Billing Transparency

Pricing regulations need tech

1 out of 5 U.S. adults received an unexpected medical bill in 2022. And so it is no wonder that one of the top five reasons people avoid medical care is due to cost.

Unknown out-of-pocket expenses, or unexpected medical bills, has kept many away from the care they need when they need it the most. One of the reasons for these unknown costs is due to dual price lists that charge self-pay patients different prices than for insured-funded patients.

As of January 2022, the No Surprises Act aimed to curb the lack of visibility in medical expenses by requiring private health insurers to cover certain out-of-network bills as in-network procedures. And as of January 1, 2023 plans must provide price comparisons through internet based self-service modules.

However, many of these regulations have lacked follow through.

A study reviewing 5,000 hospitals nationwide found only 300 were fully compliant with the Hospital Price Transparency law and 50% did not provide cost estimators on their websites. PatientRightAdvocate.org performed their own audit of 1,000 hospitals and found that less than 20% of hospitals were complying with the CMS price transparency rule and blocked uninsured or self-pay patients from seeing discounted cash prices.

To help end medical debt and meet the many regulatory requirements, providers need technology that helps consumers understand their financial responsibility, set up payment schedules, and navigate financial support.

Luckily, digital health companies like Ribbon Health and Turquoise Health are working to expand access to price transparency information through data collection. With 21% of consumers wanting a better payment experience for their healthcare, more digital health companies should lean into transparency and advocacy solutions for patients.