IB-B-2018 (May 2018)
Author: Linda Gorman
Executive Summary:
Americans pay for their health care in a variety of ways. People paying cash for services pay posted prices or prices individually negotiated with providers. Those who pay individual health plan premiums pay network providers the amount their insurer has negotiated, covering deductibles and copays with cash. Employers negotiate using competitive bidding, long-term partnering, and various specialty managers for things like disease management and pharmaceutical benefit carve-outs. Medicare pays providers amounts set by the federal government. Colorado Medicaid pays prices set by the State of Colorado.
A vast array of businesses delivers pricing information to individuals and employers in the private sector even though the amounts that large insurers pay for hospital services is considered private, commercially sensitive, information. Urgent care providers post their cash prices. Outpatient surgery centers provide firm fixed prices for procedures. Other firms bundle services for individuals and employers, providing a fixed price quote good for 60 days. Businesses help individuals negotiate service prices in advance, provide nationwide pricing information, and audit hospital bills for errors.
