Additional Fair Price Guidelines
Here are some additional tools to help you find the best available prices for medical services and procedures. The websites FairHealthConsumer.org and HealthcareBluebook.com give price estimates for a test or procedure in the non Medicare healthcare market in your region. Your doctor should be able to give you a clear description of what they are ordering, and their billing department should be able to give you the billing code associated with it so you can make an accurate price comparison among whatever facilities in your area offer that test or procedure. If it is a service by a doctor or an outpatient facility, such as a walk in clinic or a surgery center, you should receive a CPT code that describes what you need. If it is a hospital procedure that requires an overnight stay , you might receive a ICD to PCS code.
FairHealth Consumer (www.fairhealthconsumer.org) gives an estimated price based on the negotiated and out of network rates of insurers that cover that area. If you are uninsured, you should expect the initial asking price to be the out of network estimate. However it is important to remember that all prices are negotiable. Again, the cash paying patient can often get a better deal than an insured patient because doctors and hospitals do not have to bill and wait for an insurance company to process and send a check.
Healthcare Bluebook (www.healthcarebluebook.com) price estimates are based on what others outside the Medicare sector have actually paid for these services , so it is a good benchmark for what would you might expect to pay.
Neither website might list the precise procedure you are looking for or be available in your location, but they should cumulatively give you an approximate estimate of what a fair price should be.
We should be able to get many price estimates from hospital websites. Hospitals and insurance plans are now legally required to provide prices and cost sharing information to patients for common procedures but due to the insignificant financial penalty compliance has been uneven. However you have a legal right to demand the price information even if it is not conveniently posted online by your provider. Compare all the nearby hospitals in your area because one or more may offer cheaper prices for the same types of treatment than the hospital to whom you have been referred.