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Consumers Want Price Transparency Info They Don't Know They Have Access To

Analysis  |  By Alexandra Wilson Pecci  
   October 30, 2020

If consumers don't know healthcare pricing information is available and don't know how to access it, does it matter if it's there at all?

Massachusetts is among the states with gold-standard price transparency requirements, but even Massachusetts residents who want healthcare pricing information don't know they already have access to it.

That's according to a new Pioneer Institute report that hints at possible trouble ahead for those who believe that CMS's controversial price transparency mandate will be a silver bullet for healthcare consumerism: If consumers don't know healthcare pricing information is available and don't know how to access it, does it matter if it's there at all?

Related: CMS Issues Long-awaited, Controversial Final Rule on Price Transparency

"Consumers say they want price information, but only a small portion of people know they have access to it," report co-author Barbara Anthony said in a statement. "The gap between aspirations and the ability to actually obtain price information must be filled."

The researchers surveyed Massachusetts residents who have insurance through an employer or the open market.

It found that only one in five Massachusetts consumers have tried to find price information before obtaining a healthcare service.

That's not because they don't want to know, though: seven in ten consumers said they would like to know prices, but about the same percentage didn't know insurance carriers have price estimator tools they could use to find them.

When asked why they've never tried to find out the cost of a healthcare service:

  • 54% never thought of it
  • 17% thought prices would be the same no matter where they went
  • 12% thought it would be too complicated
  • 10% didn't know how to get the information
  • 2% were embarrassed to ask

These survey results belie Massachusetts price transparency rules which are some of the most robust in the country. Pioneer Institute notes that under law in Massachusetts:

  • Providers are required to give consumers the price of any procedure within two business days, if requested.
  • Hospitals must disclose the “allowed” amount, i.e., the price insurance companies pay the hospital for a service.
  • Insurance carriers are required to provide out-of-pocket information in real time through online cost estimator tools and a toll-free telephone number.
  • Massachusetts consumers must have access to cost information from their insurance carriers and providers via a 1-800 number, as well as through a cost estimate tool from insurance carriers.

Alexandra Wilson Pecci is an editor for HealthLeaders.

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