America Has Watched Healthcare Prices Grow for Decades
Since 1970, healthcare spending in the U.S. has increased from $353 per person to $11,600 per person a year. Why do we keep accepting excruciatingly high healthcare prices when cheaper options exist? Why don’t we compare the pricing of various healthcare providers like we do for virtually every other purchase that we make? The main reason that healthcare costs cannot be compared is that countless providers don’t even display their prices. It’s remarkable that our country has put up with this for so long. You would never walk into a store and fill up your cart with items without knowing their prices, yet that’s exactly what we do with our healthcare. Even those who realize that their healthcare providers are the most expensive option often choose not to consider other providers because they believe that high cost equates to high quality. This is simply not true. A 2010 study by the Massachusetts Attorney General found zero correlation between more expensive healthcare providers and higher quality care.
Healthcare Costs Encompass More Than Just Care
So, if you’re not paying for quality, what are you paying for? Healthcare costs don’t just cover the procedure itself. You are also charged for the facility size, the provider’s “name brand,” geographic convenience, and the provider’s market share. The healthcare industry lacks competition. For example, areas with only one hospital owner typically charge 15% more than areas with four or more hospital owners. Did you know that many hospital procedures can actually be performed in surgery centers? On average, hospitals charge 2.7 times more than surgery centers. Healthcare providers benefit by keeping their prices hidden. Healthcare monopolies have no incentive to lower their prices to compete with cheaper providers because patients do not even realize how much they are paying the monopolies. Healthcare prices are often even hidden from doctors. Doctors may refer a patient to another provider without realizing how much that provider charges or order a medical device without knowing its price. In fact, in 2014 it was determined that Orthopedic surgeons only correctly estimated the cost of a device 21% of the time. Healthcare consumers are ultimately the ones that pay the expenses of such devices.
New Price Transparency Laws Are in Action
The original Affordable Care Act passed in 2010 presented the nation’s first price transparency laws. It contained a requirement for health insurance companies to disclose and justify any rate increases of 10% or more. It also required insurance companies to provide a Summary of Benefits Coverage (SBC) to their members. SBCs show examples of how much coverage an insurance company provides on various medical procedures. In addition to SBCs, insurance companies were required to provide a glossary of health insurance terms. The Affordable Care Act also contained a requirement for hospitals to publish a list of standard charges for all given services. To read about additional Affordable Care Act requirements, click here. It wasn’t until January 1st, 2021, that these price transparency laws really began to take effect. This day was the deadline for hospitals to publish a list of standard charges for all given services. By January 1st, 2022, health insurance companies must publish cost estimates; negotiated rates for all covered items and services; negotiated rates and historical net prices for all covered prescription drugs; and historical payments and billed charges from out-of-network providers. By January 1st, 2023, insurers will be required to make rates and cost estimates for common services available to members.
MotivHealth Provides Price Transparency Tools
Look no further than MotivHealth to see the various costs of healthcare near you. We are dedicated to finding you high-quality healthcare at the lowest possible cost.
Price Transparency Tool
Our Price Transparency Tool is available in the member portal under “Find Care.” Once members click on “Find Care,” they will be directed to select their network and find in-network providers. They can search by provider, facility, and procedure. Lists of each will show up with estimated pricing, allowing members to shop for healthcare. Once a provider is found, they can set up an appointment.
Personal Health Assistants
Our PHAs help members find the best price by looking at our contracted rates with providers and facilities under a given members’ network. They can then present a list of best-price options for the member and help set up an appointment. Call them 24/7/365 at (844) 234-4472.
The MotivRx team functions similarly to the PHAs but works with manufacturers and members to get lower-cost options for medications. For example, they may find an equivalent generic brand instead of a high-cost, brand-name drug. They also help qualified members access assistance programs for current medications.
We provide courses that help our members better understand health insurance and how their healthcare choices affect their expenses. MotivU shows members that their healthcare is in their hands and even pays them $50 just for completing all the courses.
Stop Overpaying for Healthcare!
In summary, price transparency does not only immediately save you money by granting you the ability to shop for the lowest price, but it also forces healthcare providers to compete with one another, ultimately lowering costs in general. You don’t have to go to your area’s most popular hospital to get well. Utilize lesser-known local providers to keep you and your wallet healthy.
“The Affordable Care Act: Increasing Transparency, Protecting Consumers”
“Hospital Study Finds Wide Disparity in Healthcare Costs”
“How Has U.S. Spending on Healthcare Changed Over Time?”
Rabah Kamal et al.
“Must Doctors Disclose Their Fees Before Treatment?”
“Shining Light on Healthcare Prices”
“Transparency in Coverage Final Rule Fact Sheet (CMS-9915-F)”
“Understanding Differences Between High and Low-Price Hospitals: Implications for Efforts to Rein in Costs”
Chapin White, James D. Reschovsky, and Amelia M. Bond
“Why Can’t, or Don’t, Hospitals Post Prices Online?”
Loving this push towards showing costs before a procedure. Only makes sense.