Legal Alerts/Details

CMS' Transparency-in-Coverage Rule: One Year Later

July 31, 2023
  1. Snell & Wilmer 2023 summer associate Danny McDermott provided material assistance in the production of this article. Danny McDermott is not a licensed attorney.

  2. 26 CFR 54.9815–2715A2, 29 CFR 2590.715–2715A2, and 45 CFR 147.211. The Rule does not apply to Medicare, Medicaid, grandfathered health plans, Flexible Spending Accounts (FSAs) Health Reimbursement Accounts (HRAs), Health Savings Accounts (HSAs), or certain other excepted benefits. 

  3. CMS, Transparency In Coverage Final Rule Fact Sheet (CMS-9915-F) (Oct. 29, 2020), 

  4. 26 CFR 54.9815(b)(2)(i)(B). “Allowed amounts” are the maximum amount that an insurer will pay an out-of-network provider for a given service or item. “Billed amounts” are the amount that out-of-network providers have actually charged the insurer for a given service or item. 

  5. Plans and insurers must also provide this information in paper form upon request. 

  6. Julie Appleby, Health insurance prices for care now out there, but finding them is an ordeal, NPR (July 27, 2022),

  7. David Muhlestein, Commercial Insurer Price Transparency: A Comparison of Four National Payers, HEALTH AFFAIRS (May 25, 2023), 

  8. See Georgetown Center on Health Insurance Reforms, Transparency in Coverage: Recommendations* for Improving Access to and Usability of Health Plan Price Data, and Usability of Health Plan Price Data (last visited June 26, 2023), (“To put it in lay terms, trying to locate a single provider in the TiC files is akin to trying to find a single word in a very large dictionary that isn’t in alphabetical order.”).

  9. Senator Margaret Wood Hassan & Senator Mike Braun, Letter to CMS Administrator Chiquita Brooks-LaSure (Mar. 6, 2023), 

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