Big insurers provide incomplete transparency data: Study
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Three of the nation's biggest health insurers have provided an incomplete picture of their negotiated prices in transparency data that's required by federal rules, according to a new analysis.
Why it matters: The partial disclosures by UnitedHealthcare, Aetna and Cigna could leave employers in the dark when shopping for workplace coverage, per the analysis in the American Journal of Managed Care.
Context: Commercial health insurers have been required to disclose the prices they negotiate with providers since 2022.
- The data analysis examined the three insurers' Q2 price data disclosures and their inclusion of common billing codes in cardiology, family medicine, orthopedics, inpatient and outpatient care.
What they found: Aetna on average posted prices for 86% of the most common orthopedic surgery codes, but only about half of common hospital outpatient codes.
- Cigna reported on average 90% of common orthopedic codes but 20% of hospital outpatient codes.
- UnitedHealthcare reported 96% of common codes in orthopedic surgery and 77% of common hospital outpatient codes — but only 8% of inpatient codes.
The other side: Health insurers pushed back on the report's findings.
- "Cigna Healthcare is committed to meeting all current and future [Centers for Medicare and Medicaid Services] requirements, and we are compliant with the Transparency in Coverage Final Rule — any assertion otherwise is false," a spokesperson told Axios, adding that the insurer collaborates with outside experts to improve its data quality and usability.
- "We have long been an industry leader in providing clear, complete and actionable data so people can make informed decisions about their health care, including meeting or exceeding federal Transparency in Coverage ... requirements," a UnitedHealthcare spokesperson said.
- Aetna's parent company, CVS Health, did not respond to Axios' request for comment on the study.
Reality check: "Although we found room for improvement, we also validated that significant amounts of data ... are complete and available," the study noted.
- A separate analysis earlier this year by Turquoise Health found that national payers, including Aetna, Cigna and UnitedHealthcare, were "generally performing at a high level" when it comes to transparency requirements.
Between the lines: CMS hasn't taken enforcement action against insurers. Federal regulators have previously said states would be the primary enforcers of the requirements.
- "CMS is committed to ensuring consumers have the information they need to make informed decisions regarding their health care," Catherine Howden, director of media relations, said in an email.
- Insurer transparency rules are part of that effort, she said. CMS measures compliance in several ways, including reviewing public files and responding to complaints.
