PRA Releases New Report: Insurance Pricing Files Reveal that Hospitals are Hiding Prices

Today, PatientRightsAdvocate.org released its first Transparency in Coverage (TiC) report. This report examined newly available data from health insurance companies, which are required to disclose the previously hidden prices they've negotiated to pay hospitals and providers.  The public posting of these data files is mandated by the Transparency in Coverage rule, which took effect on July 1, 2022.  

PRA cross-referenced seven hospital price files from two of the largest healthcare systems in America, Ascension and HCA Healthcare (HCA), with the corresponding insurance plan files.  The analysis found that while the hospital file was missing prices, the insurance plan file displayed prices for that hospital.

“Today's report confirms that hospitals are hiding prices from patients and calls into question their public assertions that individual prices don't exist for many of the services they provide,” said Cynthia Fisher, founder and chairman of PatientRightsAdvocate.org. “The data made possible by the Transparency in Coverage rule reveals prices negotiated with insurers that hospitals did not disclose in the machine-readable files required by law.  Our report is just the tip of the iceberg of what the staggering amount of data in TiC disclosures will reveal."

Some of the findings highlighted in the TiC report are:

• At Ascension Seton Medical Center (Austin, Texas), the price file showed “N/A” for the CMS-mandated shoppable services, but the TiC file for United Healthcare and Blue Cross Blue Shield provided distinct prices for all of the services.

• At HCA Florida Northside (St. Petersburg, Florida), the price file posted only one price for a range of 300 coded services, but the TiC file for a single insurer provided distinct prices for each code.

• At HCA Medical City (Forth Worth, Texas), only one price was posted for 62 separate coded services, but the TiC file for Blue Cross Blue Shield provided 58 distinct negotiated rates for those same services.

 The analysis performed by PatientRightsAdvocate.org was based on the Standard Charge File data obtained from machine-readable price data files assessed in PRA’s Third Semi-Annual Hospital Price Transparency Compliance Report and TiC file data supplied by the healthcare price data firm, Visible Charges, LLC.

Read the full report HERE.