Consumer Website Tools Available through This Website
What will I find on this website?
This website is here to help both insured and
uninsured
people make decisions about healthcare. The cost
lookup tool shows you
what medical
and
dental care cost in your area. At this time, we have cost estimates for:
-
Thousands of medical and dental services (professional fees);
-
Medical supplies (e.g., diabetes supplies, walkers, canes, vision supplies, hearing
aids);
-
Anesthesia services;
-
Ambulance rides; and
-
Telehealth services;
-
Urgent care services;
-
Shoppable services; and
-
Services done in a facility (e.g., hospital or ambulatory surgery center).
The educational
resources help you
choose a health plan, pick a doctor, understand your healthcare bills, negotiate prices
with your
provider,
appeal your plan's payment, plan your costs in advance and more.
This website allows you to search for:
-
How much you might pay for a medical or dental service if you're
uninsured.
-
Out-of-network costs that you may pay if you go to doctors who are
not in your
health
plan's network.
` -
In-network costs. You can estimate how much you may have to pay for
doctors in
your
health plan's network if you haven't met your deductible.
- The average allowed amount for dental services
-
Costs and other information related to FH® Total Treatment
Cost. Our
cost estimator can show you the overall cost you can expect to pay for the many
different
services, supplies, tests
and medications involved in caring for chronic conditions like type 1 or 2 diabetes,
acute
conditions like pregnancy and
event-based procedures like knee replacement, both in-network and out-of-network
care.
-
The basics of health coverage, from the differences among plan
types to how a
deductible works and more. Health insurance is very complicated, but our
educational articles, videos and glossary terms can help you better understand how
health
insurance works.
-
Where to get help. We provide links to health-related organizations
that can
help you.
-
Cost estimates for hospital stays.
-
Shared decision making decision aids for palliative care.
-
Costs by specific venue of care, including telehealth, urgent care,
hospital
and
ambulatory surgery center.
-
Costs for elective procedures (i.e., “shoppable services).
-
Costs for various medical supplies, accessories
and equipment.
The cost lookup tools and educational content on this site are also available in Spanish
(fairhealthconsumidor.org).
In addition, a mobile app, FH® Consumer Classroom, offers the website’s
educational
content—FH Insurance Basics,
resource links, glossary, healthcare quality toolkit—along with interactive puzzles in a
concise,
user-friendly format.
The app, which links to FAIR Health Consumer’s cost estimators and shared
decision-making decision
aids, is available from the App Store and Google Play
We've also created new features and educational content especially for New Yorkers. This
website
offers a new
healthcare planning tool developed by FAIR Health for New York State residents, with
support from
the
not-for-profit New York State Health Foundation. It features information on local
physicians and
other
healthcare providers who can provide some of the healthcare services or procedures found
on this
website. You
also can compare providers by price and certain practice features, such as the number of
years
they've been
in practice, their location, the hospitals they work at and their training. In the
future, the site
will also
feature quality and cost information for certain commonly performed hospital procedures
for
hospitals in
Westchester, Syracuse, Albany and Buffalo, New York.
Who can use this website?
Insured and uninsured consumers—patients and their caregivers—can use this website to
learn about
health insurance and
estimate their costs of care. It may be of particular use to people managing a
deductible, wanting
to learn more about
health insurance or looking for access to one of the FH Total Treatment Cost conditions
or
procedures. Before you
receive care, you can use the site to plan your costs or negotiate fees. After you
receive care, you
can use it to
negotiate payment or support appeals.
Do the medical cost estimates apply to people covered by Medicare, Medicaid or other
government
programs?
No. The cost estimates generally apply only to those covered by private insurance or
uninsured.
These cost estimates do
not apply to those covered by government programs such as Medicare, Medicaid or Tricare.
However, these cost estimates may be useful to you if you have coverage under a
government program,
but you are getting
care that is not covered by that program. For example, Medicare does not cover most
dental services.
If you have
Medicare and you need to see a dentist, you can find out how much you may pay. The
information on
the site also can help
you evaluate a Medicare Advantage plan that requires you to pay more for services
outside of the
plan's network.
Note: Some private insurers (i.e., non-government) use Medicare rates to set
out-of-network
reimbursement, which means
that the insurer will pay some percentage or multiple of what Medicare would have paid
for the
services. This is not the
same as being covered by Medicare. If your insurer refers to Medicare rates in this way,
you can use
this website to
estimate your medical out-of-pocket cost: on the cost results page, selecting the
appropriate option
under the
“Estimated Reimbursement” dropdown section under “Adjust Charge.”
I searched for a cost estimate and got "N/A." What does it mean?
If you see N/A (Not Available) after searching for a cost estimate, this means that we
cannot
provide at this
time a cost estimate for the procedure code in the geographic area you searched.
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