Price Transparency May Mark a New Beginning
Every day, 1 in 4 Americans choose between paying medical bills and covering basic needs. Crowdfunding for medical debt is commonplace. A recent NY Times article reported that debt has risen among older people and that it is affecting their health.
In response to the deepening medical debt crisis the Consumer Financial Protection Bureau published a report on medical debt in the United States that found consumer credit records contain a total of $88 billion in reported medical bills (as of June 2021).
Amaze Health Founder, David Silverstein, Was a Frustrated Dad
Several years ago, David Silverstein, founder of Amaze Health, sat in his den staring at a bill from a recent ER visit for his daughter. The bill was for over $200,000. As he tried to explain the system and why the bill could be so much, he was overwhelmed by the injustice of the system.
“Hearing myself try to explain the crazy healthcare system to my daughter out loud brought a clarity and anger that first led me to buck the system, then form a non-profit, Brokenhealthcare.org, go on to drive major public policy changes, and ultimately realize that a new business model, Amaze Health, was needed,” explains Silverstein.
Price Transparency Would Level the Field
The initial impetus to push for price transparency in healthcare was the idea that if the information were available to patients, they would be able to make more informed decisions.
Silverstein noticed an awakening of sorts in the country whereby people fortified with pricing, knowledge and outrage could become active healthcare consumers, not just passive patients. Making informed care decisions that affect health and finances using newly available information could normalize discussions around medical debt and equity issues in our communities and Federal Government.
He was convinced that price transparency was the linchpin to moving the sick healthcare system toward operating as a healthy market.
‘Price transparency won’t fix everything that is wrong with the American healthcare system,’ says Silverstein, ‘but nothing can be fixed without it.’
The Fight For Price Transparency
In 2018, David Silverstein shepherding a bill through the Colorado legislature that would require all health care facilities, health care providers, pharmacies, and health insurers to disclose information about their charges.
Although that 2018 legislative effort was not successful, it caught the interest of the White House and Silverstein spent the next 2 years consulting to the President and several Federal agencies about the economics and justice of price transparency in healthcare – a non-partisan concept that enjoys universal support from the citizenry.
By June of 2019, an Executive Order was issued congruent with the previous legislative effort in Colorado requiring the prices of healthcare services to be published including the contracted rates of insurance payers. The Order also required patients be informed of their out-of-pocket costs prior to care being rendered.
Success! A Price Transparency Law is Passed
On January 1, 2021 the Federal Hospital Price Transparency law went into effect.
Hospitals were required to post their charges in two ways:
1) A ‘machine-readable file’ with specific data elements disclosing gross charges, discounted cash prices, payer-specific negotiated charges, and de-identified minimum and maximum negotiated charges (the highest and lowest charges that a hospital has negotiated with all third party payers for an item or service)
2) A consumer-friendly Display of Shoppable Services.
Change Takes Time
Throughout 2021, Silverstein found himself outraged that hospitals continued to flout the federal requirement that they publish their prices, so he turned back to the Colorado legislature in early 2022.
He wrote an innovative bill (HB22 1285) tying debt collection to price transparency. If a hospital did not have prices posted on its website on the day you had knee surgery, for example, they are forbidden from sending you to collections.
“H.B. 1285 was our effort to say we have an opportunity to use state law to give federal law a lot more teeth and force hospitals into compliance,” Silverstein said in an interview. “It needs to be a model for the rest of the country so 49 other states can enact similar legislation.” Shortly thereafter, Equifax, Experian, and TransUnion issued a joint statement to announce they were changing how medical bills would be reported on credit reports. Beginning July 1, 2022, paid medical bills will no longer be included on credit reports issued by those three companies. Unpaid bills will be reported only if they have remained unpaid for at least 12 months. Additionally, the companies announced that starting in July 2023, they will not include information furnished to them for medical bills in collection for amounts of $500 or less.
Amaze Will Help You Fight For Your Healthcare Rights
Silverstein’s laser-focus on compelling compliance with price transparency laws serves Colorado residents by providing additional tools to protect them from incurring medical debt.
He believes that passage of H.B. 1285 in Coloardo will move hospitals to comply with the Federal Price Transparency law within 30 days as it is now in their best interest to do so.
Additionally, other states now have a template to follow to protect patients and empower them to make the right healthcare decisions for themselves and their families.
At Amaze, our mission is to empower you to be a savvy healthcare consumer by helping you advocate for yourself and your family, know and understand your healthcare rights, and have the confidence and skills to get the best care at the lowest cost.