How Much Health Insurers Pay Providers Now Public

Consumers, employers, providers, and anyone else interested in health care prices can now access files for what insurers pay for care, thus answering the consumer's frequent question "What is the out-of-pocket cost?" and the provider's common question "What are other providers being paid?"

As of July 1, under the Health Plan Transparency in Coverage rule, health insurers and self-insured employers must post on websites about every price they’ve negotiated with providers for health care services, item by item.

This means pricing by CPT code for physicians, hospitals, skilled nursing facilities, and surgery centers. About the only thing excluded are the prices paid for prescription drugs.

Yes, this means everyone will know everyone else’s prices for different services. For example, providers will now know what United Healthcare and Humana pay at the same surgery center for a knee replacement.

The new rules are far broader than those that went into effect last year requiring hospitals to post their negotiated rates for the public to see and the penalties are much higher. The majority of insurance plans have already complied with the requirement by posting their machine-readable files on public websites.

The use cases for providers and consumers are endless. If interested in a dataset being processed for a use case, then contact me at gates@healthendeavors.com.

Kris Gates, gates@healthendeavors.com