In the not so distant past, understanding healthcare pricing was nearly impossible. Fortunately, new legislation is taking effect that requires payers to transparently publish their pricing. Let’s explore how healthcare price transparency impacts insurance payments and how it will benefit both patients and providers alike.
The No Surprises Act & The Transparency in Coverage Act
The No Surprises Act (NSA) and the Transparency in Coverage Act (TCA) are two pieces of federal legislation that were introduced to improve healthcare price transparency. They are intended to make sure that out-of-network charges are limited while also providing better cost estimates of medical services before they are performed. Additionally, both pieces of legislation limit surprise billing by establishing an arbitration process for resolving payment disputes between insurers and healthcare providers.
Health Plan Price Transparency & Insurance Negotiated Rates
Under the TCA, health plans must provide consumers with more information about their coverage, including detailed information about deductibles, copayments, coinsurance amounts, and estimated costs for covered health care items or services. Patients can use this information can be used to shop around for the best deal from different providers or help make informed decisions when it comes to selecting a specific provider or treatment option based on cost. Additionally, the TCA requires health plans to disclose insurance negotiated rates for all covered items or services so that providers can determine if they will accept a given patient’s insurance plan prior to providing any services.
Healthcare Price Benchmarking & Insurance Payments
The new legislationI includes provisions that require insurance companies to publish negotiated rates. This helps reduce patient confusion when it comes to understanding what is typically charged for certain types of treatments or procedures as well as ensure that insurers are not overcharging for certain items or services. By having this data readily available, doctors can also negotiate fairer rates with insurers which improves market efficiency overall while also ensuring that insurers are paying fair prices for medical services rendered by providers.
Conclusion:
These two pieces of legislation will help reduce confusion related to medical claims and insurance payments while increasing price transparency across the board. Patients are now able to make more informed decisions about their care while also reducing surprise bills from out-of-network charges. Providers will soon be able to access benchmark prices from other similar services in order to negotiate better rates with insurers as well as understand exactly what types of coverage their patients have prior to providing any service thus helping them avoid unnecessary denials due to incorrect coding or lack of coverage altogether. All in all, this new level of transparency should benefit everyone involved in the process!
Leave a Reply