Beginning
in the Fall of 2013, a new law was passed in Massachusetts that would require health
insurance carriers to provide individuals with a cost estimate for upcoming medical
procedures. By providing individuals with
cost estimates for their medical procedures, this will allow individuals to
compare prices among different facilities and choose a facility with the lowest
price. Being able to know the cost for
the procedure beforehand will allow for individuals to budget properly for this
expense. The goal of this law is to
provide individuals with a better sense of cost transparency and what they can
expect to pay for their medical procedures.
The
process of obtaining an estimate for a procedure is quite simple. Individuals call their health insurance
carrier and ask for a cost estimate for their medical procedure. The health insurance carriers are required to
provide each individual with the cost of the procedure within two days of the
initial call.
Within
the next year, the health insurance carriers will be required to provide the individual
with this information instantaneously.
The cost of the procedure or exam will be determined by the type of
health insurance plan the individual is enrolled in. This means health insurance carriers will
need to know if individuals will be subject to a deductible or a copayment for
these services. If the health insurance
carriers provide an individual with an estimate that is lower than the actual
cost of the procedure then the health insurance carriers will be responsible for
paying the difference. If the individual
has to have additional tests due to the result of his or her procedure, the
health insurance carriers will not be responsible for any treatment or service
above and beyond the initial quote.
Since
health care providers will be providing cost estimates for procedures, the goal
is to lower the cost of these procedures since the cost information is now
available. This new law will benefit
consumers and provide them with important information regarding the cost of
their medical procedure.
Please
contact our office if you have any questions on how to obtain a cost estimate
from your health insurance provider.
