15 Healthcare Terms You Need to Know

15 Healthcare Terms You Need to KnowThe words and terms used in the healthcare payments industry, for even the most experienced consumers, can seem like a foreign language. We want to make it less complicated. The better you understand the common terms thrown around in the healthcare space, the better prepared you are to secure the healthcare you deserve.

That’s why we’ve curated some of the most important healthcare terms from reliable sources for you. The following terms are defined by the Centers for Medicare and Medicaid Services (CMS) and Healthcare.gov.

  1. Allowed Amount
    • The maximum amount a plan will pay for a covered healthcare service. This may be called “eligible expense,” “payment allowance” or “negotiated rate.” If your provider charges more than the allowed amount, you may have to pay the difference out of pocket.
  2. Balance Billing
    • When a provider bills you for the difference between the provider’s charge and the allowed amount. The amount shown on this bill indicates the total out-of-pocket expense you should contribute for that service.
  3. Copayment
    • A fixed amount (e.g. $15) you pay for a covered healthcare service. Generally, plans with lower monthly premiums have higher copayments, and plans with higher monthly premiums have lower copayments. The copayment for a High Deductible Plan only activates once you meet the deductible.
  4. Deductible
    • The amount you pay annually for covered healthcare services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services out of pocket. After you pay your deductible, you usually pay only a copayment or coinsurance for covered services. Your insurance company pays the rest.
  5. Episode of Care
    • The total set of services needed to provide treatment for a specific condition.
  6. Grievance
    • A complaint that you communicate to your health insurer or plan.
  7. High Deductible Health Plan
    • A plan with a higher deductible than a traditional insurance plan. The monthly premium is usually lower, but you pay more healthcare costs yourself before the insurance company starts to pay its share (your deductible). The IRS defines a high deductible health plan as any plan with a deductible of at least $1,300 for an individual or $2,600 for a family.
  8. In-network Providers
    • Healthcare providers (e.g. physicians) or facilities that contract with your health insurance or plan. In-network expenses are typically lower than out-of-network expenses.
  9. Medicare
  10. Out-of-network Providers
    • Healthcare providers (e.g. physicians) or facilities that do not contract with your health insurance or plan. Your insurance may still pay a certain amount of out-of-network expenses, but overall out-of-network expenses are typically higher than in-network expenses. The remaining out-of-pocket balance, not covered by insurance, is referred to as balance billing.
  11. Out-of-pocket Costs
    • Your expenses for medical care that aren’t reimbursed by insurance. Out-of-pocket costs include deductibles, coinsurance, and copayments for covered services plus all costs for services that aren’t covered. If you are uninsured, all medical expenses are considered out-of-pocket costs.
  12. Pre-existing Condition
    • A health problem you had before the date that new health coverage starts, including common conditions such as asthma, cancer and heart disease.
  13. Premium
    • The amount covered individuals pay for their health insurance every month.
  14. Provider
    • A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine), healthcare professional or healthcare facility licensed, certified or accredited as required by state law. Providers help us get the healthcare treatment we need to get better and stay healthy.
  15. Specialist
    • A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of healthcare.

Although this list isn’t comprehensive, it’s a great starting point to keep your mind at the forefront of financing the unexpected. Find exact healthcare costs today.

Our information on healthcare costs may differ from fees paid through a health insurance plan. The fees may differ for each insured person, and may be lower or higher than the actual costs listed in the service. If you are covered under a health insurance plan, please check with your health insurance network to compare the amount of the service cost(s) your insurance will cover with the service cost(s) listed on HealthCost.com.

Any views or opinions represented in this blog are personal and belong solely to the blog owner and do not represent those of people, institutions or organizations that the owner may or may not be associated with in professional or personal capacity, unless explicitly stated. All content provided on this blog is for informational purposes only. The owner of this blog makes no representations as to the accuracy or completeness of any information on this blog or found by following any link on this blog. The owner will not be liable for any errors or omissions in this information nor for the availability of this information. The owner will not be liable for any losses, injuries, or damages from the display or use of this information.

HealthCost: The Network for Everyone Else

The statistics from the Kaiser Family Foundation and CDC speak for themselves. Too many Americans are left paying excessive costs for healthcare services. They’re either completely uninsured or they fall within a network with extremely high deductibles that force them to pay heavy out-of-pocket expenses for their healthcare needs.

HealthCost is giving the power back to the consumer by providing a searchable database for these families and individuals to make informed decisions.

With HealthCost, you can search for a specific medical procedure, imaging procedure or specialty physician to find the doctor you want at the cost you need.

Any views or opinions represented in this blog are personal and belong solely to the blog owner and do not represent those of people, institutions or organizations that the owner may or may not be associated with in professional or personal capacity, unless explicitly stated. All content provided on this blog is for informational purposes only. The owner of this blog makes no representations as to the accuracy or completeness of any information on this blog or found by following any link on this blog. The owner will not be liable for any errors or omissions in this information nor for the availability of this information. The owner will not be liable for any losses, injuries, or damages from the display or use of this information.

Where to go When the Doc is Out: ER v. Urgent Care Costs

There is often a level of uncertainty when you’re unable to book an appointment with your regular doctor – should you visit an emergency room (ER) or an urgent care facility? Both have their benefits, but the real kicker comes with cost. Of course, if your symptoms seem life-threatening, you should always seek out the ER or dial 911. However, there are often symptoms of non-life-threatening conditions—that always seem to pop up on the weekend or after office hours—that urgent care facilities can treat at a fraction of the cost.

Debt.org, using Medica data, brings some of these cost differences to life in the graph below.

In 2013, some of the leading principal reasons for ER visits were stomach and abdominal pains (10 million), coughing (5 million), fevers (4.6 million) and vomiting (2.8 million) – each of which can be treated at an urgent care facility or separate private practice (depending on severity). This information, combined with the graph above, raises the important question: Why you are seeking treatment in the first place? Again, if the answer is for life-threatening symptoms or injuries, go to the ER or call 911. For anything else, the alternative may be your best bet.

Reasons to visit the ER:

  • Severe chest pain
  • Severe abdominal pain
  • Wheezing or shortness of breath
  • Paralysis
  • Intestinal bleeding
  • High fevers (over 103) or rash, especially among children
  • Vaginal bleeding with pregnancy
  • Uncontrollable vomiting
  • Poisoning
  • Severe head or eye injuries
  • Allergic reactions
  • Unconsciousness

When to seek alternative options:

  • Minor abdominal pain
  • Fevers, flu or cold symptoms
  • Vomiting or diarrhea
  • Ear infections
  • Seasonal allergies
  • Bronchitis
  • Sprains and broken bones
  • Cuts and bleeding that may require stitches
  • Breathing discomfort, such as moderate asthma
  • Urinary tract infections
  • X-rays and lab tests
  • Minor neck pain

(Source: El Camino Hospital)

How HealthCost can help.

Even once you deem your symptoms unnecessary for the ER, large gaps in cost between urgent care facilities and private practices can still occur. HealthCost helps you bridge this gap by providing the tools you need to shop for healthcare services in advance. By using HealthCost, you can see specialists, procedures and facilities available in your area in real time with the price tag attached.

Below are some of the most common specialists and procedures searchable through HealthCost.

Specialists:

  • Allergist/Immunologist
  • Infectious Disease Specialist
  • Sports Medicine Specialist
  • Family Practitioner
  • Internist
  • Pain Management Specialist
  • Endocrinologist
  • Vascular Surgeon
  • Neurologist
  • Urologist
  • Gastroenterologist

Imaging Procedures:

  • X-ray (ankle, arm, hand, hip, pelvis, chest, leg, foot, skull)
  • Ultrasound Imaging
  • Breast imaging
  • CT Imaging
  • Radiography sinuses
  • Magnetic resonance imaging (MRI)

With a resource like HealthCost, it pays to stay informed. Start your search today.

Any views or opinions represented in this blog are personal and belong solely to the blog owner and do not represent those of people, institutions or organizations that the owner may or may not be associated with in professional or personal capacity, unless explicitly stated. All content provided on this blog is for informational purposes only. The owner of this blog makes no representations as to the accuracy or completeness of any information on this blog or found by following any link on this blog. The owner will not be liable for any errors or omissions in this information nor for the availability of this information. The owner will not be liable for any losses, injuries, or damages from the display or use of this information.

Let’s Address the Cost of Care

By Douglas Tardio, HealthCost Founding Partner

The Wall Street Journal recently published an article discussing 2018 projected healthcare premium increases. It states that, on average, insurers will ask for a 20 percent increase in premiums, with some asking for over 50 percent. Before we get lost in the numbers, let’s consider a few points:

  1. Annual premium increases are not new
  2. They are not a one-time event while the market re-stabilizes
  3. The lack of clarity on future subsidies are not driving them
  4. “All the healthy people” that haven’t purchased insurance are not to blame for rising premiums

The Kaiser/HRET of Employer Sponsored Health Benefits (1994-2004) provides some clarity. Keep in mind that employer-sponsored plans have little or nothing to do with Obamacare or the Exchanges. These plans aren’t new, and they still cover a majority of the insured consumers in the country (roughly 147 million v. 20 million for ACA exchange plans). Below is a graph from Kaiser/HRET to better understand the changes in premiums over the years.

And yes, while you might not see a 50 percent jump in any one year for employer-sponsored plans, one thing is clear: The true answer lies in the access to and cost of care. By access, I don’t mean access to insurance – I mean access to healthcare services. Let’s look at drugs, for example. Direct-to-consumer advertising of drugs was legally approved in 1985, but rapidly accelerated in 1997 with FDA review. Today, if you watch the nightly news, you understand the impact to access this has made. If not, “go ask your doctor about it.” And second, the cost of healthcare services. Again, drug cost increases lead the way, but they are often followed by inpatient hospital cost increases. For example, aligned with the acceleration of direct-to-consumer drug advertising, the U.S. Bureau of Labor and Statistics found a 195 percent inpatient hospital cost increase from 1997 to 2016.

The problem is that we don’t find out about the majority of these cost increases until after services are performed. At that point, there is little you as a patient can do. But there is a lot Congress can do, if they would only stop for a moment and address the cost of care.

Any views or opinions represented in this blog are personal and belong solely to the blog owner and do not represent those of people, institutions or organizations that the owner may or may not be associated with in professional or personal capacity, unless explicitly stated. All content provided on this blog is for informational purposes only. The owner of this blog makes no representations as to the accuracy or completeness of any information on this blog or found by following any link on this blog. The owner will not be liable for any errors or omissions in this information nor for the availability of this information. The owner will not be liable for any losses, injuries, or damages from the display or use of this information.

Any views or opinions represented in this blog are personal and belong solely to the blog owner and do not represent those of people, institutions or organizations that the owner may or may not be associated with in professional or personal capacity, unless explicitly stated. All content provided on this blog is for informational purposes only. The owner of this blog makes no representations as to the accuracy or completeness of any information on this blog or found by following any link on this blog. The owner will not be liable for any errors or omissions in this information nor for the availability of this information. The owner will not be liable for any losses, injuries, or damages from the display or use of this information.

The Reality of Healthcare Pricing: Price Variance

By HealthCost

Price variance is the term used to describe price differences for the same medical procedure from one facility to another. Customers expect pricing to be consistent. Imagine the controversy if residents of California were expected to pay 400 times more for a gallon of gas than those in New York were expected to pay!

The secret to eliminating price variance in healthcare is in price transparency. HealthCost.com shows you actual costs for actual procedures. Using data from HealthCost, below are five of the most cost variant procedures in the United States.

Any views or opinions represented in this blog are personal and belong solely to the blog owner and do not represent those of people, institutions or organizations that the owner may or may not be associated with in professional or personal capacity, unless explicitly stated. All content provided on this blog is for informational purposes only. The owner of this blog makes no representations as to the accuracy or completeness of any information on this blog or found by following any link on this blog. The owner will not be liable for any errors or omissions in this information nor for the availability of this information. The owner will not be liable for any losses, injuries, or damages from the display or use of this information.

Talking Costs with Your Doc Shouldn’t be Awkward

By Russell A. Amico, M.D., HealthCost Co-Founder

When it comes to most of the major purchases we make, we readily discuss and often negotiate the cost with a seller. Think, for instance, about used or new cars. We also turn to online resources to find the best deals on a whole host of purchases, from books to hotel rooms. Yet, when it comes to healthcare costs, most of us have somehow come to believe two things—the cost is what it is and it’s inappropriate, or even rude, to talk about anything related to costs with our healthcare providers. Both are inaccurate and don’t do any good.

What you pay for healthcare services⎯be it a doctor’s visit, an imaging procedure or a surgery⎯can vary greatly. Two healthcare providers located on the same block may be close in proximity but miles apart in their pricing. For instance, in one American city, the cost of a diagnostic colonoscopy can range from $1,900 to over $8,000! Which would you rather pay? In some cases, you may want to pay more for an experienced surgeon. In other cases, you may want to know that a more reasonable MRI can be had at a facility a little further down the street. The key is there are choices, and you should be aware of them.

So, when pricing can vary this much, it’s in our best interest to ask about it. Yet, we often don’t talk costs with our doctors and other healthcare providers. We’ve been conditioned to think that it’s somehow wrong to do so. But this just isn’t the case! Our beloved capitalistic system depends on open, free markets with transparent pricing. Besides, every consumer has the right to know just what they’re paying⎯for every single thing they buy, including healthcare. None of us should hesitate or feel the least bit awkward about asking what healthcare services cost. Remember, the answer may mean keeping hundreds, if not thousands, of dollars in your own pocket.

So how do you inquire about costs? Here are some tips:

  1. Clear your inhibitions. As noted above, the first step is to abolish any notion that discussing pricing is wrong. It’s not!
  2. Negotiate. Before you schedule an office visit or procedure, ask about the cost. Regardless of what you’re quoted, ask if there’s any “wiggle room.” For instance, if you don’t have insurance, can they reduce the price if you pay cash?  If you do have insurance, see if they are open to accepting whatever your insurance covers with no additional out-of-pocket costs. Remember, it can’t hurt to ask.
  3. Do additional research. Don’t book the appointment or procedure based on your initial conversations. Instead, tell them you’ll get back after doing some price checking. This sends a si
  4. gnal to the healthcare provider that cost matters and you’re shopping around. Search this site, HealthCost.com, and compare prices from other providers in your area. You’ll likely be able to negotiate a lower payment than what was originally quoted.
  5. Make an informed decision. Armed with this insight, you can then choose a provider based on his or her qualifications and your budget.

Here’s the bottom line: It’s your health and your money. You have a right to know everything the doctor does regarding your health. And you have every right to know what caring for yourself or a loved one is going to cost.

So, ask away.

Any views or opinions represented in this blog are personal and belong solely to the blog owner and do not represent those of people, institutions or organizations that the owner may or may not be associated with in professional or personal capacity, unless explicitly stated. All content provided on this blog is for informational purposes only. The owner of this blog makes no representations as to the accuracy or completeness of any information on this blog or found by following any link on this blog. The owner will not be liable for any errors or omissions in this information nor for the availability of this information. The owner will not be liable for any losses, injuries, or damages from the display or use of this information.

Physicians Can Now Use Technology to Set Rates

By Douglas Tardio, HealthCost Co-Founder

The healthcare system is broken—not just for patients, but for providers as well. Until now, there has never been an open or straightforward way for doctors and healthcare professionals to adjust their own fees or share their actual pricing with their patients. The process has been mostly one-sided for decades. Providers participate in health plan agreements to gain access to commercially insured patients. But commercial insurance has held all the cards. Reimbursements to providers are complicated and rate structures are proprietary. In the end, the physician has little to no control over their rates, how they’re reimbursed for the services they perform and, worse, they have no control over what patients they see. Why? Because the uninsured can’t afford the prices dictated by the government and insurance groups, and they’re limited in seeing only patients within the insurance networks they have joined.

We have a solution—a way to open the restrictions and put the physician and the patient back in control.   

HealthCost, the first network offering healthcare providers the freedom to set and manage their own network prices, is changing all of this. Through HealthCost.com, providers join an open, transparent network where pricing data is readily available to any consumer. HealthCost providers then have the freedom to market their own services to new consumers no matter how, or if, they are covered under insurance. Healthcare providers can now expand beyond their current health plan networks and reach new, traditionally unreachable patients. Now providers can reach the millions of uninsured, self-insured small business, out-of-network and other self-pay consumers.

A vet charges more on the weekends. Why isn’t it the same for doctors?

It’s fairly standard that a visit to the vet is more expensive on the weekends and holidays. The same is true for many other products and services. Pricing varies throughout the week and by location when booking an airline ticket, for example. Shouldn’t these free market principles be the same for doctors and medical professionals?

As part of a free market, healthcare providers should be free to entice consumers with fair market pricing, based on value and demand, not predetermined pricing. Why shouldn’t providers have the freedom to flex when they need to? Just like every other category in our free market, providers should be able to offer lower rates for procedures on days when demand is low or higher rates when demand is high.

Register with HealthCost.com Today

Are you a healthcare provider who wants to gain control of your rates and meet new patients? It’s easy to become a HealthCost Networks provider. Simply visit our provider page and click the “Join Now” button. You’ll be able to fill out a simple form to enter our system and begin the registration process. Once registered, you will be able to check your published rate and make changes as you see fit.

There are upwards of 50 million people that aren’t being reached by healthcare providers today. We believe that when providers control their own rates and patients are given the knowledge they need to make the best healthcare decision for themselves and their families, everyone wins.

Any views or opinions represented in this blog are personal and belong solely to the blog owner and do not represent those of people, institutions or organizations that the owner may or may not be associated with in professional or personal capacity, unless explicitly stated. All content provided on this blog is for informational purposes only. The owner of this blog makes no representations as to the accuracy or completeness of any information on this blog or found by following any link on this blog. The owner will not be liable for any errors or omissions in this information nor for the availability of this information. The owner will not be liable for any losses, injuries, or damages from the display or use of this information.

My Penicillin Will Cost What?

By Douglas Tardio, HealthCost Co-Founder

It’s been 75 years since the miracle drug Penicillin has hit the market. This got me thinking. With the media spotlight shining brightly on the cost of drugs in recent months, I wondered just how much this universally known, widely available drug might actually cost today.

My research began where most Americans start their search—Google. After typing “cost of penicillin” into my browser, the first site brings me to a list of what it calls “fair prices,” ranging from $8 for Amoxicillin all the way up to $1,324 for Bicillin. Wow, that’s the difference between buying lunch and making a mortgage payment for many Americans.

Maybe a general Google search isn’t the right approach. So, I moved on and went directly to the U.S. Food and Drug Administration (FDA) website.  After all, they are the federal agency with “drug” in their actual name. Surely, they can give me a price, right?  My search resulted in numerous official-looking meeting notes from as far back as 2000. However, after scanning hundreds of pages—nothing on the cost of penicillin.

So why is this so hard? Why can’t we do a simple search to find the cost of a drug, whether it’s Penicillin or its various derivatives? There were so many that I had to find another clinical website just to identify all of them.  By now, I’m more than frustrated that I won’t ever be able to find out the real cost of a single dose of Penicillin. But I gave it one more shot and went straight to a drug manufacturer’s website. Finally, I found a price. But…only for the price of the company’s stock. I give!

So, what is my point? Whether you’re searching for the cost of a drug or a healthcare procedure, the experience is the same. Costs are hidden. No one knows exactly what they’re paying for and everyone gets frustrated. I’ve been in the healthcare industry for 25 years. Understanding why the public is not informed on the costs of healthcare procedures and drugs has baffled me for decades. Which is why my partners and I decided to tackle the issue of bringing price transparency to the market. Although we haven’t tackled the cost of drugs, what we have brought you is a searchable database where you can find the exact cost of a healthcare procedure (from an appendectomy to an x-ray) or an office visit (whether that’s with an allergist or a vascular surgeon) so that you can make an informed decision about who you see and what you can afford.

Any views or opinions represented in this blog are personal and belong solely to the blog owner and do not represent those of people, institutions or organizations that the owner may or may not be associated with in professional or personal capacity, unless explicitly stated. All content provided on this blog is for informational purposes only. The owner of this blog makes no representations as to the accuracy or completeness of any information on this blog or found by following any link on this blog. The owner will not be liable for any errors or omissions in this information nor for the availability of this information. The owner will not be liable for any losses, injuries, or damages from the display or use of this information.

Imaging Procedure Costs Now Searchable

By Douglas Tardio, HealthCost Co-Founder

We’re constantly adding data and making improvements to HealthCost.com to enhance the shopping experience for healthcare procedures and office visits. For this reason, we’re thrilled to now offer imaging services to our searchable database.

With 34 searchable imaging categories, including more than 300 procedures, you can now comparison shop for imaging services.

What can patients search for?
With the addition of imaging procedures, HealthCost now shares the exact costs nationwide for:

  • 64 episodes of care categories with nearly 850 specific procedures
  • 47 categories of specialty providers
  • 34 imaging categories with more than 300 procedures

The launch of imaging data includes private practices and imaging facilities and will soon integrate outpatient hospital imaging. Although there are other search tools available, HealthCost is the only search tool offering exact pricing; other search tools simply offer average or estimated costs on a local or regional basis. With HealthCost, you can compare per doctor, per facility and make an informed decision on the care you’d like to receive.

And consumers aren’t the only ones to benefit.
Take, for example, a free-standing imaging facility across the street from a hospital. Both offer the same services, but the former may be one third less than the cost of the hospital. With exact rates in easy view, HealthCost not only helps consumers make decisions, but also offers providers the freedom to set their own HealthCost NetworksSM rates and promote their offerings (in terms of specific equipment they use or their individual expertise). We want to strengthen a healthcare provider’s ability to operate in the free market, and providing clear and explicit communication between providers and consumers is the first step.

Where does HealthCost get the quality and pricing data?
HealthCost quality and pricing information is sourced from publicly available information that originates directly from the Centers for Medicare & Medicaid Services (CMS), the entity that sets reimbursement rates for doctors and hospitals. Although this data is available to the general public, it is not easily accessible or understood. HealthCost has tackled this big data challenge and solved it with a user-friendly, free-market solution, available to anyone with internet access or a smartphone.

Millions of Americans are faced with high-deductible plans or are completely uninsured – forcing them to pay for healthcare expenses out of pocket. Before HealthCost, there was no way to shop, compare and understand what they were paying before multiple unexpected medical bills arrived in the mail. We’ve changed all of this by giving exact pricing information in advance.

This is the first time this has been done, and it’s about time. Start your search today.

Any views or opinions represented in this blog are personal and belong solely to the blog owner and do not represent those of people, institutions or organizations that the owner may or may not be associated with in professional or personal capacity, unless explicitly stated. All content provided on this blog is for informational purposes only. The owner of this blog makes no representations as to the accuracy or completeness of any information on this blog or found by following any link on this blog. The owner will not be liable for any errors or omissions in this information nor for the availability of this information. The owner will not be liable for any losses, injuries, or damages from the display or use of this information.