today.
