Transparency Rules!

At Mantis Massage, we believe in easy to understand pricing - we don’t even offer add-ons to “upsell” your massage. Love cupping? So do we! If that’s a service your therapist offers, there’s no extra charge. Scalp massage? Yes, please. No need to pay for an extra ten minutes, scalp love is included. Want some tiger balm or peppermint essential oil applied to that painful spot in your back? We got you - and no, it doesn’t cost extra. 

If only the rest of the healthcare industry could get on board with such a streamlined, no nonsense approach. We see clients with all kinds of aches and pains, and maybe your doctor has ordered an X-ray of your painful shoulder. Where to start with pricing that? In the last couple of years, however, rule changes at both the federal and state levels have tried to address the murky mess of medical billing. Think of this blog post as a Mantis PSA!

The Hospital Price Transparency Rule

Did you know that hospitals are required to disclose their pricing? This federal regulation went into effect in January of 2021, and it requires hospitals to provide easily accessible pricing information online for all items and services - both insurer-negotiated and cash prices. They’re supposed to do this two ways: in a comprehensive machine readable format (a spreadsheet, in other words) and a standard charges display for the 300 most common services. The Hospital Price Transparency Rule is meant to allow patients to shop around for the best prices. Doesn’t that sound great?

Unfortunately, compliance has been abysmal and rule enforcement lax. You might find missing, incomplete or hard to understand information from your local hospital. Also, this rule only applies to hospitals - what if you just want to get a mole checked, or follow up with your primary care provider?

Health Plan Price Transparency Rule 

Starting in July 2022, health insurance companies were required to list online the prices they pay for covered items and services. This pricing is also available to third parties - looking at you, app developers. Imagine being able to easily shop around for the most affordable root canal or MRI. 

Both of these federal rules fall under the purview of the Centers for Medicare and Medicaid Services. Is your hospital or health plan not compliant? Drop CMS a line and let them know.

Texas Hospital Price Transparency Rule

Taking a cue from the federal government, Texas’ own hospital price transparency rule went into effect in March 2023. The requirements are similar to the federal rule, but with stiffer fines for violations.

So if your doctor does want an X-ray of your achy shoulder, here’s a short guide on how to shop for prices.  

Additional reading:

Necessity and Limitation of Price Transparency in American Health Care - AMA Journal of Ethics

FEBRUARY 2023 SEMI-ANNUAL COMPLIANCE REPORT — PatientRightsAdvocate.org