Finding health insurance quotes for care is an ordeal: the shots

Insurers are bound by federal rules aimed at price transparency that took effect July 1, but consumer use of the data may have to wait for private companies to collect it.

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Insurers are bound by federal rules aimed at price transparency that took effect July 1, but consumer use of the data may have to wait for private companies to collect it.

DNY59/Getty Images

Data giants who own powerful computers are thrilled. Ordinary consumers, not many.

This is the reaction after two weeks of dumping the data in huge proportions. Health insurance companies publish their negotiated rates for each type of medical service they cover across all providers.

But so much data is pouring in from insurance companies — tens of thousands of massive digital files from a single insurance company is not unusual — that it may still be weeks before data companies put it into usable formats to achieve their intended goals: employers, researchers, and even patients.

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“There’s data out there; it’s just inaccessible to mortals,” he said. Sabrina Corlettis a research fellow at the Center for Health Insurance Reforms at Georgetown University.

She and others said insurers are adhering to federal rules aimed at price transparency that took effect July 1. Realistically though, consumer use of the data may have to wait until private companies collect it — or additional federal requirements begin next year with the goal of making it easier for consumers to use price information to shop for scheduled medical care.

So why post prices? The theory is that advertising this set of prices, which will likely vary widely for the same sponsorship, will help mitigate future costs through competition or improved price negotiations, although there is no guarantee.

And hospitals last year underwent a similar directive, stemming from the Affordable Care Act, to publish what they agreed to accept from insurance companies — and the amounts they charged patients who pay cash. after a lot drag their feet, saying that the rule is expensive and time-consuming. Their trade association, the American Hospital Association, I filed a lawsuit to no avail to stop it. Many hospitals never complied, and federal government enforcement has proven lax.

While government regulators have sent more than 350 warning message To hospitals, potential civil fines have increased from $300 a day to $5,500, and only two hospitals have been fined so far.

The requirements of insurance companies are broader than those faced by hospitals, although they do not include cash rates. They include negotiated prices paid not only to hospitals, but also to surgery centers, imaging services, laboratories, and even doctors. Amounts billed and paid for “out-of-network” care are also included.

Penalty fines for not posting can be higher than those hospitals face—$100 a day per violation, per affiliate affected, which adds up quickly for mid- to large-volume insurers or self-insured employers.

“We are seeing high compliance rates because of the high sanctions,” he said. Jeff LiebachPartner with Guidehouse Consulting.

Difficult to access information

The data is posted on public websites, but it can be hard to access – mainly because of volume, but also because every insurance company treats it differently. some, like Cigna, requires potential viewers to cut and paste a very long URL into a browser to access the table of contents of the pricing files. Others, including united health careWebsites that directly list the table of contents.

However, even the tables of contents are huge. The UnitedHealthcare webpage warns that it may take “up to 5 minutes” to load the page. When that happens, there are more than 45,000 entries, each listed by year and name of the plan or employer for job-based policies.

For consumers, getting to any one plan will be a challenge. Currently, it is also more difficult for employers who want to use the information to determine how well insurers are at negotiating compared to others.

Employers said they “really need someone to download and import the data”, a format that can be read by computers but not easily searched, Randa Deatonvice president of buyer engagement at Buyer Business Group on Health, which represents large employers.

After an initial peek, I noticed a huge disparity in costs.

“On one of the plans, I could see negotiated prices between $10,000 and $1 million for the same service,” Deaton said.

But the bigger picture won’t be clear until more data is cleaned up: “The question is what story this data will tell us.” She said. “I don’t think we have the answer yet.”

Congress and administration policy-makers expected that insurance company data would be overwhelming and that private companies and researchers would step in to conduct the deep analysis and produce the data.

One of those companies is turquoise health“I was thrilled with the amount of data,” said Marcus Dorstel, Vice President of Operations.

The company, which is one of the companies aimed at commercializing data, had by mid-July downloaded more than 700,000 unique files Or about half a petabyte. For context, 1 petabyte is Equivalent 500 billion pages of standard written text. Dorstle added that his expectation is that the total download will end up in the 1 to 3 petabyte range.

Turquoise hopes to share the structured data with its paying customers soon — and offer it free to regular consumers sometime after that on its website, which already lists available hospital rates.

What can you do now

What is possible now?

Suppose patients know they need a particular test or procedure. Can they look online at insurance company data publications to choose the most cost-effective treatment site, which could be beneficial for those who haven’t yet met their annual deductible and are in trouble for some or all of the cost?

“Maybe an individual with a laptop could look at a file for one plan,” Dorsteel said, but consumers will find it difficult to compare across insurance companies — or even across all plans offered by one insurer.

Consider, for example, what it takes to try to find the negotiated price for a particular type of brain scan, MRI, from a particular insurance company.

The first hurdle: selecting the right file. “Coverage transparency” or “machine-readable files” may appear with the name of the insurance company and its results in Google. Self-insured employers are also supposed to publish the data.

The next step: Find the exact plan, often from a table of contents that can include tens of thousands of names because insurance companies offer many types of coverage products or have many employer clients that must be listed as well.

Downloading and decoding interlacing codes to select one that describes a particular service is next. It helps to get the service code, which the patient may not know.

From January 1, another rule is in effect that can provide consumers with some relief.

It includes other apps and tools that some insurance companies already make available to policyholders so they can estimate costs when preparing for a visit, test, or procedure.

The new rule bolsters existing information and requires insurance companies that do not offer such tools to be ready by that date. Insurance companies must make the patient charge available online, or on paper, if requested List of 500 selected governmentsCommon “shopping services”, including knee replacements, mammograms, a range of types of X-rays, and, yes, MRIs.

The following year – 2024 – insurers must provide consumers with the cost-sharing amount for all services, not just those initial 500.

Explanation of benefits as well as price comparison

Another regulatory layer stems from the No Surprises Act, which went into effect this year. Its overarching goal is to reduce the number of insured patients who receive higher-than-expected bills for care from out-of-network providers. Part of the law requires providers, including hospitals, to provide a “good faith estimate” in advance of non-emergency care on demand. Currently, this part of the law applies only to patients who are uninsured or who use cash to pay for their care, and it is not clear when will start For insured patients using their coverage benefits.

When that happens, insurers will be required to provide policyholders with cost information before they receive care in a format described as an Explanation of Benefits Advance – or EOB. It will include how much the provider will charge, how much the insurance company will pay – and how much the patient will owe, including any deduction owed.

In theory, this means there could be both an EOB upfront and a price comparison tool, which a consumer might use before deciding where or who to get the service from, Georgetown University’s Corlett said.

However, Corlett said, she remains skeptical, given all the complexities, that “these tools will be available in a usable format, in real life, to real people anywhere near the envisioned timeline.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. It is an editorially independent driver for KFF (Caesar Family Foundation).

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