Today’s guest blogger, Robin Gelburd, responds to an article by Contributing Editor Shana Sweeney about her struggles with educating employees about the costs of out-of-network claims. Have you encouraged employees to use Fair Health’s consumer cost lookup tool? Share your thoughts in the comments. —Andrea Davis, Managing Editor
The topic of health care costs is front-page news. Calls for greater transparency in health care prices are a common refrain as the many parties in the nation’s health care system try to understand the observed variability in costs and outcomes. Such calls include the recent
In 2009, then-New York State Attorney General Andrew Cuomo uncovered conflicts of interest in how out-of-network claims were being reimbursed. As a result, FAIR Health was formed to establish and maintain a new database of health care claims information that could be used to help payors develop reimbursement rates for out-of-network services. Our second charge was to develop a free online tool that patients could use to research the cost of health care services in their area and generate estimates of their out-of-pocket costs should they seek services out-of-network.
Today, FAIR Health uses its database of over 16 billion billed medical and dental services to power its
Given the interest in making the cost of
We have approached the development of our Consumer Cost Lookup tool with great care, and have refrained from adding information that would be misleading or difficult to understand without the appropriate context. We have also consulted with health literacy experts to develop language on the site that contextualizes the estimates that we offer and to explain when consumers may need to seek additional information from their physician or providing facility. For employers, like Ms. Sweeney, who want to offer guidance for employees about plan selection and out-of-network decision-making, we license our data, in part so that these professionals can combine FAIR Health’s charge data with information specific to an employee’s health plan in order to ease some of these confusions.
Our cost estimates are based upon the rich repository of claims information that we oversee but, given our tool’s intended application to a general consumer audience, cannot incorporate patient-specific variables that might impact a bill. We nevertheless have confirmation from users that we are indeed providing them with critical building blocks to an accurate and informed estimate. In other words, the FAIR Health data may not be the "end of the discussion” for the consumer but may instead be a valuable starting point on the quest to gain clarity about anticipated costs for care. More importantly, it provides an accurate reference point and shines light on costs previously left opaque in the marketplace.
Cost transparency tools such as FAIR Health’s are critical first steps in the effort to provide clarity in health care costs to consumers, but we all have a long road ahead. We’re not alone – many organizations, including
Robin Gelburd is President of