Heath Care Pricing Transparency and Consumer Rights: Comparing prices
Health insurance companies negotiate with healthcare providers to get discounted rates for their members. The result is negotiated prices ("allowed amounts") for literally thousands of services, procedures and tests. These negotiated prices were formerly concealed from patients as trade secrets. However since federal regulations took effect in 2021, consumers can access this information.
As preparation to begin gathering health care price estimates, first read your insurance policy thoroughly. Also, review health insurance terms and meanings. These are the four main pathways to get price estimates:
Billing and customer service
Sometimes it can be helpful to speak with billing customer service before actually scheduling care. Say what you plan to be seen for, and ask if there is anything you should know about billing, or any policies that tend to be misunderstood (for example, the price differences between screening and diagnostic colonoscopies). You could ask for tips for getting the lowest price -- for example, scheduling the service at a clinic rather than in the hospital. If you anticipate lab tests, you could ask which laboratories they use, and then double-check with your insurance company to make sure they are in-network.
Check online reviews
Check Google Reviews, Yelp, and Better Business Bureau websites for reviews containing the words "charge" "bill," etc. Google Reviews has a keyword search feature that can help bring those reviews to the top. Consistent, ongoing complaints about unreasonable charges, unexpected billing practices or difficult communications are all potential red flags. Some providers known for top-notch medical care can have billing departments with negative reviews.
Additional resources
- Detect prices before and after the serviceArticle "How much will that cost / did that cost?" at ClearHealthCosts.com
- Opting not to use one's insurance planBased on the right to privacy, this federal regulation allows insurance customers the right to avoid involving their insurance when receiving health care, and pay cash instead: 42 CFR § 154.122 (a)(1)(vi). Cash prices can sometimes be less than the price negotiated by insurers.
- Healthcare BluebookHelps users identify a "fair price" for procedures based on zip code. This information could be useful for negotiating self-pay prices with health care providers.
Youtube videos
- Pricing transparencyDr. Eric Bricker explains how prices for the same service can vary widely among in-network providers.
