price-transparency-guide

Health plans are legally required to publish their rates and they all comply with this now. You can literally just go to any payer web site and download the MRF. There are occasional data errors but overall the numbers are generally accurate. https://www.cms.gov/priorities/healthplan-price-transparency... https://github.com/CMSgov/price-transparency-guide

But that's entirely dependent on the data - if you read the article, you'll see that the author is pointing out how different datasets are reporting different values for the same healthcare service. A correct, properly labeled example is just that - a document where values are accurate rather than misreported. If you want to get a sense of what a correct, properly labeled example might look like, you should visit the CMS's guidance [1]. Health insurers should be providing documents that follow the format described there, and most importantly, reporting values that are accurate. [1] https://github.com/CMSgov/price-transparency-guide

The author has replied to me, and shared these great examples of transparent prices: https://github.com/CMSgov/price-transparency-guide/tree/mast... Along with this fantastic guide: https://github.com/CMSgov/price-transparency-guide I recommend them to anyone who wants to see good examples of price transparency.

I'm the author. When I write articles I have to make a choice: make them readable by the public, or detailed enough to satisfy the experts. I try to strike a balance, but I can't have both. Please take a look at the CMS Price Transparency Guide https://github.com/CMSgov/price-transparency-guide and familiarize yourself with the schema. You can also take a look at the federal ruling: https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-... The metadata you're talking about is specified in the files themselves. I've limited my search to fee-for-service (non-capitated, non-derived, non-bundled) institutional claims. You can write to me if you have more questions. alec@dolthub.com

I'm the author. Take an example like this https://github.com/CMSgov/price-transparency-guide/discussio... I don't know how closely you've worked with this data -- you clearly have some kind of expertise -- but how do you explain this? The insurance companies had 18 months to talk to the CMS and ask for a better data model. If they're not able to explain how much things cost with 5 different negotiated types -- negotiated, percentage, derived, fee schedule, and capitation -- then they should have asked for another one. The hospital and insurance rates are both fee-for-service base rates for items billed individually. If there's some nuance in interpreting how "fee for service" "dollar amount negotiated" goes, definitely write to me and let me know. I talked with experts in healthcare pricing before I published this. You can write to me at

I'm the author. Publishing my reply to you (as I understood your question): > No one can produce the corrected/missing rates but the insurance companies themselves. All we can do is point out when we’ve found rates/patterns that don’t make sense. E.g. https://github.com/CMSgov/price-transparency-guide/discussio...

I'm not sure what format they store their records in, but I have a hunch it's a lot more structured than what we see in the CSV files. The data dumps have to comply with some CMS guidelines set out here: https://github.com/CMSgov/price-transparency-guide

The health insurance companies are now required to publish this and in fact the rule went into effect July 1 2022. Look up price transparency by CMS (the data will be published in this format: https://github.com/CMSgov/price-transparency-guide) Note: the data being published by payors in machine readable format (MRF) is MASSIVE - terrabytes of data. Example: https://transparency-in-coverage.uhc.com/

FYI, there is a similar effort going on that requires all health plans to host machine readable files containing negotiated rates by provider and procedure code by 2022-01-01: https://github.com/CMSgov/price-transparency-guide

They are doing that as well. They are posting general requirements, as well as providing details on specific situations. From the main project @ https://github.com/CMSgov/price-transparency-guide Section: Overview > All machine-readable files must [...] made available to the public without restrictions that would impede the re-use of that information. Section: Public Discoverability > These machine-readable files post made available to the public without restrictions that would impede the re-use of that information.