How are Health Plans impacted by Hospital Price Transparency Rule effective 1/1/19


Hospitals are now required by CMS to post, via internet, a list of their standard charges for all the services they provide and to update this information at least annually. While this effort will improve patient visibility into the cost of healthcare, it could also cause confusion and increase the challenges patients must navigate while managing their healthcare. Health Plans are likely to experience increased call volume due to confused members trying to understand the pricing posted on the websites, vs the pricing they are seeing on their explanation of benefits.

Health Plans will need to prepare to spend time and resources to help their members understand this information and the difference between the rates the hospitals post, and the fees they pay on the member’s behalf. Helping members understand the available financial information and the cost of care is a way Health Plans can promote themselves as a trusted partner and build member loyalty.

Additional information:

  1. CMS
  2. Health Payer Intelligence
  3. JDSUPRA