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Keeping it Transparent   

When it comes to health care, the federal government sees transparency as an important thing. However, because of contractual obligations, insurers like Blue Cross Blue Shield of Michigan have not been able to accomplish transparency goals on their own.  Now there are transparency requirements that allow health plans to provide more information regarding costs. These two different sets of regulations that will go into effect for health plans over the next year.

Payer transparency

Last October, the federal government issued a final rule on price transparency for health insurers. This final rule required health plans to publicly display several things related to the cost of health care starting Jan. 2, 2022. These items include:

  • In-network negotiated rates for services
  • Out-of-network historical payments of allowed amounts
  • Historical net prices for all covered prescription drugs

Blue Cross Blue Shield of Michigan and Blue Care Network plan to publish this information monthly on bcbsm.com. We are currently looking at the legislation to make sure that we’re following all the necessary requirements and watching for additional guidance from the government that should be coming out later this year.

Transparency requirements from the Consolidated Appropriations Act of 2021

The CAA was signed into law in December of 2020 and it contained some member cost transparency measures that are meant to provide additional insight into member cost sharing and overall cost of care for individual and group market coverage (including self-funded plans). Changes for Jan. 1, 2022 include:

  • Advanced EOB: Upon receiving notice from a Provider regarding a scheduled service, Issuers must provide beneficiaries with certain information regarding estimated costs.
  • Price comparison tool: Issuers must offer a price comparison tool that allows members to compare patient-specific cost-sharing information for in-network services.
  • Provider directory database: Provider directories must contain up-to-date information.

When it comes to health care coverage, federal and state regulations are always changing the landscape. Part of our commitment to our employer groups is to keep you informed of these changes and what it means for your business. We’ll continue to publish this information here and if you have any questions, you can also reach out to your sales representative.

NOTE: None of the information included herein is intended to be legal advice and as such it remains the Group’s responsibility to comply with all applicable state and federal laws and regulations. This blog post in no way alters or amends any contractual relationship between Group and Blue Cross.

Photo credit: Getty Images

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