“Under a new Maine law, health insurers must compensate customers who find a better deal on many common medical services,” Jackie Farwell wrote in July over at Bangor Daily News. “Customers will be rewarded for shopping around for less expensive CT scans, lab work and other care by keeping a share of any savings they realize. Here’s an example of how it will work: A hypothetical Lewiston patient is experiencing knee pain so her doctor orders an MRI of her leg. That service costs $981 on average in Maine. But she decides to use a shopping tool her insurer must offer under the new law, and finds the same scan is available in nearby Auburn at a price of $417. By choosing the Auburn provider, she and her health plan save $564. They split the savings, and her insurer compensates her $282. … The incentive for shopping around applies to only some consumers. That part of the law affects consumers in the ‘small group’ market, or those who get health insurance through a small business where they work. Those consumers must also have a plan that offers a health savings account. All told, the provision will affect about half of all small group policyholders in Maine, or about 33,000 consumers, when it kicks in on Jan. 1, 2019. It does not apply to plans sold through the Obamacare marketplace, due to concerns about how the incentive payments could affect income-based subsidies that help people afford that coverage. The law’s drafters hope to see the provision expanded. … Another provision affects anyone with private health insurance. It requires health providers upon making a referral to inform patients that they have the right to get that service from another provider and that they may review a health care price comparison tool offered by their insurer. Insurers have leeway in how they compensate customers. The bill originally stated that insurers must split any savings 50-50 with their policyholders and pay out the incentive in cash or apply it against their deductibles. But the final law stipulates no percentage of savings that the insurer must pay, or the form of that payment. Some possibilities are gift cards, lowering monthly premiums, or credit toward out-of-pocket costs such as co-pays. Four categories of care are considered ‘shoppable.’ They are physical and occupational therapy, radiology and imaging, laboratory services and infusion therapy. Insurers could conceivably also add other non-emergency outpatient services to their incentive programs, but the law requires only these four.” Jackie Farwell, “New Maine law rewards consumers who find better deals on health care,” Bangor Daily News.
Jeanne Pinder is the founder and CEO of ClearHealthCosts. She worked at The New York Times for almost 25 years as a reporter, editor and human resources executive, then volunteered for a buyout and founded... More by Jeanne Pinder