Health Affairs May 19, 2023
Beginning July 2022, group health plans and issuers of group or individual health insurance were required by the Centers for Medicare and Medicaid Services (CMS) to make pricing information for covered items and services publicly available. The goal of the first stage of the CMS initiative is for third parties, such as researchers and software application developers, to use the machine-readable pricing files that insurers are required to post to “help consumers better understand the costs associated with their health care.” The pricing files must be posted monthly and contain both negotiated in-network rates and amounts allowed and charges billed by out-of-network providers with whom prices were not negotiated upfront.
In this article, we compare the new pricing data from...
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