Despite the many challenges, price transparency initiatives are increasing. Whether through laws and regulations or tools offered by health systems, insurers, or third-party vendors, these efforts seek to make cost information available to consumers responsible for significant portions of their care costs.

These efforts come as the healthcare industry shifts from a utilization-focused to a value-based approach.

Understand Your Insurance Coverage

When choosing a plan that fits your health needs and budget, consider the cost of the premium and the potential costs when you access care. These include deductibles and copayments.

For self-insured employers, price transparency can help them understand what providers charge and negotiate better prices. They can ask their health plans, “What do other employers pay for this service at this provider?”

The federal TiC rules allow patients to see the specific “in-network” and “out-of-network” coverage benefits of their plan – which may help them avoid surprise medical bills by keeping them out of higher-cost hospitals. Consumers can also contact their plan’s member services team for more information.

Know Your Options

US healthcare prices are notoriously high, and it’s no wonder why. Research shows that one in three Americans have postponed medical treatment due to costs, and many patients are intimidated by asking their doctors about the cost.

Fortunately, new tools and information are available to help consumers combat these rising costs. For instance, the Hospital Price Transparency Rule requires hospitals to publish their pricing information online in machine-readable files. It includes gross charges, discounts to cash payers, and their contracted rates with insurance companies.

While these factors contribute to spiking inflation, there is also a growing trend of large health systems consolidating, leaving employers with fewer options and negotiating power. It can lead to higher cost increases for self-insured employers. Luckily, the right navigation solution can offset this challenge by hedging against cost inflation. That’s where our AI-driven plan for care feature comes in. Predictive analytics gives employees a clear picture of the anticipated out-of-pocket costs for each shoppable service, helping them make more informed decisions that align with their financial situation.

Look for a TPA

A TPA handles the back end of a self-funded healthcare plan and can help you control costs. They don’t sell insurance or take the risk of paying actual claims that may exceed collected premiums.

TPAs often manage employee health benefits administration, ensuring compliance with government regulations, reporting on data, and handling claims. They can also connect your healthcare plan to trusted provider networks, provide employee customer service, and offer various other services.

Look for a TPA that offers the needed services and is a good fit for your company size. Look for a TPA that is transparent about their fees.

Ask about a TPA’s network access. A TPA’s network selection can significantly impact an employer’s self-funded cost savings. They should be able to provide detailed reports and show you how the selected network compares to others. A TPA should also be able to offer full customization of the self-funded plan.

Compare Prices

Unlike big-ticket purchases like cars, where price comparison tools are readily available, healthcare consumers must dig to find the information they need. It can be challenging and time-consuming.

To facilitate comparison shopping, the government’s hospital pricing transparency rules require hospitals to post their standard charges and negotiated rates in machine-readable formats. Health insurers also provide cost estimators to help their members make informed decisions.

Lastly, independent third-party websites and apps help patients shop around by providing the cash (self-pay) price for a particular procedure at a given provider. In addition, some employers offer price comparison tools customized to an individual’s specific healthcare coverage and deductible. These tools can be an excellent way for employees to get the information they need to become more savvy shoppers. It can ultimately impact their financial wellness, which in turn impacts their productivity in the workplace.