Despite law, healthcare price transparency remains murky in MA

If you’ve been keeping up with healthcare news this week, you may have noticed the headlines buzzing about the demand for price transparency or the lack thereof—even in states where it is required by law.

The Health Care Cost Institute (HCCI), a non-profit, non-partisan organization—supported by Humana, Aetna, Kaiser Permanente, and UnitedHealthcare—made waves this week after Dr. David Newman, executive director of the Institute, spoke at the Health Financial Management Association’s Annual Institute Conference last week in Orlando.

Newman was quoted saying, “If you want consumers to make informed healthcare decisions, you have to provide them with pricing information they can actually use.”

Earlier this year, the HCCI released their own price transparency website——a site where healthcare consumers can check “average national and regional charges for [78] common medical procedures that can be planned for in advance, like child birth and knee replacements,” as reported by this Health Data Management article.

The same article reports that Guroo “represents a threat to many hospitals.”

And that may be true. But a true price transparency tool would represent a threat to more than just hospitals. After all, other high-priced providers and insurance companies all benefit from obscure medical pricing.

Insurance companies experience higher revenues, and as a rule, higher profits, when the price of care is more expensive. Regulations surrounding medical loss ratios (MLR) create an economic system that pits carriers against the best interest of their insured members to drive costs higher. The carriers’ true motivation towards high-cost healthcare is evidenced in their poorly designed health plan offerings, blatant discouragement of health savings accounts, and perhaps most prominently, in their pathetic effort to provide price transparency to their members.

Insurance companies really have no incentive to support price transparency—which explains why the tool released by the HCCI and supported by four large insurance carriers has yet to offer any “pricing information that [healthcare consumers] can actually use,” like Newman declared our healthcare system needs.

Massachusetts passed a law last year “requiring all hospitals, physicians’ clinics, and insurance companies to give [healthcare consumers] the price of medical services and procedures within two business days of a request.” But a recent investigation by Boston-based news channel WCVB revealed a blatant disregard for the law and indifference towards the rights of healthcare consumers.

During the WCVB investigation only one of the 23 hospitals they called had a “price estimator hotline,” and “after eight days and multiple calls” their investigators had still not received answers from seven of the hospitals.

Another investigation on price transparency by the Boston-based Pioneer Institute found similar results after surveying 22 hospitals and 10 clinics, reporting that “it took anywhere from 10 minutes to seven business days to get answers [on pricing for a left knee MRI], with prices ranging from $700 to more than $8,000.”

When WCVB confronted the Massachusetts Hospital Association with the results of their investigation, they released a statement that seemed to suggest and even shift some of the blame towards insurers:

“Hospitals contract with multiple insurers all of whom have numerous and differing products making the process of obtaining this information complex…[and] it is necessary for hospitals to work closely with insurers…since the insurer will have the most up-to-date information on how much a patient owes after insurance.”

Both investigations prove that the law isn’t working. And the cavalier attitude of the Hospital Association showcases the lack of enforcement of the law and highlights how the rules may not be clearly defined for hospitals and insurance carriers.

Is there another market in our economy where consumers tolerate such obscure pricing?

Without anywhere near as much legislation, obscure medical pricing is quickly becoming a problem of the past in adjacent New Hampshire. MyMedicalShopper™—a company created by and devoted to healthcare consumers—has launched a comprehensive price transparency platform that far surpasses anything currently available to their neighbors down in Massachusetts. The service is available online and through a mobile app for Apple and Android devices, allowing healthcare consumers to take control of their physical and financial health by giving them the power to shop for their healthcare based on price, quality, and convenience. Users can do all of this without ever having to jump through hoops like calling providers, insurance companies, or any other middlemen.

And MyMedicalShopper will be available to Massachusetts residents later this year.

Most people don’t know what real healthcare price transparency looks like, but there are thousands of healthcare consumers already taking advantage of it in New Hampshire, and they are really liking it.


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