If there was ever a time to increase price transparency in the medical industry, now is it. Fortunately, the Trump administration is taking the next step to ensure that patients can know the exact costs of their prescriptions and medical treatments well in advance of care.
With direction from the White House, the Center for Medicare and Medicaid Services (CMS) is now telling hospitals to follow a 2021 law, which requires them to list “actual prices of items and services, not estimates.” Even better, the departments of Labor, HHS, and Treasury also issued a request for information on health plans’ readiness to comply with drug price disclosure requirements.
The 2021 federal price transparency rule was never properly enforced by the previous administration, leading to widespread hospital noncompliance. Procedures can vary in price by more than ten times between hospitals and even between departments at the same hospital. Patients, meanwhile, are unaware of the difference until they are charged an overinflated bill long after they undergo treatment.
CMS’s recent direction “requires hospitals to publicly share a ‘standard charge dollar amount’ for services whenever possible, including gross charges, cash prices, payer-specific negotiated rates and any minimum negotiated charges. If a dollar amount isn’t available, hospitals can list prices as a percentage.”
Insurers will also have to update their reporting format for rates for covered items and services, out-of-network allowed amounts and negotiated rates for covered prescription drugs, according to guidance from the DOL, HHS and Treasury.
This guidance is a huge win for American patients of all backgrounds and health challenges. Polling by Echelon Insights found that 96 percent of Americans agree that they “deserve to know the price of their healthcare before they receive it.”
Fortunately, no matter the outside circumstances, Solidarity HealthShare is committed to price transparency for its patients, which is one of the many reasons why Members are able to enjoy lower health care costs. We rely on a method called Reference Based Pricing that allows any provider to bill us directly for the services provided. We then reprice the bill to make sure that the charge is fair and reasonable. Solidarity bases our repriced bill off of what Medicare would pay for the same procedure where the patient lives.
Using this pricing method, Solidarity shared a total of $22,647,303 in eligible medical expenses in 2024, which is a 65 percent reduction in cost of the original bills. This April alone, Solidarity saved its Members nearly 60 percent on medical bills.
Patients should never have to wonder if they can afford basic healthcare leading up to treatment. For more information on how you and your family could save on care that aligns with your values, give us a call at 737-SHARING.
