# Health insurance fee schedules are now public information in the U.S **URL:** \ **Category:** Miscellaneous and Personal Stuff I Must Share\ **Created:** [July 7, 2022, 6:09pm UTC](https://boards.straightdope.com/t/health-insurance-fee-schedules-are-now-public-information-in-the-u-s/967570 "2022-07-07T18:09:12Z")\ **Posts on this page:** 4\ **Page:** 1
**Author:** ![Max\_S](https://avatars.discourse-cdn.com/v4/letter/m/46a35a/32.png) [@Max\_S](https://boards.straightdope.com/u/Max_S)\ **Post date:** [July 7, 2022, 6:09pm UTC](https://boards.straightdope.com/t/health-insurance-fee-schedules-are-now-public-information-in-the-u-s/967570/1 "2022-07-07T18:09:12Z")
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](https://www.federalregister.gov/documents/2019/06/27/2019-13945/improving-price-and-quality-transparency-in-american-healthcare-to-put-patients-first), the Trump administration’s [actions in November of 2020](https://www.federalregister.gov/d/2020-24591/p-13), 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](https://thedailywtf.com/articles/a_case_of_the_mumps), and [horror stories](https://news.ycombinator.com/item?id=32013137).) 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](https://github.com/CMSgov/price-transparency-guide)), many gigabytes in size and fit only for machine reading. [Here’s the page](https://www.floridablue.com/members/tools-resources/transparency/machine-readable-files) describing and linking to the files for Florida Blue, a big insurer where I live. [CMS is counting on “third party developers”](https://www.cms.gov/healthplan-price-transparency/consumers#:~:text=When%20plans%20and,best%20for%20you) 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](https://www.cms.gov/files/document/transparency-coverage-500-items-services-508.pdf). 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 ---
**Author:** ![Riemann](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/riemann/32/3133_2.png) [@Riemann](https://boards.straightdope.com/u/Riemann)\ **Post date:** [July 7, 2022, 6:19pm UTC](https://boards.straightdope.com/t/health-insurance-fee-schedules-are-now-public-information-in-the-u-s/967570/2 "2022-07-07T18:19:11Z")
> [@Max\_S](#): > > 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_. 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. ---
**Author:** ![Max\_S](https://avatars.discourse-cdn.com/v4/letter/m/46a35a/32.png) [@Max\_S](https://boards.straightdope.com/u/Max_S)\ **Post date:** [July 7, 2022, 6:31pm UTC](https://boards.straightdope.com/t/health-insurance-fee-schedules-are-now-public-information-in-the-u-s/967570/3 "2022-07-07T18:31:10Z")
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 ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [July 9, 2022, 2:27pm UTC](https://boards.straightdope.com/t/health-insurance-fee-schedules-are-now-public-information-in-the-u-s/967570/4 "2022-07-09T14:27:04Z")
> [@Max\_S](#): > > Thanks to President Trump’s [executive order 13877](https://www.federalregister.gov/documents/2019/06/27/2019-13945/improving-price-and-quality-transparency-in-american-healthcare-to-put-patients-first), the Trump administration’s [actions in November of 2020](https://www.federalregister.gov/d/2020-24591/p-13), statutory authority from the Patient Protection and Affordable Care Act of 2010, and the Biden administration’s follow-through One of the few things Trump did that i wholeheartedly supported. I hope this actually works.