Health insurance companies may not be ready to fully comply with new price transparency rules, but the government is ready to issue the fines.
At the start of July, federal regulators began enforcing a requirement that health insurers disclose the negotiated rates they pay to in-network providers and the potential out-of-network billable amounts patients may owe. Insurance carriers must present these data in a publicly available, machine-readable format online. Along with a related rule mandating hospitals disclose prices, the policy aims to help patients understand their costs and seek lower prices.
The regulation is vague and underwent changes late in the process, which makes it difficult for insurers to understand just what it means to be in compliance, said Dan Kuperstein, a senior vice president of compliance at consultancy Corporate Synergies and an attorney who specializes in employee benefits law. That’s even more true for smaller carriers, employers and third-party administrators, he said.
“The rule was written in very ‘legalese’ terms,” Kuperstein said. “It’s my job to break the legalese down, and even I found this one tough compared to other regulations I have been looking at.”
A week before the regulations took effect, the Centers for Medicare and Medicaid Services clarified that self-funded employers lacking consumer-facing websites could post the prices negotiated with providers on their third-party administrators’ websites.
But many other details about how to comply remain unclear. For example, businesses that use recruitment services to find job candidates are unclear about whether it’s sufficient to only post negotiated rates on third-party careers websites, Kuperstein said. Insurers that rent provider networks from other carriers are also unsure whether they are responsible for posting rates on their own websites, or if it’s enough for the other health insurance company to make the prices publicly available, he said.