Massachusetts becomes first state to require price tags on procedures

New law requires insurers, providers to make prices public

Massachusetts earlier this month became the first state to require insurers to post online up-to-date prices for health care procedures by provider, WBUR/Kaiser Health News reports.

The change was brought by a 2012 state law that requires insurers and providers to make prices public and available in a consumer-friendly format.

The law took effect on Oct. 1, 2014. According to WBUR/KHN, it is unclear if all insurers met the deadline to post the information, but "all the major players did."

Details of the new price tags

Massachusetts consumers can now compare prices via their insurers' websites. In addition, the sites include online calculators to allow consumers to calculate, if applicable, how much they will spend toward their deductibles and their out-of-pocket maximums.

According to WBUR/KHN, there are several issues with the data, such as:

  • Listed prices vary by insurer and provider—because such rates are the result of individual negotiations—with the price of an upper back MRI ranging from $614 to $1,800;
  • Most prices are listed for outpatient care, and there are not many prices listed for inpatient care;
  • Not all insurers list prices for the same tests and procedures;
  • Patient satisfaction scores comprise most of the available quality data, with little information available on other quality measures;
  • Prices seem to change frequently; and
  • Some posted prices do not include all charges, such as facility fees.

How does your state grade on price transparency? 45 get an 'F'


Bill Gerlach, director of member decision support at Blue Cross Blue Shield of Massachusetts, says, "As more and more members are faced with greater and greater cost share, this sort of information is really important."

Barbara Anthony, state undersecretary for consumer affairs and business regulation, says she is hopeful that the price transparency will result in more competition among providers, which could result in lower prices (Bebinger, WBUR/Kaiser Health News, 10/9).

Your guide to price transparency

As the number of high-deductible health care plans increase—and more patients consider cost when choosing providers—organizations need to get up to speed on price transparency. This guide outlines objectives for:

  • Maximizing your patient financial counseling department;
  • Preparing your department for the increased volume of patients asking about out-of-pocket medical costs and pricing for scheduled procedures;
  • Creating collateral that explains out-of-pocket financial responsibility for a medical service to patients; and
  • Developing online portals and third-party avenues to help create a culture of price transparency.


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Daily roundup: Oct. 9, 2014

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