I Can See Right through You! Health Transparency Rules Result in Increased Scrutiny of Provider Fees

Many employers provide their employees with health coverage—the Affordable Care Act making it more likely. Enter the Consolidated Appropriations Act, 2021 (CAA), bringing new rules on surprise billing and price transparency. Employers spend time negotiating with their insured plan providers, or self-insured plan-third-party administrators, deciding on pricing. And, courtesy of the CAA and newly issued transparency regulations, employers now have access to (or should have) ample data not previously available providing them with insight to health plan pricing. Some employers are especially unhappy with the results and are challenging these vendors in court. 

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Related Content

• Transparency Disclosure Rules for Group Health Plans
  Reference the rules that require health plans and insurers to provide a substantial amount of cost, coverage, provider, and other coverage information to eligible and covered individuals and make rate information publicly available. They apply for most employer-sponsored group health plans (both self-funded and fully insured) as well as to health insurance policies in the individual and group markets. Many of the new requirements became effective on January 1, 2022.
• Transparency Reporting and Compliance Rules for Group Health Plans
  Review the new reporting and other requirements for employer group health plans enacted under the No Surprises Act and other provisions of the CAA. The reporting measures require affected entities to provide substantial amounts of information to oversight agencies to help the agencies, lawmakers, and other stakeholders better understand the factors driving prescription drug and other health care coverage costs as well as to help assess broader trends in the health care market and the effectiveness of transparency and balance billing reforms.
• Transparency in Coverage, No Surprises Act, and Consolidated Appropriations Act, 2021, Requirements Checklist
  Use these charts to review the requirements for health plans, health insurance issuers, and providers regarding transparency, balance billing, and other matters imposed under (1) the Transparency in Coverage rules (extending rules of the Affordable Care Act); (2) the No Surprises Act (enacted as Title I of Division BB of the CAA (Pub. L. No. 116-260)); and (3) additional rules enacted under CAA, Division BB, Title II.

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