I learned a few things today, that as of January 1, 2024 the full impact of the Transparency in Coverage law is in effect regarding price transparency.
see: https://www.cms.gov/healthplan-price-transparency/consumers
Highlights:
- All insurers now need to provide "machine readable files" about their negotiated rates for ALL services (in 2023 it was just 500 services). It can be hard to find this but search google should find it or ask them. These files are not easily readable by a layperson (intentional I'm sure) - the ones I saw use JSON, a web format. The files are also large, multi-gigabytes, which can prevent easy processing of them. However, the data is indeed inside to review.
- The cost estimators that insurers provide now need to cover all covered services, not just the 500 list from 2023. Your insurer should provide a cost estimate for anything they would cover.
- If you are having trouble getting either of those, you can submit a complaint now to CMS:
https://www.cms.gov/healthplan-price-transparency/contact-us
I hope that someone will do some good analytics on these data files and that something good will come of them.
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