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Haller: Insurers flunk checkup on consumer price laws

April 5, 2017

Concerned about unpredictable health prices that were spiraling ever higher, in 2012 Massachusetts lawmakers required health insurers to “provide a toll-free telephone number and website that enables consumers to request and obtain … the estimated amount the insured will be responsible to pay” within two days. Unfortunately, the law hasn’t appreciably expanded patients’ access to price lists.

Recently, I left the doctor’s office knowing that I could be facing potentially substantial medical bills for an injured middle finger. So I decided to investigate the prices of two possible procedures — a cortisone injection and an MRI.

Dutifully, I went to my insurer’s website, but the only reference to cost estimates was a description of the firm’s pricing and quality transparency tool. This promising tool informed me that, even for a simple procedure like an MRI without contrast, “Specific prices are currently unavailable in your area.” When I tried zip codes outside Greater Boston, I got the same message. Now let’s keep in mind the law requires that insurers provide a “website that enables consumers to request and obtain” price estimates.

Failing online, I turned to more old-fashioned communications techniques. I called my health insurer and was told that the tool’s shortcomings were the result of “spotty” coverage, and that online estimates could only be received through e-mail. Fair enough, but the website provided no such direction five years after the health care transparency law was enacted.

The insurance company representative asked me for provider information, the date of the proposed services and the specific procedure codes. My doctor mentioned these procedures as possibilities, but didn’t give me any codes or other details.

As a consumer who has a plan with deductibles, I simply wanted a price before purchasing the services. The law clearly instructs insurers to provide estimates “based on the information available” and does not require patients to have a scheduled appointment.

After explaining the law to my insurer, I completed an estimate request for the cortisone shot and was promised a response “probably by the end of the week.” Frustrated, I noted that the law requires a response within two working days.

When I requested help identifying the lowest-priced in-network MRI provider, my insurer claimed not to have access to their own contractually negotiated prices. I was instructed to contact each provider separately, obtain their “charged amount,” and relay it back to the insurer to receive the “allowed amount” for which I’d be responsible.

Shifting the burden of information gathering to members, unlawfully strips away the protections and rights consumers are guaranteed under state law. It’s also bureaucratic torture.

These days, there are a lot of people like me who are enrolled in high-deductible plans. An umpteenth special legislative commission on price transparency just wrapped up its work and issued yet another report. Meanwhile, the laws already on the books are not being enforced.

Madam attorney general? Insurance commissioner? We need a leader who will actually enforce the law.

Scott Haller is a research fellow in health care at Pioneer Institute, a Boston-based think tank.