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Employers, hospitals and insurers butt heads over transparency proposals

June 6, 2019 / SUSANNAH LUTHI 

For months, the White House and lawmakers have been urging more transparency for the healthcare system as they try to grapple with their $3.4 trillion cost problem.

But this week, insurers and hospitals drew their own lines in the sand for Congress. Their comments on the Senate health committee’s draft legislationthat aims to cut expenses across the system exposed the gulf between the financial interests of those industries and employer plans that pay for most Americans’ care.

One contentious provision is the proposed mandate on hospitals and insurers to give patients a cost estimate for any upcoming treatment within 48 hours of a request.

The measure has the support of the major insurance lobbying group America’s Health Insurance Plans (AHIP) as well as the Blue Cross and Blue Shield Association and the ERISA Industry Committee, which represents large employer plans.

“We believe that providers, in coordination with our (third-party administrators) can also provide this information to patients,” the ERISA group’s senior vice president of health policy James Gelfand wrote. “Indeed, access to this information should help patients to better navigate the healthcare system.”

Hospitals weren’t so happy.

Chip Kahn, CEO for the Federation of American Hospitals that represents investor-owned health systems, made it clear he doesn’t want hospitals to be on the hook to give out-of-pocket cost estimates on behalf of their contracted physicians.

He also stressed that a patient’s final cost could look significantly different than an initial estimate.

“These differences can be particularly marked where a patient suffers an unforeseen complication that necessitates additional services and increases the patient’s cost-sharing liability,” he said.

Moreover, he told the committee, patients’ insurers should be responsible for “good faith estimates” of prices.

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Chris J. Stewart

Chris currently serves as Chief Operating Officer at Ortho Spine Partners. Prior to that, he was the assistant vice president and business unit leader of Medical Device Management for HealthTrust.

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