A rarely discussed but transformative patient protection policy implemented by the Trump administration has proven to be an extremely effective tool for solving the US medical pricing chaos. According to the order, hospitals must provide the federal government with records of all prices they negotiated with private insurance companies.
Some hospitals joined forces to sue the government (they lost…twice), and the trade association of insurance companies Wrote a 57-page letter The government calls transparency rules “unconstitutional” and implies that too much transparency is not good for ordinary healthy consumers.
Every American should be able to obtain the health care information they need in a manner tailored to their own situation when they need it in order to make smart health care decisions for themselves and their families. This information should enable patients and consumers to seek and receive care from medical service providers based on accurate and personally relevant information about cost and quality. If implemented properly, price and quality transparency should simultaneously enhance consumers’ healthcare experience and reduce prices and costs for consumers (and employers and other payers) on average. AHIP and our member health insurance providers know that consumer-centric transparency strategies and tools are critical to our ability to fulfill these promises, and we know that departments share these goals and promises… The proposed rules are too broad and Regulations will ultimately not enable consumers to make more informed healthcare decisions.
when New York Times Decided to take Deep dive After learning about compliance with the policy, they discovered that medical power brokers might have good reasons to hide their pricing system from the public eye.
However, data from compliance hospitals hints at why the powerful industry wants this information to remain hidden.
It shows that for the same basic services, hospitals charge patients very differently: the procedure is as simple as an X-ray or pregnancy test.
It provides many examples of major health insurance companies-some of the largest companies in the world, and Billions of annual profits -Negotiate surprisingly unfavorable prices for their customers. In many cases, insured patients get a higher price than they would if they pretended to have no insurance at all.
For example, the New York Times went on to list the comparative cost of a standard colonoscopy at the Mississippi Medical Center: $1,463 for the Cigna plan, $2,144 for the Aetna plan, and a staggering $782 for no insurance at all.
Naturally, those who follow the logic of the free market understand that subsidies always increase costs.We saw In the student loan industry And the field of green energy. Insurance companies can apportion the increased care costs to their consumer groups, which is basically a subsidy to the hospital. When your partner is willing to pay $1,400 for the same service, why charge $700 for a service?
But the “New York Times” also found that there are still some bad actors who insist on fulfilling their legal responsibility for transparency. These “bad guys” are one of the most profitable medical institutions in the United States.
Five major insurance companies-Aetna, Cigna, Humana, United and Blue Cross Blue Shield Association-all declined reporters’ requests for interviews.
Cedars-Sinai of Los Angeles told the New York Times, “We do not publish standard cash rates, which usually do not reflect the price of care for uninsured patients” They have not yet provided pricing. The New York Times reporter said that initially the hospital released a 2.5 GB file with more than 1 million lines but no data.
New York University Langone also ignored the policy and has not yet announced the rates and prices.
Stanford Healthcare said, “Services that do not have a fixed payer specific rate are shown as variable.” Their available data provides more than 300,000 possible insurance and medical pricing combinations. The price it offers is only 479.
The University of California, San Francisco Medical Center took a similar approach, saying that they listed pricing “where possible” and described pricing as “variable” when it is impossible. Of the more than 8 million possible pricing combinations at the University of California, San Francisco, they only listed 346 pricing. They continue to conceal pricing.
The Montefiore Medical Center in the Bronx refused to announce the price and hoped that patients believed that there was no direct link between the hospital’s surgery costs and the patients’ costs, told the New York Times “The resources we provide ensure that our patients know what kind of help they can get, and ultimately, they know how much a procedure will cost, not us.“
Vanderbilt University Medical Center, Orlando Health Center, and Long Island Jewish Medical Center are also organizations that refuse to comply with the federal government’s mandate of transparency.
The Republican division of the House Fundraising Department, led by Rep. Kevin Brady (R-TX), said that the data provided in the New York Times report proves Tron by forcing our healthcare industry to open the door on how to determine pricing. They still worry that the Biden administration will not enforce full disclosure.
A woman trying to find an affordable rabies vaccine for her son discovered that the cash price quoted by the hospital was wrong because she received an extra $2,260 bill a few weeks later.
According to insurance plans, common, similar-goods services (such as MRI) vary by thousands of dollars.
Even the pregnancy tests at the same hospital vary depending on the plans issued by the same state.
These data prove the Trump administration’s vision of price transparency, which is a major victory for patients and consumers frustrated by the complexity of the healthcare system. The Biden administration has increased penalties for hospitals that fail to comply with regulations and open prices, but more work must be done.
On a bipartisan basis, Congress requires all Americans to receive a personalized, true and honest cost estimate before scheduled surgery. The Biden administration has announced that they will not implement this rule before the date stipulated by the law. They should change course and work quickly to fully implement the clause in accordance with Congress’s intentions.
Read the complete and highly detailed report of the New York Times here. Thank you that this outlet shines in the deliberately dark corner of medical pricing. Patients across the country can thank the Trump administration for protecting patients from excessive medical bills and fuzzy pricing structures when it comes to their most important thing… their health.
