Health insurance fee schedules are now public information in the U.S

Miscellaneous and Personal Stuff I Must Share
1

A fee schedule sets the amount the health insurer agrees to pay a provider of medical services. Thanks to President Trump’s executive order 13877, the Trump administration’s actions in November of 2020, statutory authority from the Patient Protection and Affordable Care Act of 2010, and the Biden administration’s follow-through, as of last Friday all health insurance fee schedules in the United States are public information.

Or at least they should be.

I have a feeling many insurers, like hospitals before them, couldn’t make the deadline because their IT systems are a steaming patchwork of 1970s technology nobody in their right mind wants to touch with a ten foot pole. (For those interested in comp. sci / database management: article, and horror stories.)

Secondly, the information isn’t published in a format the average consumer can read. It comes in the form of huge JSON data files (the feds posted a technical specification on GitHub), many gigabytes in size and fit only for machine reading. Here’s the page describing and linking to the files for Florida Blue, a big insurer where I live. CMS is counting on “third party developers” to step in and create “price transparency tools”, and by January of next year insurers will be required to provide human-readable pricing information on 500 common procedures.

Overall I think this is a good regulatory step, but a person (or company) shopping for a plan doesn’t have meaningful access to pricing information… yet.

~Max

2

I’m not sure why this would matter when shopping for a plan. When it would matter is when a patient is uninsured and haggling with a provider who is trying to charge five times the rates that insurance companies have negotiated.

3

It matters when patients have coinsurance rates (the insurance only pays X% of their hitherto secret fee schedule, the patient pays the rest) or deductibles (the patient pays 100% of the hitherto secret fee schedule until a certain threshold is passed).

Most patients under the Medicare age, and many above it who took replacement plans, have insurance with one of the above cost-sharing practices. (I work at a doctor’s office and it is my job to explain to the patient why we have to collect $X even when they have insurance.)

~Max

4

One of the few things Trump did that i wholeheartedly supported. I hope this actually works.