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Few Consumers Use Health Plan Pricing Tools

Daylina Miller/Health News Florida
The Florida Channel
Monday's meeting was the latest in a series of gatherings by the hospital finance commission, appointed earlier this year during a contentious legislative session.

Most health insurance providers offer pricing tools for consumers.

But Floridians are skeptical of the information they see on these sites, the Governor's Commission on Healthcare and Hospital Funding learned Monday in Tampa.

The nonprofit Catalyst for Payment Reform (CPR) shared its 2015 "Report Card on State Price Transparency Laws," which shows Americans don't trust their insurance companies to give them accurate price information.

"More and more studies are showing that while the health plan is providing information and tools to the consumer, the consumer is less trusting of that information when the source is the health plan," CPR's Andrea Caballero told the commission meeting at the University of South Florida. 

Gov. Rick Scott created the commission earlier this year to look for ways the state can make health care costs more transparent to Floridians. Members say they want to create a calculator-like tool for consumers to compare out-of-pocket health care costs. 

On Monday, commissioner Dr. Jason Rosenberg said he worries about spending state money on tools people may not use.

"Ninety seven percent of commercial insurers have a cost calculator but only 2 percent of people use them, Rosenberg said. “So we're going to spend millions and millions and millions of dollars and countless hours making perfect tools no one uses, is that what you’re telling me?”

Credit All-Payer Claims Database Council
The Florida Channel
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Today, 12 states have created an independent database which collects health prices for consumers from multiple public and private sources. 

This "All Payer Claims Database" provides a larger data pool  of more accurate information, and it's not tied to any one health insurance plan, Caballero said. 

With more than 50 percent of Americans enrolled in employee-based health insurance plans, Commissioner Robert Spottswood wants employers to have access to this pricing information, too.

"Some of these tools need to be rearranged and made available to a different party that's also incurring the costs, at an earlier date,” Spottswood said.

Credit Catalyst for Payment Reform
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

According to the CPR report card, Florida earns an "F" grade for price transparency laws, as did most other states. Only New Hampshire received an "A" grade, followed by Colorado and Maine with "B" grades, which have these databases. 

Monday's meeting was the latest in a series of gatherings by the hospital finance commission, appointed earlier this year during a contentious legislative session. Scott, a former health care company executive who did not attend Monday's meeting, has repeatedly said that hospitals need to be held more financially accountable, especially as it pertains to payments related to Medicaid.  

In a press release distributed during the meeting, Scott proposed the following reforms:

  • Update the existing law governing the website to include expected out-of-pocket expenses and chances of experiencing adverse incidents at a specific health care facility.
  • Require hospitals to post on their websites prices and average payments received for all products and services offered, and performance scores on patient quality measures selected by the State Consumer Health Information and Policy Advisory Council. 
  • Create protections against "unconscionable" prices: including all products and services rendered to a patient during a medical emergency or other "medically essential" treatment.  Patients could complain of price gouging at hospitals and surgical centers to law enforcement or regulatory authority.
  • Require tax-exempt hospitals to post annual financial reports (Form 990) to the IRS online. Under current law, only for-profit, publicly owned hospitals must do this.

Daylina Miller is a reporter with WUSF in Tampa. WUSF is part of Health News Florida, which receives support from the Corporation for Public Broadcasting.