Publish all the data you want. Won't help unless the data is easily accessible and usable.
Won't be accessible and usable without personalization for the specific treatment, on the specific date, by the specific providers, at the specific treatment facility.
Just as important, data reflects past pricing.
America needs the Good Faith Estimate (GFE) and the Advanced Explanation of Benefits (AEOB), part of the No Surprises Act, signed into law by President Trump in his first term.
We are still waiting
Why not have the Trump Administration ask the private sector to provide an assist to the Department of Labor.
I would be happy to work with a TPA or an insurer to show the DOL what would be best practices - an AEOB that shows not only the pricing for what the idividual and their providers planned, but a lower priced alternatives for the same treatment available from other providers.
Patients aren’t the primary audience (for now). Employers and vendors and navigators who work with them are. That’s how we use the data today to help navigate members and waive their cost-sharing at higher quality, lower cost sites of care.
Without a requirement to obtain a GFE/AEOB, coupled with a plan design that enforces that requirement, you'll only reach a handful, perhaps even a small minority of patients seeking non-emergency treatment.
Further, and importantly, where employers, vendors and navigators recommend different providers, that smells like "steering" - and you open yourself up to litigation should the outcome be adverse.
Why can't we have both processes?
I mean, the GFE/AEOB was statutorily mandated in 2020! What are you/others/DOL afraid of? Implement, see results, adjust or if ineffective, reverse/emasculate (a la Section 89, CLASS, Medicare Modernization Act of 1989, Individual Mandate, etc.)
No regulatory action of any significance since 2022.
Better option is to let the private sector develop a GFE/AEOB and let the DOL go to school on what an industry participant believes would be best practices.
Until then, there is no requirement, folks can offer GFE/AEOB, but no one does, or at least few do and even fewer apply it consistently.
What provision are you referencing in the insurer transparency regulation - certainly not the GFE/AEOB process/guidance which no one is effectively using today.
Unfortunately, I am a "frequent flyer" of medical procedures now, so I can comment on this from a patient viewpoint.
MarinHealth (formerly Marin General Hospital) now sends me an estimate for my procedures. They are surprisingly accurate. Not only that, they also provide a prepayment discount of up to 25% off of their portion.
I can't comment on the discount part except to say they must have a hard time with collections if they are willing to take 25% off of their cut.
Like to think that is of value. Have to think that, according to Rand studies, that the hospital charges are 250+% of Medicare Allowable, and 350+% of Medicaid Allowable, so a 25% discount only means that you are paying perhaps 200% more than I would, as a Medicare eligible beneficiary, for the same service on the same date at the same location delivered by the same providers.
Publish all the data you want. Won't help unless the data is easily accessible and usable.
Won't be accessible and usable without personalization for the specific treatment, on the specific date, by the specific providers, at the specific treatment facility.
Just as important, data reflects past pricing.
America needs the Good Faith Estimate (GFE) and the Advanced Explanation of Benefits (AEOB), part of the No Surprises Act, signed into law by President Trump in his first term.
We are still waiting
Why not have the Trump Administration ask the private sector to provide an assist to the Department of Labor.
I would be happy to work with a TPA or an insurer to show the DOL what would be best practices - an AEOB that shows not only the pricing for what the idividual and their providers planned, but a lower priced alternatives for the same treatment available from other providers.
Patients aren’t the primary audience (for now). Employers and vendors and navigators who work with them are. That’s how we use the data today to help navigate members and waive their cost-sharing at higher quality, lower cost sites of care.
Without a requirement to obtain a GFE/AEOB, coupled with a plan design that enforces that requirement, you'll only reach a handful, perhaps even a small minority of patients seeking non-emergency treatment.
Further, and importantly, where employers, vendors and navigators recommend different providers, that smells like "steering" - and you open yourself up to litigation should the outcome be adverse.
Why can't we have both processes?
I mean, the GFE/AEOB was statutorily mandated in 2020! What are you/others/DOL afraid of? Implement, see results, adjust or if ineffective, reverse/emasculate (a la Section 89, CLASS, Medicare Modernization Act of 1989, Individual Mandate, etc.)
Dude that’s in the insurer transparency regulation already. You’re welcome.
See: https://www.reginfo.gov/public/do/eAgendaViewRule?pubId=202504&RIN=1210-AC14
No regulatory action of any significance since 2022.
Better option is to let the private sector develop a GFE/AEOB and let the DOL go to school on what an industry participant believes would be best practices.
Until then, there is no requirement, folks can offer GFE/AEOB, but no one does, or at least few do and even fewer apply it consistently.
What provision are you referencing in the insurer transparency regulation - certainly not the GFE/AEOB process/guidance which no one is effectively using today.
Nice masonry hand signal there, dr. oz.
Unfortunately, I am a "frequent flyer" of medical procedures now, so I can comment on this from a patient viewpoint.
MarinHealth (formerly Marin General Hospital) now sends me an estimate for my procedures. They are surprisingly accurate. Not only that, they also provide a prepayment discount of up to 25% off of their portion.
I can't comment on the discount part except to say they must have a hard time with collections if they are willing to take 25% off of their cut.
Like to think that is of value. Have to think that, according to Rand studies, that the hospital charges are 250+% of Medicare Allowable, and 350+% of Medicaid Allowable, so a 25% discount only means that you are paying perhaps 200% more than I would, as a Medicare eligible beneficiary, for the same service on the same date at the same location delivered by the same providers.