Price transparency in health care is more than a price list.
As the cost of health care continues to rise, the federal government created Transparency in Coverage (TiC) regulations to support a patient’s right to know what a service or procedure costs in advance. While access to a price quote is helpful, the Surest health plan takes transparency to a whole new level.
The Surest health plan is designed to show upfront prices for care using value-based copays and provides clear information about what’s included in the price for the episode of care. There’s no deductible to hit or coinsurance to figure out. It’s insurance that’s meant to be clear from day one — plain and simple.
Transparency for all, almost.
As of July 1, 2022, TiC required most group health plans and issuers of group or individual health insurance to post pricing information for covered items and services. In January 2023, these groups had to make price comparison information available on an initial list of 500 identified items and services to enhance consumers’ ability to shop for health care. The final stage of TiC went into effect Jan. 1, 2024, and requires plans and issuers to make price comparison information available with respect to all covered items and services. In addition, they had to make information accessible through an internet-based self-service tool and in a paper form, upon request.1
Even with the TiC mandate, part of the health care transparency equation is still missing —quality. How can patients know if the price they are paying is for high-quality care? Shouldn’t that be clear, too? After all, when shopping for organic vs. nonorganic groceries, a consumer can decide if the health benefit is worth the price.
“Fewer than 1 in 5 U.S. adults are aware of health care costs before receiving care.”
-Bentley-Gallup Business in Society Report 2
In health care, doctors and clinics may charge widely varied prices for the same procedures or treatments, with very little connection to quality of care. For instance, a colonoscopy may cost $425 at one clinic and $1,500 at another, for the same test. Examples like this illustrate a disconnect and why patients need to know not only the cost of the service, but also the quality of those providing it to truly know the price of care.
“Americans believe health care costs do not reflect quality.”
-Bentley-Gallup Business in Society Report 2
Through the Surest app or website, a member can make a connection to quality using the value-based copay assigned to a service or procedure. Providers and facility locations that achieve better patient health outcomes, have lower rates of complications, use resources more efficiently, and charge less for their services are evaluated as high value and assigned a lower copay. Meaning, with the Surest plan, lower prices indicate providers evaluated as high-value options — or providers who may help you feel better, faster.
“Aligning prices with the quality really serves a patient’s best interests,” said Norris Vivatrat, MD, chief medical officer at Surest. “When the value of service is reflected in the price, then people can begin to make more informed choices about their health care and find comfort in knowing the provider or facility has a history of providing quality care.”
Questions answered in the palm of your hand.
While TiC does require prices to be listed and accessible to consumers, it can still be time consuming to piece together all the services that take place at a visit. Adding up services like anesthesia, lab work, and X-ray can be hard to figure out before a visit.
Surest bundles health services that often occur together and prices them accordingly so a member can see what’s included in a single price in advance using the Surest app or website. By grouping services — like combining all the tests and services that accompany a major medical procedure into one price — members can more easily know a complete price for a health care event and see it in advance, at their convenience.
“Patients generally have no way of knowing what will happen at a visit or how much they will eventually pay for a medical visit. Our plan provides information, in addition to prices, to give members a clearer view of the likely services related to a condition or procedure,” said Dr. Vivatrat. “We assign a single price so members can choose providers for themselves and know, in advance, what’s included in that visit to help them better evaluate care in totality. And, they can see all of this right from our app.”
Another piece of clarity the Surest plan offers is that after care, members receive one bill for that episode of care — not several — which helps reduce confusion about what a member is actually paying for.
“We don’t want our members to be afraid to get care because they don’t know how much things will eventually cost,” said Dr. Vivatrat. “Our plan aims to uncomplicate the price of health care and give members clear choices so they can get the care they need.”
1 https://www.cms.gov/healthplan-price-transparency/consumers
2 https://news.gallup.com/poll/609434/few-americans-know-healthcare-costs.aspx