Prices revealed in newly released health insurance company data files show some major American hospitals are omitting prices from their required price disclosures in violation of the federal hospital price transparency rule, according to a new report – Transparency in Coverage Report – from PatientRightsAdvocate.org. Two separate federal regulations enacted recently require disclosure of healthcare prices:
a) The Hospital Price Transparency Rule (effective Jan. 1, 2021): Hospitals are required to make public data files that include all negotiated prices with health insurers and discounted cash prices.
b) The Transparency in Coverage (“TiC”) Rule (effective Jul. 1, 2022): Health insurers are required to make public pricing files that include the rates they negotiate to pay to all healthcare providers, including hospitals.
By cross-referencing 20 price disclosures made by hospitals and health insurers in accordance with these two rules, PatientRightsAdvocate.org (PRA) discovered several instances in which prices were omitted from the hospital files but appeared in the insurance company files. The discrepancies indicate that some large hospitals are not posting their complete price lists as required by the hospital price transparency rule. The examples of missing hospital pricing data uncovered by PRA include prices negotiated with insurers such as Blue Cross Blue Shield (BCBS), United Healthcare, and Cigna. The hospitals whose data disclosures were found to omit prices include some of those owned by HCA Healthcare (HCA) and Ascension, two of the largest hospital systems in the country.
For example, some of the prices that are found in insurance company price files appear with an “N/A” or are blank in the corresponding hospital price lists. This concrete evidence from the insurance files demonstrates that real prices exist and hospitals are flouting the hospital price transparency rule.
- Transparency in Coverage Report. PatientRightsAdvocate.org. October 2022