Empowering healthcare consumers: FAIR Health online tools shed light on healthcare costs

March 16, 2012 in health care costs, Health Insurance, Insurance Bills, Member Stories, News

By Robin Gelburd

Recent survey reports have shown that current economic uncertainty and continued unemployment are compelling millions of Americans to delay or forgo medical and dental treatments.

Consumers concerned about healthcare expenses should be able to find out the cost of procedures or treatments in advance of seeing a doctor – regardless of whether or not they are insured. And, if consumers are insured, they should be able to determine if their doctors are in their insurance plans’ networks.

This is where the not-for-profit organization, FAIR Health, comes in. FAIR Health was created to bring transparency to healthcare costs and out-of-network reimbursement. FAIR Health created a free tool that gives consumers access to estimated costs of medical and dental treatments based on insurance status, level of insurance, and geographic area.

How does FAIR Health do this? FAIR Health maintains a database with records for more than 13 billion de-identified, private healthcare procedures from the last ten years. The database reflects the healthcare claims experience of more than 125 million people covered be private health insurance, making it the largest such data resource in the nation that is owned and overseen by an independent, third-party organization.

FAIR Health receives the data directly from private insurance companies, who remove all identifying patient information before sending us the billing codes, costs, and locations of procedures. FAIR Health works to ensure that the data are objective and reliable by applying a robust auditing and validation process that is guided by prominent statisticians, healthcare economists, and researchers.

Since the launch of the Medical and Dental Cost Lookup Tools last year, these resources have been used by consumers to obtain costs estimates before visiting a doctor’s office or undergoing medical or dental treatment; while at a doctor’s office as part of a negotiation over the price of a procedure; and during the appeals process with their insurance company over an out-of-network reimbursement.

FAIR Health encourages consumers to use these helpful tools as they make healthcare decisions for themselves and their families. And, as FAIR Health is always trying to improve its site, send feedback to info@fairhealth.org.

Robin Gelburd is president of FAIR Health.


2 responses to Empowering healthcare consumers: FAIR Health online tools shed light on healthcare costs

  1. Hmm, the cost estimates provided by fairhealth are about 50% less than those provided by my insurer for the same procedures in the same zip code, where there is 1 hospital and 1 (large) provider group. Why the Delta and who is right? When I ask the providers folks they always say ‘we dont know’ as if they’ve never billed a patient before, lol. dont know or wont tell me.

  2. Mike,

    Thanks for visiting our site and for your question. There may be a few reasons for the discrepancy you noticed. First, cost estimates on our site currently do not reflect facility-related charges (i.e., the technical component for a hospital or surgery center) but rather offer estimates on the provider’s fee in performing a specific service or procedure. We are working to make these charges available.

    Second, your insurer may use a different percentage when determining out-of-network reimbursement rates. You can adjust these numbers based on what your insurer uses by using the sliders provided under your cost estimate. You may also choose to see our article on Understanding Your Cost Estimate (http://fairhealthconsumer.org/medical_estimate.aspx), which provides additional context regarding cost estimates on our site.

    In any case, we’d be happy to help you better understand the estimate you received, and the reasons for the discrepancy. We will contact you offline for more specifics regarding your search.

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