Price Transparency in Coverage Rule

Price Transparency in Coverage Rule. In 2020, the U.S. Federal Government declared the “Transparency in Coverage” Rule requiring health insurance companies, group health insurance plans, and self-funded clients to provide cost data with consumers. This rule will increase price transparency and give consumers the tools needed to fully access hospital pricing information through their health plans.

There 2 major ways this cost information can be shared:

  • Machine-readable files: These files are currently available on public sites for plans beginning on or after January 1st of 2022. The files show pricing for covered items and services based on in-network rates and allowed out-of-network amounts.
  • Consumer price transparency tool: An online tool that insurance members can use to see their personalized cost-share estimates for all covered services and items. This is for plans beginning on or after January 1st of 2023.

Hi-Neo is an example of a consumer price transparency tool. Through the app, insured individuals will be able price compare the costs of medical services within their network. App users can see out-of-pocket cost information as well as negotiated rates for covered services including prescription drugs.

You can check out our blog on “Understanding Your Hospital Bills” to get a detailed breakdown on how costs add up on your hospital bills and why some hospitals are more expensive than others. With Hi-Neo, you have the power to make informed financial decisions about your health and get the best possible care at the best possible price.

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