Understanding the costs of the top 500 codes used in medicine
Pulling the curtain back on healthcare pricing
Pulling the curtain back on healthcare pricing
Healthcare pricing is confusing. Prices vary widely for the same procedure within the same market and consumers have no easy way to effectively shop for value
We work tirelessly to stay informed about the latest changes in your health insurance policy. We can provide you real-time information on what costs for a given procedure will be
We work with your insurance company to give insured a real-time accurate assessment of the cost for a particular procedure
Not necessarily. The amount shown on Promire health reflects the contracted rate for a specific procedure (CPT code) for a given provider. Your exact out of pocket responsibility will depend upon your specific insurance plan and how much of your deductible that you have met. Additional factors include site of service (typically clinics run by the hospital will have an additional fee added called the facility fee).
Promire health allows you to quickly compare prices with different providers. Once you have selected a provider or facility then you can reach out to your insurance carrier for an advanced explanation of benefits.
According to the No Surprises Act insurers and healthcare payers are required to provide an Advanced Explanation of Benefits to their members whenever they schedule a healthcare service at least three days before the service, or at a member’s request if the service is unscheduled.
Beginning July 1, 2022, most health plans and issuers of group or individual health plans were required to post pricing information for procedures, services and items.
The ability to search negotiated rates for procedures is a result of the 2020 “Transparency in Coverage” rule. This rule forced new transparency requirements for many health plans. This rule was further expanded in 2019 by an executive order that required insurers to disclose information about expected out-of-pocket costs before a patient receives care. Then, in 2021, President Biden signed an executive order directing HHS to continue the price transparency initiatives set for by Trump. This is a wonderful example of a bipartisan solution address a frustration seen within the healthcare marketplace.
Theoretically now. However, we are currently in process of adding insurance carriers one by one. Unfortunately, there are many insurance policies (did you know United healthcare has over 78,000) and integrating into our system takes time. We would recommend that you send us an email of your insurance policy so that we can expedite to add it to our database.
While the requirements for payers are to make the negotiated rates machine readable, there is no centralized location for each plan. Therefore, we will need to add these payers to our database. Please contact us
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