The hospital pricing transparency rule, which was created by the Trump administration and went into effect on Jan. 2, 2021, says that hospitals must provide an easily accessed place on their website for pricing information for consumers.
Currently, hospitals are fined $300 per day for noncompliance. However, the Biden administration is planning to up the penalty fee to a maximum of $5,500 per day for hospitals with more than 30 beds. The fines for smaller hospitals with less than 30 beds will stay the same. Some large hospitals have been criticized recently for hiding pricing pages from search engines with embedded codes on websites. This issue is one of the reasons a larger penalty is being assessed, especially for larger hospitals for whom a $300 a day fine isn’t compelling enough to comply.
Health Insurance companies will fall under the same rule starting in 2022. Again, federal regulators are warning against using coding that hides pricing transparency results from search engines.
Source: This information from this post was sourced from the Wall Street Journal and the entire WSJ article can be found on their website, but a subscription is required. Similar articles can be found on Modernhealthcare.com.
COVID caused many people to lose their jobs or have reduced hours and the ripple effect was that many people lost health care coverage. As part of the American Rescue Plan. The government provided some assistance for employers with less than 20 employees which are typically exempt from COBRA. There are some requirements for employers. You can read more details about this at Bloomberg Law.
Source: Bloomberg Law
An investigation by the Wall Street Journal demonstrated that cash-paying patients without insurance are charged more by hospitals than patients with insurance. Insurance companies and plan providers are able to negotiate better rates for procedures and treatments. Uninsured consumers, who are largely unaware of hospital prices, don’t have access to the leverage of large health plans and without pricing transparency, they are unable to get better pricing. A rule put into effect by the Trump administration requires hospitals to post their pricing information in a machine-readable format on their websites. Pricing transparency is thought to be a way to increase marketing competition and provide more affordable options for non-insured patients.
Source: This information from this post was sourced from the Wall Street Journal and the entire WSJ article can be found on their website, but a subscription is required.
In addition to hospital pricing transparency, new rules for health plan pricing transparency go into effect in early 2022. The new rule states that group health plans must disclose cost-sharing information to participants, beneficiaries, and enrollees and “disclose in-network provider negotiated rates, historical out-of-network allowed amounts and prescription drug pricing” via their websites. Plan providers are being warned against hiding pricing information from search results like some hospitals have been caught doing. You can read more here.
As the pandemic begins to wind down, insurance companies are quietly ending the waivers for Covid. Patients who contract Covid may be responsible for their co-pays, hospital care, and medications. Federal law requires free Covid testing and vaccinations so those services remain free to the public.
Waivers for those who have mild Covid may not result in substantial savings, however, those who are hospitalized with the disease or who have long-Covid could now be responsible for significant medical expenses.
The decision for many insurers to waive Covid-related fees was part public relations strategy, and part of a strategy to reduce the number of rebates they would be required to pay under the ACA. Read more here.