How well will new rules on health care cost transparency work?

Lisa Freeman recently tried an experiment: Before having a medical diagnostic test, she tried to figure out what it would cost.

“It took no less than five phone calls, and I still never got to the end of the thing,” said Freeman, executive director of the Connecticut Center for Patient Safety.

A major state law passed last year aims to change that, with a host of transparency provisions that begin rolling out this month. They’re aimed at making it easier for patients to learn the cost of their medical care ahead of time, including any charges they might face if they seek care outside their insurer's network.

So how will it work in practice? A study on a similar law in Massachusetts wasn’t encouraging, according to its authors. They found that a year after transparency provisions took effect, it still took an average of two to four business days and numerous phone calls to learn the price of an MRI.

Hospital officials in Connecticut say they’re working to ensure they comply with the new law, but say meeting some of its requirements is more complicated than it might sound.

ARIELLE LEVIN BECKER / CTMIRROR.ORG

Dr. Rocco Orlando

“We’re certainly committed to transparency. We don’t want folks to be surprised,” said Dr. Rocco Orlando, chief medical officer at Hartford HealthCare, which includes five hospitals. “Where we struggle is the complexity of the actual implementation.”

A top official with the state’s medical society, meanwhile, warned that for the first six months, there could be problems with the accuracy of information physicians provide because they won’t necessarily know the details of a patient’s insurance network until insurers meet new information requirements that begin in July.

“It’s going to be imperfect at first,” said Matthew Katz, executive vice president and CEO of the Connecticut State Medical Society.

And legislators already have received requests to revisit the law.

Freeman says having information about care cost and options is key for patients to become more involved in their care. She's waiting to see how the provisions are implemented, but even if it’s not perfect, she said, the measure puts the state on the right path.

“You have to start somewhere,” she said.

What changes when

The changes are part of a larger health care law that drew significant controversy, particularly over new requirements on changes in hospital ownership. The transparency provisions themselves prompted little opposition; those who weighed inpraised their aim, although some questioned which groups were best situated to provide the information and how to ensure it was useful to patients, rather than simply more paperwork they would probably ignore.

The first big transparency provisions in took effect Jan. 1:

• Health care providers must determine if patients who schedule nonemergency care are uninsured or if the provider is outside the patient’s insurance network. If so, the provider must tell the patient in writing how much will be charged. For patients whose insurer doesn’t include the provider in its network, the notice must indicate that the care will probably be subject to out-of-network rates. Click here to continue reading.