Health Care Pricing
Here are some tips on how to get the best care for your money.
Note: If you want to estimate provider prices without insurance, you can skip to the section called Estimating Prices When You Don’t Have Coverage.
Prices Will Vary
The cost of the same surgery can be very different from one hospital to another. This is the case with all providers, including doctors and specialists. Studies have shown that higher prices don’t mean higher quality medical care.
Providers Set Their Own Prices
Doctors, hospitals, and other providers decide how much they will bill for a given service. If you don’t have insurance, choosing the provider with the lowest billed amount can save you money. However, if you have insurance, choosing the provider with the lowest billed amount doesn’t always mean you will pay less.
Insurers and HMOs Negotiate Different Discounts with Providers
Insurers and HMOs negotiate lower prices with their in-network providers. For example, if an in-network provider normally charges $5,000 for a surgery, an insurer or HMO may negotiate a reduced price of $2,500.
If you haven’t met your deductible for the year, the negotiated price will mean you pay less out of pocket. If you only have to pay coinsurance, the amount you pay will be based on the negotiated amount rather than the higher billed amount.
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Last updated: 10/06/2015