Massachusetts hospitals and physicians will be required to provide their own cost estimates to patients by January, according to a Boston Globe report.
Beginning next month, hospitals and other providers must provide cost estimates within two working days to patients and potential patients who request the information, according to the report.
Some hospitals are concerned about the complexity of the provision, as it may be difficult to field requests from hundreds of patients who have different insurance plans and benefits.
One hospital mentioned in the report, Beth Israel Deaconess Medical Center in Boston, has already provided more than 500 written estimates to patients since May as part of a pilot program that includes certain specialties and procedures. The hospital often provides the estimates prior to service, whether the patient requests the information or not.
Health insurers in the state have been required since October to provide cost estimates to their enrollees, but the Boston Globe says many consumers may be unaware of this provision of Massachusetts' unique healthcare law. Requests for estimates from the state's three largest insurers— Blue Cross Blue Shield, Harvard Pilgrim Health Care and Tufts Health Plan — have been modest, according to the report.
Many insurers have set up phone lines to field estimate requests. Their estimates are considered binding, according to the report. If a provider charges a patient more than the insurer's estimate, or the estimated range, then the payer must make up the difference.
Barbara Anthony, an official from Massachusetts' Office of Consumer Affairs and Business Regulation, told the Boston Globe there is a learning curve with this provision, as providers and insurers have not been required to disclose this level of pricing information before.
Patients, too, are in the middle of a cultural shift. They may have been shy about inquiring about pricing specifics in the past, but now Ms. Anthony says there is a shift to be "aggressive and not afraid to speak up," according to the report.
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Price Transparency: Why It's an Issue & Where Hospitals Fit in