Summary of States’ Transparency Laws
More than two dozen states now have laws mandating transparency in health-care pricing, in some form or another—including everything from pilot programs to full-blown implementations. New Hampshire: The Granite State was an early advocate of transparency. In 2003, the state created a system that provides comparative information about the fees that hospitals, surgery centers, physicians, and other health-care professionals receive for services rendered. The system also supplies information specific to the inquirer’s health benefits. The uninsured can make similar use of the system, as can employers seeking to compare the health-plan premiums of various insurance companies and weigh those against what each plan offers in terms of benefits. Texas: In 2007, Texas mandated that providers give estimates of expected charges, along with itemized statements, to patients who ask for them. At the same time, hospitals and physicians were required to begin standardizing their billing procedures. Minnesota: The state passed a law two years ago that (among other mandates) authorized creation of an online system to enable consumers to see the dollar averages that insurance companies pay to Minnesota’s largest providers for over 100 common procedures. South Dakota: The state has a website where consumers can find the median prices for the top 25 inpatient procedures for every hospital. In 2008, South Dakota added outpatient procedures to this roster. New York: Steps were taken last year to create a database that consumers in the Empire State can use to determine usual, customary, and reasonable rates for out-of-network providers. Wisconsin: Next year, Wisconsin will require health-care providers to disclose the cost of their 75 most common inpatient procedures and their 25 most common outpatient procedures. The state also will compel insurers to provide information on the median amount that they pay for each of these listed procedures. Other states: States that currently feature mandated price transparency (or soon will) include Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Kentucky, Maine, Maryland, Massachusetts, Michigan, Missouri, Nebraska, Nevada, New Mexico, North Carolina, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, and West Virginia. —R. Smith