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Most Adults Look to Insurers for Healthcare Pricing Information

Analysis  |  By Jay Asser  
   July 22, 2022

A survey reveals only 36% of respondents have researched prices for healthcare services and when they do, it's usually not through providers.

It's payers, not providers, that most Americans turn to when seeking out pricing information for healthcare services, according to a survey on price transparency.

The poll, conducted by YouGov on behalf of AI for healthcare operations company AKASA, highlights the need for both insurers and providers to follow pricing regulations for the sake of the patient experience.

Of the 2,026 adults surveyed nationally in March, just 36% indicate they have researched prices for services, of which 60% say they would look to their insurance company for pricing information.

When seeking out information through a payer, 44% would look on the insurer's website and 29% would call their insurer.

When looking to a provider for information, 39% would visit a physician or hospital website, while 34% would call their physician or hospital. A remaining 32% would access a patient portal for prices.

However, respondents say information from payers isn't always available, with 44% answering their insurance company does not provide pricing information for local providers. Another 34% don't know if this information is available.

CMS now requires payers to disclose pricing information and comply with price transparency regulations, as of July 1. This includes providing machine-readable files containing in-network rate files for all covered items and services between the health plan and in-network provider, as well as the allowed amount file for billed charges from out-of-network providers.

Hospitals, meanwhile, have been required to follow the price transparency rule since its implementation on January 1, 2021, by providing a machine-readable file with all items and services, and a display of shoppable services in a consumer-friendly format.

Though the onus has so far mostly fell on providers to provide patients with pricing information, the survey and recent regulations show insurers must do their part.

"As the data indicates, patients are most often either turning to their insurance company or to their care provider through a variety of platforms to understand their price of care," said Ben Beadle-Ryby, co-founder of AKASA. "Clearly, both providers and payers have a critical role to play, and the healthcare industry as a whole must work together to holistically improve price transparency, which is a key piece of the puzzle to improving the overall patient financial experience."

Jay Asser is an associate editor for HealthLeaders.


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