On a quest for price transparency, drop confidentiality clauses


There's a growing trend in the healthcare industry--disclosing costs for services. In any other industry, that's a no-brainer necessity for a consumer to make an informed decision about what to purchase. But when it comes to health insurance, consumers often must determine whether to undergo a test, procedure or exam without knowing those services' accompanying price tags. 

That's why I rejoiced when I read about Rhode Island Insurance Commissioner Chris Koller's recent bulletin that requires health insurers to disclose coverage costs to providers and consumers upon request. So now when consumers want to know about the costs of options being presented to them, for example, choosing between undergoing orthoscopic surgery or getting physical therapy for a knee injury, their doctors can help them make a cost-effective decision.

When doctors currently ask insurers how much they pay other providers for the same services, insurers often refuse to disclose such information because of confidentiality clauses within their provider contracts. But Koller has now directed insurers in his state not to enforce those non-disclosure agreements because they "do not appear to have any real or ascertainable value."

"We're just saying, 'Tell us what your plan is, what you're going to disclose to who.' We didn't say everybody gets access to everything," Koller said. "The market is already moving toward disclosing this information to consumers. I think we as regulators want to be a little bit more thoughtful about it, making sure that it happens but leaving room for the insurers to innovate."

And that's where I think he hit the nail on the head--the industry is indeed moving toward becoming more transparent when it comes to pricing. But it can't happen in one fell swoop. Rather, small steps are needed along the quest for price transparency.

Another key step launched by insurers in neighboring Massachusetts focuses on providing cost estimates to their members. Harvard Pilgrim, Blue Cross Blue Shield of Massachusetts and Tufts Health Plan have all begun work on different versions of a cost estimator tool, delivering deductibles, out-of-pocket expenses and costs of services straight to the consumer.

Such information couldn't come at a better time as the case of healthcare's "financial toxicity" is being brought to light. One recent study published in Health Affairs found that cancer patients are more likely to go bankrupt, but very few actually ask about the costs of care. Arming patients with valuable cost information, especially about small variations in their available care, could literally save millions of dollars each year.

I know that I personally appreciate doctors taking the time to speak with me about all my medical options and the associated costs. But whenever I ask them if they know whether my specific health plan covers a certain procedure, for example, I'm inevitably met with a shake of the head.

Of course doctors shouldn't be solely responsible for dispensing all financial information about any given service, but it would certainly benefit them and their patients to be in the loop when it comes to costs. And if they don't know the price of coverage for something in particular, it would be so helpful if they or someone on their staff could reach out to an insurance company to find the right information and then deliver it to the patient.

I can only imagine how patients undergoing cancer, who are likely fraught with worry, fear and overwhelm, would be incredibly appreciative if they didn't have to engage in multiple conversations with an insurance company to determine costs of all their options. If they could just walk into their doctor office, receive recommendations for care along with corresponding costs and coverage options that would be a gigantic load off their already burdened minds.

So I'd like to hope that insurers in other states follow in Rhode Island's footsteps, regardless of whether their regulators require it, and begin offering more financial information to doctors and members. It's a long quest, but it's a very worthy one. - Dina (@HealthPayer)