Frequently Asked Questions

It is any healthcare service that can be scheduled by the patient in advance. Magnetic resonance imaging, cataract removal and computerized tomography scans are some of the most commonly shopped healthcare services. Consumers who participate in high-deductible health plans most commonly engage in comparison shopping for healthcare services.

Shopping for healthcare services is not limited to price considerations alone. Other factors such as quality and distance to provider can be considered by the consumer.

HDHPs are defined by the Internal Revenue Service (IRS) as any health insurance plan with a deductible of at least $1,400 for an individual and $2,800 for a family. Yearly out-of-pocket expenses (deductibles, co-payments and coinsurance) in 2022 cannot exceed $7,050 for an individual and $14,100 for a family.

HDHPs now constitute the fastest growing percentage of all employer-based health insurance plans.

HSAs are tax-advantaged enrollee-owned accounts that let you save pre-tax dollars for future qualified medical expenses. They are required to be paired with a HDHP with the tradeoff of significantly more first-dollar, out-of-pocket medical expenses.

Due to its tax-advantaged status, HSAs have proven to be an attractive option for health plan enrollees who are also enrolled in a HDHP. In 2022, the limit on HSA contributions will be $3,650 for an individual and $7,300 for a family.

CPT® codes are five-digit identifiers that form the universal system describing and reporting medical services for payment. Created more than 50 years ago by the American Medical Association (AMA), these five-digit codes are used by consumers to make medical service purchasing decisions. Click here for additional CPT® code information.

The negotiated insurance price is the contracted amount of payment between your health insurance plan and a provider for an outpatient healthcare service. Your financial responsibility is dependent on your health insurance plan benefits. If you have not reached your health insurance plan deductible limit or have additional cost sharing responsibilities such as copayments or coinsurance, your financial responsibility will be based on this negotiated insurance price.

The discounted cash price is the charge that applies to an individual who pays cash (or cash equivalent) for a healthcare service or procedure. Also known as the self-pay price, discounted cash prices are usually lower than insurance negotiated prices.

With the continued growth of high-deductible health insurance plans, consumers are shouldering an ever-increasing load of upfront healthcare expenses. If you are a participant in one of these plans you are responsible for upfront healthcare expenses until your deductible and cost-sharing limitations are met. With the federal government now mandating that hospitals publicly post insurance plan specific prices for healthcare services, consumers who participate in these plans can now consider price, in addition to other factors, when making healthcare purchasing decisions.

Enrollees in high-deductible health plans have a strong financial incentive to shop for healthcare services. At a minimum, there are currently 73 million enrollees in high-deductible health plans. These plans have considerable cost sharing responsibilities with out-of-pocket expenses of up to $7,000 for an individual and $14,000 for a family in 2021.

Similarly, participants in short-term medical plans typically have a large incentive to shop for medical care. Designed as a safety net to fill short-term gaps in coverage, these plans can have deductibles of up to $10,000.

Uninsured consumers can also benefit by making healthcare decisions based on the right information. HealthPriceCompare includes the discounted cash price that providers offer to uninsured, self-paying or out-of-network consumers who are willing to pay cash or its equivalent for healthcare services.

Your physician should provide you with a written order for the service you need. This physician’s order should consist of a a five-digit CPT® code along with a description of the requested service.

Input the desired zip code, procedure description or five-digit CPT® procedure code then select your insurance plan or the discounted cash price option to be instantly provided with price, distance to provider and quality information for a range of providers. You can expand the geographic range of your search by up to 50 miles.

©2022 HealthPriceCompare LLC - All Rights Reserved.
CPT© copyright 2022 American Medical Association. All Rights Reserved.