Health Insurance Industry Issues and Legislation

A full three years after the Hospital Price Transparency Rule went into effect only 34.5% of 2000 U.S. hospitals reviewed were compliant. That percentage is down from the 36% that were compliant at the end of the second year. While none of the hospitals owned by the largest hospital systems including HCA Healthcare, Tenet Healthcare, and Providence was compliant, CMS has issued civil monetary penalty notices to only 14 hospitals for noncompliance.

Private insurers are averagely paying 2.5 to 3.0 times more than Medicare for the same hospital services. That multiple varies state to state some private insurers paying less than 2 times the Medicare rate, others more than 3 times. Insurers are paying widely different amounts for the same services in the same markets with some hospitals charging 50% more than others. Greater consolidation correlated with higher prices with market share accounting for 18% of price variations.

With hospitals in the same market charging vastly different amount for the same services, two-thirds of providers not complying price transparency rules and consolidation driving prices ever higher, it more important than ever for self-funded payors to have highly skilled, highly experienced negotiators like those at HHC Group working to help them pay only an appropriate amount for the services their Plan enrollees utilize.

The HIPPA amended rule will shield protected health information (PHI) from being used to punish women for the mere act of seeking or obtaining reproductive health care and cannot be used to identify women who have done so. The changes' purpose is to avoid disclosure of person's PHI that could be harmful to the interests that HIPAA seeks to protect and to avoid providers leaving gap or including inaccuracies which could impact future care.