Issues

Americans need and want greater upfront transparency about what health plans do and do not cover and the costs they will incur. As an advocate for consumers, Consumers for Quality Care is highlighting some of those areas at the emergency department, in the hospital and at the pharmacy counter that the health care industry can and should address to provide increased clarity, and cost savings to health care consumers.

Those areas include:

• Insurer Anti-Consumer Practices: Insurance policies like high-deductible plans, broadly offering skimpy short-term, limited duration insurance (STLDI) plans, surprise medical bills, prior authorization protocols that allow for dangerously delayed and misguided decisions on prior authorization requests and emergency department denials after-the-fact are major contributors to rising out-of-pocket health care costs and uncertainty.
• Hospital Pricing: Hospital care is the largest single component of national health care spending in the U.S. Surprise bills, billing errors and vast swings in average prices for similar tests and procedures underscore the need for transparency in hospital pricing.
• Pharmacy Counter Issues: Policies like preventing copay coupons from counting against consumer deductibles and rising out-of-pocket medication costs for senior citizens on Medicare are a significant concern.