Know Your Costs Before You Buy – What A Novel Idea!

By Bill Rusteberg

Under new government health care transparency rules health care consumers are now able to see prices before they buy instead of learning prices after they purchase services. What a novel idea!

Scott Borden’s short video is worth sharing.

Why don’t plan sponsors make it a pre-certification requirement mandating plan members must “pre-certify” prices before the plan will consider payment? Otherwise the plan doesn’t pay at all, or pays 100% of Medicare with the patient left to fight the balance billing-monster-dragon along with hordes of aggressive repo artists (pay up or we’ll take your new born baby!).

“It’s your business where you go for care, it’s our business how it’s paid” – Bill Rusteberg

This kind of transparency has a significant impact on Reference Based Pricing plans because it eliminates the fear factor upon which third party intermediaries prey, earning millions in fees. Gone should be the days of paying RBP vendors 10-12% of billed charges or high PEPM fees in return for legal representation and balance bill assistance. It’s simply not needed anymore if plans incorporate common sense strategies.

Plan sponsors must be ready to comply with these new transparency rules. From what I can tell some have not because they think it doesn’t apply to them or if it does government punishment exposure is limited to emergency room and out-of-network services and they are willing to face the consequences in the perceived rare event they get a visit from the Compliance Police. Others on a Reference Based Pricing model incorporating direct provider contracts believe they are not sponsoring a “network” plan so they are off the hook to a large extent which of course is not true.

Individual responsibility is becoming more mainstream in this dynamic and fast changing health care system of finance, eroding the heretofore entitlement health care mentality nurtured over the past 40 years.

A few forward-thinking radical health care agitators have been practicing health care pricing transparency for years but few have followed their example until recently. That number has grown exponentially over the past five years with the rise of organizations like Health Rosetta whose membership includes brokers across the country who are not afraid to challenge the status quo.

In the 50 years I’ve been involved in this business I have never seen a market as dynamic and fast changing as we are seeing now.