Pratter is significantly different and better and the cost tool estimators do not do what we do.
Warning: don’t be fooled! Think hard about the following points:
a. Why do insurance companies provide estimates when they are the ones who wrote and own the contracts with hospitals for pricing?! They wrote the contract with the exact dollar amount - so why the “wrong estimate?"
b. Why do insurance companies provide ranges (e.g. $400 - $800; a big range for a test) when they are the ones who wrote and own the contracts with hospitals for pricing?! Do you buy anything else with a range? They wrote the contract with the exact dollar amount - so why the “big range?"
c. NO hospital charges are included. The consumer needs the charge because 20% of claims are denied. And then that charge is the consumer’s bill. If the medical facility is out of network, then a 40% coinsurance of that high charge instead of an in network 20% is the consumer’s bill. Pratter refers to this hospital charge (sticker price) as one half of the Holy Grail of cost transparency.
d. No insurance company payment (aka negotiated discount price) is included. If a health insurance company pays $900 for a lumbar spine MRI to Hospital X then consumer Y should pay $900 - and never more - but it doesn’t work like that now. Pratter refers to this payment amount (aka fair market value price) as the other half of the Holy Grail of cost transparency.Self-insured companies pay for their employees’ health care. They deserve to know this fair price.
By hiding this fair market cost of care, the insurance company states they get to keep their “competitive advantage.” Translation: they are taking care of themselves - not you, the health plan bill payer, aka the employer and employee consumer.
e. Some exclude surgery centers. Why? Because they compete with hospitals and insurance companies need hospitals – not surgery centers - to insure bodies to generate big revenue. This means that the insurance cost estimator tool has incomplete data and does not provide you with all in-network medical provider estimates.
f. They don’t include out-of-network providers. In many instances, it is worth big money to go out of network for consumers with high deductibles. Business is conducted to steer you where to go for care, and not necessarily in the best interest of your family budget. This is especially true for “integrated” hospital systems – the word for when the insurance company and hospital are one and the same entity. In this circumstance, they want to keep your business in-house.
g. They have a limited number of medical procedures in their search engines, which are not as friendly, or procedure loaded, as Pratter.us.