Increasing Hospital Transparency

HAP and its member hospitals are committed to increasing transparency around health care costs and quality, as well as improving their hospital operations.

Consumers are seeking more information from hospitals about the cost of their care and the quality of that care so they can make informed decisions. They also need a similar commitment from insurers, physicians, and other providers. With all parties working together, consumers can navigate the complex care system, armed with sufficient information to make the best choices about their health care.

Surprise Balance Billing

Surprise medical bills may occur when a patient receives care from an out-of-network provider or when his or her health plan fails to pay for covered services provided at an in-network facility.

This issue has received significant federal attention.

At the federal level, H.R. 3630, the No Surprises Act, and S. 1895, the Lower Health Care Costs Act, both contain language intended to protect patients from balance billing, when a patient is billed for the difference between what a provider bills and the insurance company pays. But the legislation defines how providers will be paid—rate-setting—by establishing a benchmark rate, which HAP opposes. HAP has advocated to protect patients from surprise medical bills by prohibiting balance billing and holding patients harmless to in-network cost sharing obligations. HAP urges Congress to protect patients first, and allow providers and insurers to resolve payment disputes without government interference, such as rate-setting.

HAP also is engaged with state policymakers regarding surprise balance billing practices. HAP continues to advocate that any state balance billing proposal be grounded around any federal action on the issue. 


Publishing Standard Charges and Negotiated Rates

HAP and other national provider organizations have serious concerns about a new federal proposal calling for hospitals to:

  • Post a list of all of their standard charges  and payor-specific negotiated rates for all items and services in a machine-readable format on their websites
  • Post payer-specific negotiated rates for all items and services, and also publish the negotiated rates for 300 "shoppable" services, including 70 defined by the Centers for Medicare & Medicaid Services

Posting standard charges and negotiated rates does not provide consumers with helpful information about out-of-pocket costs. While there are standard charges, there is no standard patient or treatment, and chargemasters alone don’t tell the whole story. In addition to a host of legal and operational concerns, requiring the posting of negotiated rates would likely undermine competition in the private market, and result in increased prices.

Patients are urged to speak directly with their physicians, insurers, and hospitals to get the most appropriate information about the cost of care. Many hospitals already have implemented price calculator tools that patients can use, and all hospitals have billing professionals who can assist patients with individual circumstances. 

HAP Contacts

For more information, contact Warren Kampf, senior vice president, advocacy and external affairs; Jeffrey Bechtel, senior vice president, health economics and policy; Jolene Calla, vice president, health care finance & insurance, or; Laura Stevens Kent, senior vice president, strategic integration. For media inquiries, contact Rachel Moore, director, media relations.

HAP News

June 29, 2020

U.S. House Passes Measure to Stabilize ACA Marketplace

The U.S. House of Representatives today passed legislation to bolster critical portions of the Affordable Care Act (ACA). The measure’s momentum comes on the heels of recent action by the Trump Administration aimed at dismantling the ACA.

May 12, 2020

CMS Issues Proposed Payment Policies with Transparency Provisions

Yesterday, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule for fiscal year 2021 Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital Prospective Payment System.