by Healthcare Blue Book

In this changing healthcare environment, when costs are climbing, and coverage is changing, it’s critical that you take greater responsibility for knowing as much as possible about the healthcare services you are getting – including what they cost.

If you have health insurance, you are most likely paying more out of pocket than ever before as a result of higher co-payments, deductibles and co-insurance. If you do not have health insurance, you have probably experienced sticker shock after receiving a bill from your provider.

Unfortunately for consumers, it is very difficult to find and compare prices on healthcare services.

Providers frequently charge uninsured cash paying customers 2-5 times more than what they accept from an insurance company for the same service. Even if you have insurance but are paying for part of your treatment (deductible or co-insurance), you could be charged a wide range of network prices for the same service. A recent Thompson Healthcare study reported that insurers frequently pay between $500 and $3,000 for the same MRI. Choosing the best provider can save you $2,500 or more.

With the rising cost of healthcare, and a larger portion coming out of your pocket, it is more important than ever to know what healthcare costs before you receive treatment. Knowing your treatment options and their cost will allow you to select the right care for you, at a price that won’t break your budget. [Top]

How do providers figure out what to charge?

Most providers have a standard fee that they ask for their services. This standard fee is frequently called the billed amount. You can think of the billed amount as the list price, or the "sticker price". Insurance companies negotiate with providers to pay a fee that is usually far less than the billed amount. The negotiated fee is frequently called the “allowed amount” for services.

Providers’ billed amounts are typically 2 to 5 times higher than the allowed amount they accept from the insurance company as payment in full. The allowed amount sounds like a great deal for consumers, but there is a catch. Insurance companies often negotiate a different allowed amount with each provider for the same service. For example, a recent Thompson Healthcare study reported that insurers frequently pay an allowed amount of between $500 and $3,000 for the same MRI. With such a large difference in cost, most consumers should ask their doctors about price before receiving treatment!

Patients without insurance are often charged the sticker price with no discount off of the billed charges. [Top]

How much should I pay for my service?

Regardless of whether you have health insurance or are uninsured, you should pay a fair price for healthcare services.

Uninsured patients should never have to pay the full billed amount for healthcare services. The good news is that if you are uninsured and are paying cash for your healthcare services, many providers will accept a price that is lower than the standard billed amount. But, in order to receive the lower price you have to ask your provider for the discount.

The Healthcare Blue Book will help you identify the fair price for services. [Top]

How do I use the Healthcare Blue Book to find a fair price?

Using the Healthcare Blue Book is easy.

Once you know part or all of your required treatment, there are two ways to find a fair price for healthcare services.

Type search terms related to your service or treatment into the search box and then click on the "Search Prices" button. You don’t need to know the full treatment name to search the Healthcare Blue Book. For example, if you type “Hip” for a hip surgery, you will see several choices related to hip treatment. Click your desired treatment and the Blue Book gives you a recommended fair price for the service. For pricing in your local area enter your zip code into the box provided and search again.

You can also select services from the care categories listed at the top of the page. If you know that you need a laboratory test for your diabetes condition, select the Labs tab, scroll down and click Diabetes. The Healthcare Blue Book will give you a list of all major lab tests related to Diabetes. Click your test and the Blue Book will present a recommended fair price for the service.

If you are unsure of the treat or services you need, please see Understanding your treatment options. [Top]

What is the Healthcare Blue Book fair price, and how is it determined

The Healthcare Blue Book fair price is the cash price you should pay for a service or product at the time of treatment. It is the payment amount that many high quality providers accept from insurance companies as payment in full.

The fair price is calculated from billing and medical payment data. It is usually the average fee that providers in your area accept as payment from an insurance company for a particular service. [Top]

Why do some prices have several components?

Many Healthcare Blue Book prices for inpatient surgical procedures, such as a hip replacement or knee surgery, have three distinct components. Prices assume a standard procedure without complications. The components represent the three major cost categories for most surgical procedures:

Physician Services:

The fair price for the services of the physician performing the procedure

Hospital Services:

The fair price for the hospital services, including overnight stay, nursing, supplies and most medications

Anesthesia Services:

The fair price for the services of the anesthesiologist