Price Transparency in Primary Care: Can Patients Learn About Costs When Scheduling an Appointment?

J Gen Intern Med. 2017 Jul;32(7):815-821. doi: 10.1007/s11606-017-4003-4. Epub 2017 Feb 6.


Background: Cost-sharing in health insurance plans creates incentives for patients to shop for lower prices, but it is unknown what price information patients can obtain when scheduling office visits.

Objective: To determine whether new patients can obtain price information for a primary care visit and identify variation across insurance types, offices, and geographic areas.

Design: Simulated patient methodology in which trained interviewers posed as non-elderly adults seeking new patient primary care appointments. Caller insurance type (employer-sponsored insurance [ESI], Marketplace, or uninsured) and plan were experimentally manipulated. Callers who were offered a visit asked for price information. Unadjusted means and regression-adjusted differences by insurance, office types, and geography were calculated.

Participants: Calls to a representative sample of primary care offices in ten states in 2014: Arkansas, Georgia, Iowa, Illinois, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania, and Texas (N = 7865).

Main measures: Callers recorded whether they were able to obtain a price. If not, they recorded whether they were referred to other sources for price information.

Key results: Overall, 61.8% of callers with ESI were able to obtain a price, versus 89.2% of uninsured and 47.3% of Marketplace callers (P < 0.001 for differences). Price information was also more readily available in small offices and in counties with high uninsured rates. Among callers not receiving a price, 72.1% of callers with ESI were referred to other sources (billing office or insurance company), versus 25.8% of uninsured and 50.9% of Marketplace callers (P < 0.001). A small fraction of insured callers were told their visit would be free. If not free, mean visit prices ranged from $157 for uninsured to $165 for ESI (P < 0.05). Prices were significantly lower at federally qualified health centers (FQHCs), smaller offices, and in counties with high uninsured and low-income rates.

Conclusions: Price information is often unavailable for privately insured patients seeking primary care visits at the time a visit is scheduled.

Keywords: Affordable Care Act; audit; insurance; price transparency; primary care.

MeSH terms

  • Adult
  • Appointments and Schedules*
  • Female
  • Health Expenditures*
  • Humans
  • Insurance Coverage / economics
  • Male
  • Medically Uninsured
  • Office Visits / economics*
  • Patient Participation / economics*
  • Patient Participation / methods
  • Primary Health Care / economics*