- What is OutOfPocket.com?
OutOfPocket.com is a website to provide consumers with true prices (how much things really cost) for routine health care services. The website allows consumers to post prices they paid for health care services and search the directory to look up true prices for services. The directory is supplemented with Medicare price directories for common services and true price lists from health care providers.
This grass-roots initiative hopes that by getting consumers like you involved to reveal true health care pricing, consumers will become a powerful force to encourage healthy competition in the industry. All consumers are invited to participate, including the insured and the uninsured, by posting prices they paid for health care services. ( top )
- Why should you care?
Your participation can make a difference. We invite everyone to help us expose health care pricing by posting prices you paid for, such as doctor visits, services provided at outpatient facilities, diagnostics tests, and clinics in our directory. Health care costs are spiraling out of control and something needs to be done. Doing nothing is no longer an option. We need you to participate. ( top )
- Who can benefit?
OutOfPocket.com benefits the insured, uninsured, and under-insured. Knowledge is powerful. Consumers can look up how much a routine health care service will cost before they visit a doctors office or facility. Not the inflated list price, but the true price for the service.
The 10 million consumers with high-deductible health insurance plans need to know what a specific procedure or service will cost up front in order to find the best value and make the most out of health care dollars. It’s called being a good consumer.
The 47 million uninsured Americans can use this directory to negotiate discounts with providers. Uninsured consumers have the right to know up front the true price for a service they will pay for in cash – not the inflated list price.
Insured consumers selecting a provider or service out-of-network can use OutOfPocket.com to find out the true price the provider charges for services – before you visit the provider.
If you have a traditional, “first-dollar-coverage” health insurance plan, where your insurance plan pays for all of your health care, you probably feel your health care is free. You might even be careless about services you use, or whether a provider is a good value. OutOfPocket.com might not be useful for you today, but when you move to a high-deductible health insurance plan, you will become more cost conscious about your health care spending. ( top )
- Is this a free service?
Yes. Participation in OutOfPocket.com is always free. You can search the directory anytime and share our own visits by posting them to the directory. Consumers that wish to add visits are required to register. Registration is simple and takes less than a minute to complete. The more people that participate, the more meaningful the directory will become. Be sure to tell your friends and family about OutOfPocket.com. ( top )
- Who can enter data in the directory?
Anyone can contribute visits to the directory, including providers, consumers, employers and insurers. The more stake holders that contribute, the more meaningful the directory will becom. ( top )
- What documents do I use to obtain price information for my health care services?
In most situations, you can refer to one of several documents to obtain your out-of-pocket costs for health care services. Every insurance company appears to have their own standard for providing price information to consumers. If you have health insurance, one type of document might be the explanation of benefits (EOB) from your insurance plan. That or you might find price information on a statement sent to you by the provider of health care services. Many insurance plans now have this information available to their members on their website using a secured login and password. If you do not have health insurance, your health care provider will probably send a bill statement directly to you. This document should have the entire price and discount information. If you have any questions, please contact us at mona.lori@outofpocket.com. ( top )
- Do health insurance companies provide their members with price information for health care services?
After you visit a doctor or facility your health insurance plan typically sends you an Explanation of Benefits (EOB). This document includes the provider’s name, date of service, type of service, list price, discount amounts, and the amount you are responsible for. Some health insurance companies are offering members tools to gain access to more information about cost and quality of health care services. This is definitely a step in the right direction; however, the tools are not what they need to be to provide full transparency. Just recently my health insurance provider introduced a tool on their website called, “Treatment Cost Advisor”. This tool provides members with a price range for a list of common health care services; however the services have a wide range of prices are not meaningful to my specific out-of-pocket expenses ---and it is only available to members. The tool identifies the estimated cost of an MRI: $1200-$1700. After I had the MRI performed, I found out that the list price on my explanation of benefits for my MRI was $1116, and the discounted (negotiated) price through the insurance was $664. My conclusion is that the tool on the insurance provider’s website is not that useful. If you have a story you would like to share about your health care experience, we’d love to hear from you.
Search the internet and I am sure that you will find blogs filled with stories of insured and uninsured individuals that were unable to get pricing information up front for routine health care services. ( top )
- How can I use this information in the OutOfPocket.com directory if I do not have health insurance?
The visit information in the directory is contributed by consumers with and without health insurance. The true prices revealed in our directory can be extremely valuable for you to negotiate reduced rates for services with health care providers. If you know the true price of what other consumers paid for similar services in your area, you can use this information to negotiate a discounted rate - and you should. It is no secret that uninsured consumers often pay inflated prices for their health care services. Informed consumers are the best consumers - so be sure to use OutOfPocket.com to do your research. ( top )
- Where does the price information in this directory come from?
Consumers like you contribute all the visit information that you see in the directory. The directory also includes Medicare price information provided by CMS (Center for Medicare and Medicaid Services) and includes average payments for common services across the nation. ( top )
- My searching is not returning any results. Why is this?
The contents of the directory are contributed by consumers to share with other consumers. We launched OutOfPocket.com in late June 2007 and are inviting consumers to post their visits. We rely on collaboration to build this directory. As a result, the more people that contribute prices, the more meaningful the directory becomes. ( top )
- How do I search for Medicare data?
We loaded the CMS data for thousands of Medicare prices for common procedures across the nation. To find this data your search should include a zip code and a search term. Some common procedures in the Medicare directory include “biopsy”, “hernia”, “colon”, or “scope”. These are just some ideas to get you started searching. ( top )
- In addition to pricing, do you provide any recommendations on providers?
To determine the true value for any health care service, you really need to know the cost and the quality of the provider. In addition to collecting true prices, our website allows consumers to enter comments and recommendations for each provider. Today, many health care sites provide recommendations and content on providers and treatment. We suggest you refer to these sites for further research. ( top )
- How do I register?
It’s easy. Select the “Register” link in the upper right hand corner. A registration form will be displayed, and you will be prompted to enter the following information about yourself: e-mail address, create a password, year you were born, and your zip code. ( top )
- Do I have to register before adding a visit to the directory?
Registration is not necessary to add a vist. ( top )
- How do I enter a “visit” to your directory?
Just select the link, add a visit, to access the form that allows you to “Add Your Visit.” A wizard will guide you through the steps and prompt you for the information required. When you are finished, you select the “submit” button and receive confirmation of your information entered. Your visit will be available for other consumers to search and compare costs. There is a slight delay while the database indexes your visit information. ( top )
- What is the difference between “list price”, “true price” and “out-of-pocket” amount?
When you enter a visit, you are prompted to enter three different amounts: (1) list price, (2) true price, and (3) out-of-pocket amount.
The list price is also known as the, “retail price”. It can be compared to purchasing a car where the list price is the sticker price. Most people don’t pay the sticker price for a car, they negotiate.
For healthcare services, insurance companies don't pay the list price, they negotiate pricing. The negotiated price is what we refer to as the “true price”.
List prices are often a wildly inflated over the negotiated prices. Unfortunately, the uninsured, unable to benefit from insurance companies' negotiations, are often charged the list price. So those that can least afford it are charged the highest prices for healthcare.
The out-of-pocket amount is the actual amount you paid the provider. This may or may not be the same as the “true price”. If you have a co-pay, or coinsurance, or have met your deductible, your out-of-pocket could be significantly less than the “true price”. Consumers with traditional health insurance plans might have an out-of-pocket of zero for the visit. On the other hand, consumers with a high-deductible plan or without insurance will pay for the entire service themselves and in this case the “true price” and out-of-pocket amount with be the same.
When you add your visit to the directory, keep in mind that consumers who will be using this directory will not necessarily have the same insurance, deductible, co-pay, or coinsurance as you. When you enter your list price, true price, and out-of-pocket information, think of how other consumers could benefit from your information. If you have any questions, please contact us at mona.lori@outofpocket.com. ( top )
- Do you sell this information?
No. Your information is completely confidential. We do not sell your registration information or the provider and price information in the directory. ( top )
- How accurate is this data?
The visit data in our directory is entered by consumers like you to share with other consumers. We do not validate any of this information. We have found that most consumers are very happy to share this price information to benefit other consumers. They have no desire, and there is no benefit to misrepresent the information.
The information provided on OutofPocket.com is not intended to be a substitute for professional advice. We cannot guarantee that all the information provided on this site is accurate or complete. Moreover, changes in information resulting from ongoing research and price changes may affect the timeliness of the information provided. ( top )
- Am I allowed to print (or download) out-of-pocket cost information from the directory?
The OutOfPocket.com directory is for your personal, non-commercial use only. OutOfPocket.com authorizes you to view or download a single page of the material on the website solely for your personal, noncommercial use. If you have any questions, please contact us at mona.lori@outofpocket.com. ( top )