Federal Price Transparency & Consolidated Appropriations Act
As July 1, 2022 approaches, so does the first phase of the new Transparency in Coverage rules. In this first phase, insurance carriers and plans are required to make machine-readable pricing files publicly available. Most conclude that there is no employer requirement to do anything at this stage, as no information is realistically available to the average consumer (that comes in January 2023). These machine-readable files are to include:
Negotiated in-network provider rates for all covered items and services
Historical payments to, and billed charges from, out-of-network providers
In-network negotiated rates and historical net prices for all covered prescription drugs at the pharmacy level. – This provision has been delayed indefinitely
Starting in January of 2023, the carriers/plans must make this same information available to individual insureds. This information will be personalized to show the member’s level of out-of-pocket costs for 500 covered items and services, including prescription drugs (the Rx may be delayed?). In January of 2024, this personalized information is set to include ALL covered services, not just the 500 required in 2023. At this point individual insureds need to be made aware of this information and employers will have some need to notify them (more direction to follow, but this may require a link on your company’s public website).
Similar information (but not as granular) has been available on most insurance company websites for years and is very lightly utilized. Also, with complex procedures, or when complications arise during a procedure, these pricing tools may be of limited use. That said, we are hopeful that this new information will help consumers make better-informed health care decisions and look forward to this new step!
As always, if you have any questions or if we can help in any way, please reach out!
Call us at (805) 687 - 3225, or send us an email at info@petersmilam.com. We can't wait to hear from you!
-Dave Peters & Steve Milam
