The federal government will begin enforcing the Transparency in Coverage Rule (TCR) in July, 2022. Essentially, the rule states that insurers must publicly post machine readable files that include pricing on all covered items and services. Commercial and self-insured health plans must post such files.
The TCR includes three different types of files, though the third file is not required at this time. The first file will include in-network negotiated payment rates. The second file includes historical out of network allowed amounts. The third file will deal with prescription costs, but again, insurers are not required to post this file yet. Insurance companies must update these files every month.
For many years Blue Cross and Blue Shield of Arizona has posted pricing information on many of the most common medical procedures. Broken down by provider, zip code, etc., procedures such as an MRI on the right shoulder can be comparison-shopped for the lowest price. They also list hospital ratings as well.
Under the Transparency in Coverage Rule is the Consumer Price Transparency Tool (CPTT.) Under the CPTT, in 2023 health insurers must offer online tools that members may use to look up cost-share estimates. The 2023 file will include 500 covered services. By 2024 all covered services must be listed.