Insurers: Price transparency rule puts 'staggering,' expensive burden on us

Insurers charge that the Trump administration’s price transparency rule will cost 26 times more than estimated, and the amount of data they must disclose is “staggering.”

Insurer groups blasted the proposed rule released by the Treasury, Labor and Health and Human Services departments late last year that would force insurers to disclose negotiated rates for in-network providers and allowed amounts for out-of-network care. The crux of comments from insurers on the rule focused on the massive burden and cost for implementation and that the data would confuse consumers.

The Blue Cross Blue Shield Association (BCBSA), which represents 36 Blues plans, said that an economic analysis from the firm Bates White found that the total setup and maintenance cost for an insurer to comply with the rule was $13.63 million. That is 26 times higher than the administration’s estimate of $510,000.

“Some plans have indicated they would be forced to run two sets of tools—one designed to meet member shopping needs and another implemented only to meet the requirements of the proposed rule,” BCBSA said in submitted comments.

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The rule would require plans to publish machine-readable files with their payment amounts for all health services and items. Insurers would also be required to post a tool that can help consumers get an estimate on out-of-pocket costs for any item or service before they get care.

“The sheer volume of data health plans would be obligated to disclose is staggering,” BCBSA said. “There are more than 94,000 codes that exist currently … covering institutional inpatient, outpatient and professional claims.”

America’s Health Insurance Plans (AHIP) said in comments that the proposal appears to be more targeted at providing data for third-party app developers than “ensuring consumers have access to meaningful, personalized data.”

The Trump administration is essentially asking insurers to share “both their trade secrets and their enrollees’ sensitive personally-identifiable information with app developers that are not bound by the same heightened level or privacy and security rules that apply to health insurance providers,” AHIP said.

Posting just the data also could be confusing for consumers that don’t have the necessary context, argued the Association for Community Affiliated Plans, which represents 67 nonprofit and community-based safety net plans.

“In the absence of quality data, consumers may determine that higher cost equates to higher value, select the higher-cost providers, and ultimately drive up medical expenses,” the group said in comments.

The reaction from provider groups was more mixed. Golden Valley Memorial Healthcare, a rural hospital in Missouri, wants the rule to provide the cost-sharing information to providers as well as patients. 

"Patients reasonably turn to providers for this information when contemplating or scheduling health care services, but providers often face barriers in accessing the necessary details from insurers to provide a timely, accurate estimate," the hospital said in comments. 

The American Hospital Association (AHA) said it agrees with the proposal to improve patient access to cost-sharing information. But AHA vehemently disagreed with the proposal for insurers to release all negotiated rates.

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AHA argued that the First Amendment of the Constitution doesn’t “permit compelled public disclosure of such confidential and trade secret pricing information.”

The Trump administration also doesn’t have the legal authority to force payers to disclose negotiated rates, AHA said. The Affordable Care Act (ACA) gives the federal government authority to compel certain information regarding coverage, including how a health plan must be certified to be on the ACA’s exchanges.

But AHA contends that the administration can’t require disclosure of negotiated rates, because they refer to price and not coverage.

The AHA is used to making these types of arguments because it is among several hospital groups suing the Trump administration over a final rule that requires hospitals to post payer-negotiated rates. While insurers have also opposed that rule, none have joined the lawsuit.