MA price transparency effort gets underway

Massachusetts is gradually rolling out a price transparency law, but patient advocates have raised some concerns that insurers have set up obstacles that make it difficult for patients to receive data. 

As of Oct. 1, health insurers have to provide consumers with cost estimates for office visits to physicians, and specific tests and procedures at hospitals and surgical centers, the Boston Globe reported. The quote would also include a patient's out-of-pocket costs. Currently, payers have two days to respond to a request, but by October 2014 they will have to respond instantaneously. By January 2014, physicians and hospitals will also have to provide cost estimates.

Any estimates for specific procedures are binding, according to the new law, the article reports. If the patient is charged more and the fee does not include unexpected care, the insurer will have to make up the difference.

"This is a really revolutionary law that hasn't gotten a lot of attention yet,'' Barbara Anthony, undersecretary of the Office of Consumer Affairs and Business Regulation, told the Globe. She added that it represents a cultural shift for patients and will allow them to become more aggressive on seeking price information.

Although many consumer advocates have called for greater price transparency in healthcare delivery, few states or jurisdictions require it, and there has been resistance in the provider community. As a result, prices for some procedures or services can be grossly inflated.

To date, the Bay State's insurers have fielded fewer than 250 price requests since October, according to the Globe.

Moreover, patient advocates have raised some concerns about potential obstacles for price inquires. Massachusetts Blue Cross Blue Shield requires an inquiry to include a specific billing code. The insurer said it plans to drop that requirement, according to the Globe.

Hospitals have also fretted about the requirements.

"Hospitals already work to try to provide information about what various procedures and services will cost," Karen Granoff, senior director of managed care policy for the Massachusetts Hospital Association, told the Globe. "They do not have all the information at hand. How much does a patient have left on their deductible for example. Providers have to work with insurers to try to get this information.''

To learn more:
- read the Boston Globe article