Your Health Plan Has to Quote Your Price Over the Phone in 2027. Hospitals Just Got Warned About Half-Prices.

If you’ve ever called your insurer to ask what an MRI will cost and been told to “check the online tool,” that answer has an expiration date.

A final federal rule published October 6 makes health plans give you your price over the phone, on the call, using the number on your insurance card. It applies to plan years that begin on or after January 1, 2027. If your plan runs on the calendar year, that’s three months away.

What changes on the phone

Since 2023, most plans have had to post a price tool online and mail the same answer on paper if you ask. If you never went looking for it, you’re about to get a shortcut. The Treasury, Labor and Health and Human Services departments just added the phone.

The rule says the answer “must be accurate at the time of the request and must be provided at the time of the request.” Translation: no “we’ll mail you something in a few weeks.”

What you’re owed is the same list the online tool owes you. Your estimated cost-sharing for that service at that provider. How much you’ve already paid toward your deductible and out-of-pocket limit. The negotiated rate, in dollars. And whether the plan needs something from you first, a “prerequisite” in the rule’s language, before it covers the service.

Here’s the catch. The plan can cap you at 20 providers per day. It has to tell you the cap when you call.

The hospital half of the story

A day earlier, FTC Chairman Andrew Ferguson sent letters to 24 of the largest healthcare services companies. The message: posting prices the way CMS requires “does not create a safe harbor.” A price quote can still be deceptive “if it is incomplete, such as when it omits physician or facility fees or covers only a portion of the expected course of care.”

That’s the trick you’ve probably seen. The hospital quotes the scan. Then the radiologist bills separately.

Why the call is worth 10 minutes

The FTC says it plainly: prices for the same service often differ “dramatically from one facility to the next.” Your deductible decides who pays the difference.

Our example, with made-up numbers. Your deductible is $3,000 and you’ve paid $1,000 toward it. Imaging center A’s negotiated rate is $1,400. Center B’s is $500. You haven’t hit your deductible, so you pay the whole rate either way. That’s $900 for picking up the phone.

The departments figure each of these calls takes a plan rep about 9 to 10 minutes, paperwork included. That’s a good hourly rate for you.

Do this

Check when your plan year starts. It’s in your plan documents or on your benefits portal. Calendar-year plans get phone quotes in January. A plan that renews July 1 doesn’t owe you one until July 1, 2027.

Before any scheduled scan, surgery or procedure, call the member services number on your card. Ask for the estimate at two or three in-network facilities, and ask how much of your deductible you’ve met.

Then ask the hospital, in writing, whether its estimate includes the physician, anesthesia and facility fees. If it doesn’t, you now know what the FTC thinks of that.

Paying cash with no insurance? Different rule, different right. Read how the good faith estimate and its $400 dispute work. If the deductible part of this was fuzzy, start with deductibles explained.

The fine print

The rule covers non-grandfathered job-based plans and individual-market coverage, so an old grandfathered plan may not owe you this. Medicare isn’t part of it. The estimate excludes balance billing from out-of-network providers where state law allows it. The rule takes effect December 7, 2026.

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