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How to find out what your health insurance pays in advance

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Last year, the hospital I had to start posting a list of prices to charge at each step.. Accessing the data has never been easier. A serious flaw is that these are just the price of the sticker, not the price the insurance company or anyone else actually pays. By the way, as of July 1st Insurance company You need to post a list of negotiated prices. This is much more convenient, but once again it’s hard to actually shop with it.

Part of the reason this is all so confusing is that so many companies are involved. If you’ve perused the benefits description (the one that says “This is not an invoice” in the email after the procedure), you’ll know the price. you Payments depend on hospital fees, the amount the insurance company negotiates with, and the amount the insurance company expects you to start. The new Price Transparency Rule aims to provide all this information. Previous You have surgery and services.

The deadline for July 1st is the first Three phases With the new price transparency method.

  1. Insurance companies now need to publish a “machine-readable” list of all prices negotiated with hospitals and healthcare providers.
  2. Starting January 1, 2023, we need to provide a human-use online tool that estimates the price of 500 “shoppable services” (that is, pre-shopping, such as non-urgent surgery). ..
  1. After January 1, 2024, its online tools need to be covered all Services covered by insurance companies.

(Many insurers already have a cost estimation tool, but its usefulness varies. You often need to log in to a member account to use the tool, and all eligible services It may not be included or may not provide as much information as the final information obtained. It is required by law.)

There are still some potential obstacles to getting an accurate price for future care. First, insurance companies may decide that they do not want to post the information they need. (According to, only 14% of hospitals posted a price transparency list in the first year. report Fortunately, the fines for insurance companies that do not follow this are higher than the fines for hospitals. At $ 100 a day per “affected member”, it can skyrocket very quickly.

Another major obstacle now is what you need machine Readable. Imagine something like a spreadsheet. It’s hard to read and too big to scroll. They also take forever to download. One insurance company (Anthem) explains: “These files are in CMS-defined format (JSON) and are not intended for member-friendly searches of rates, benefits, or cost sharing.”

The idea is that a third-party service or app is born to do the job of helping people buy the best coverage. You have to wait to see how well the plan works.

But in the meantime, the file itself is easy enough to google. Throw the name of the insurance company into a search engine with the word “machine readable file”, Something Should pop up. (Some of these look incomplete, but they’re probably working on it.) Here to start the five biggest insurance companies Etna, national anthem, Signa, KaiserWhen United Healthcare..

How to find out what your health insurance pays in advance

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