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Taking the Lead on Price Transparency


Published Jul 14, 2022 • by AHIP

Every American should have the personalized health care information they need, so they can make better, more informed decisions as they seek and receive care.

A major part of that is making affordable choices clear and available. To help, commercial health insurance providers offer price transparency tools that enable hardworking Americans to make health care decisions that deliver better health at lower costs.

As of 2021, nearly 94% of commercial health insurance providers have supplied enrollees with meaningful price transparency by offering cost estimator tools to help them shop for the care that’s right for them. That’s well in advance of the January 1, 2023, deadline, set by the federal government, for all commercial health insurance providers to make such tools available.

“Right now, more than one hundred million people already have access to this information – and the number is growing,” said Kelley Schultz, vice president of commercial policy at AHIP. “And we know this data has to be more than just available – it must be actually useful, which means clear, concise, and easy to understand.”

A recent analysis by Consumers’ Checkbook (a nonprofit organization that provides information on pricing and quality for various services) commended the operability of several health insurance provider tools. It noted that while many hospital and third-party apps and websites are glitchy or difficult to navigate, insurance provider plans, in practice, proved useful.

This month, another federal price transparency requirement went into effect — the public disclosure of in-network negotiated rates and out-of-network allowed amounts via large “machine-readable” files. As you can imagine, it’s a lot of really complex data — far more so than the list of prices that hospitals have been struggling to deliver in the months since their requirement went into effect. And large data files do not provide actionable, personalized price transparency information for consumers.

It’s clear: For patients, their health insurance providers are the best resource for individualized cost information. Health insurance provider tools include information specific to an individual enrollee’s coverage, such as their benefits, provider network, progress toward deductibles or out-of-pocket maximums. They can flag if the member needs prior authorization for a specific service, and also include information on provider quality measures. While third-party developers may create price transparency apps or tools using this data, they can’t deliver accurate, real-time, and personalized cost estimates to help consumers make informed decisions.

Better health outcomes and more affordable health care are goals we can all get behind, and increased price transparency is a step in the right direction. Health insurance providers will continue to roll out cost comparison tools and features, making improvements so that people can get the information they need to make important decisions about their health and care.

Read more about price transparency here.