How Much Do Wisconsin Health Insurers Pay? Rates Now Public

WISCONSIN — For the first time, Wisconsin residents, employers and others will be able to see how much their health insurers pay for almost everything.

The unprecedented transparency is the result of a new law effective July 1 that gives health care consumers the chance to price shop for the best deal possible.

The law requires insurers to disclose the prices they’ve negotiated with providers for almost everything — the exception being prescription drugs, except those administered at hospitals or doctors' offices, Kaiser Health News reported.

That includes reimbursement rates for “every physician in-network, every hospital, every surgery center, every nursing facility,” Jeffrey Leibach, a partner at the consulting firm Guidehouse, told Kaiser. The law makes public “trillions of records,” Leibach said.

Read more: How Much Health Insurers Pay For Almost Everything Is Now Public

Though negotiated prices are now public, they’re not easy to find, because the database is so large, Kaiser reported.

Most people “will find it very hard to use the data in a nuanced way,” University of Chicago Harris School of Public Policy Dean Katherine Baicker told Kaiser.

However, that’s likely to change as entrepreneurs translate the trillions of records into user-friendly formats, Kaiser reported. And by Jan. 1, health insurers are required to provide tools that allow consumers to get the best prices on medical care they can schedule ahead of time.

Rich, user-friendly data sets will allow Wisconsin health care consumers to see the difference in reimbursement rates between Common Ground Healthcare Co-Op, the state’s largest health insurer, and others.

The new requirements complement a requirement last year that hospitals post negotiated rates, and allow consumers do more robust comparison shopping.

“If you're going to get an X-ray, you will be able to see that you can do it for $250 at this hospital, $75 at the imaging center down the road, or your specialist can do it in office for $25,” Chris Severn, CEO of Turquoise Health, told Kaiser.

The requirements stem from the Affordable Care Act and a 2019 executive order by then-President Donald Trump.

“These plans are supposed to be acting on behalf of employers in negotiating good rates, and the little insight we have on that shows it has not happened,” Elizabeth Mitchell, president and CEO of the Purchaser Business Group on Health, an affiliation of employers who offer job-based health benefits to workers, told Kaiser.

“I do believe the dynamics are going to change,” she said.

Reporting by Kaiser Health News, a Patch news partner.