As both consumers and providers of healthcare plans are aware, the details of health insurance can trigger confusion for those enrolled in a policy. That’s why the federal government created Transparency in Coverage rules in 2020, with several deadlines for compliance on certain parts of the new law. One of those deadlines just passed on July 1.
Beginning on July 1, all healthcare plan providers must provide cost-sharing data to consumers. This information is designed to help consumers understand healthcare service pricing and their own out-of-pocket spending.
How can you find this information? Providers are required to provide this data via machine-readable files, published on a publicly-accessible website. The data includes pricing information for all covered items and services according to in-network negotiated rates, and also certain historical data on out-of-network rates that have been allowed. Not all historical data is required; if there are fewer than 20 out-of-network claims for a service by any particular provider, that information is not required to be included.
A third set of data will disclose prescription drug rates. However, the deadline for that part of the Transparency in Coverage law has been delayed due to a need for further instructions. Therefore, that information might not yet be available from all insurance carriers.
The information in all of these files should be updated monthly to reflect changing rates and new data.
What does “publicly available” mean? Consumers are not required to create a user account, provide a password, or submit any other type of credentials in order to access this information. The information must be published on a website where the general public can access it. Ask your health insurance provider and they will direct you to the the appropriate website.
Again, these files should be published by July 1, so that consumers can access information on cost-sharing from this point forward. If you have any questions about compliance with this new law, or need help interpreting the data, call your health insurance representative.