Pricing Healthcare is a completely open, independent, online marketplace for direct-pay healthcare.
Our aim is to bring visibility to healthcare prices and make paying for healthcare more simple and direct. We believe this will do more
to lower costs and improve the quality of U.S. healthcare than anything else.
A growing number of medical and dental facilities are listing their prices and marketing their services on our site. They're
simplifying payment models and streamlining their processes in order to better compete for patient customers willing to pay
up front (and who don't require the filing of insurance claims). At the same time, patients and employers are increasingly turning
to facilities that publish affordable, bundled, direct-pay rates.
Access to our site is free and open to anyone in the world wanting to view prices and other information posted by healthcare
facilities throughout the U.S.
Who can benefit from this site?
Like any marketplace, our site benefits both buyers and sellers of healthcare. We help patients
find quality, affordable, direct-pay healthcare. We help providers by bringing awareness to their facilities and services,
and we are an important resource for employers and other organizations providing healthcare benefits for their members.
As cash rates come down to levels comparable with and in many cases lower than insured rates, it's not just the uninsured who
are interested in self-pay prices. More and more of the insured are interested in searching for and comparing healthcare providers on our site,
including patients with high deductible plans and those receiving care through employers. In fact, studies show a majority of patients in the U.S.
have a vested interest in finding more affordable care.
Pricing Healthcare helps consumers find providers of various specialties,
whether at home, away from home, moving to a new area, or wanting a change for a variety of reasons.
We're also working to help patients find information about quality of care and provider service quality.
Is access to all data totally free?
Yes. All content on our site is free for guests and registered users alike. This includes our growing provider
directories and all price lists published by medical or dental providers. Consumers and employers rarely have such great information
available free and clear out in the open. It's opening up healthcare interactions that would never have been possible otherwise.
What's the size of the direct-pay market?
A lot more than just the 40+ million or so uninsured have an interest in self-pay rates. 30-40 million in the U.S.
have high deductible insurance plans, including those with plans through government exchanges. A minority with high-deductible plans ever
reach their deductible, which means most of these are paying providers 100% out-of-pocket, and are very interested in lower rates.
Self-insured employers provide coverage for more than 100 million Americans, though many of them are not aware that their
employer pays provider bills rather than an insurance carrier.
On top of all this, in 2011 12% of all medical claims were out-of-network (not covered by insurance rates), and that will only increase
as Obamacare causes insurance networks to shrink. A growing number of physicians and practices are also moving to stop accepting
new Medicare/Medicaid patients, and hundreds are converting to cash-only practices in all 50 states.
Can a primary care physician use Pricing Healthcare when referring patients?
Yes. While many are predisposed to refer within their employer's health system or to facilities in which they
have an ownership stake, many are independent-minded and are increasingly looking out for the financial concerns of their patients.
As long as a patient understands that paying direct may mean the cost won't be applied to their deductible, there are no legal or
ethical issues with a physician referring to a direct-pay provider on our site.
Patients are becoming more and more comfortable asking about cost when being referred somewhere by their doctor.
The providers on our site are some of the highest quality in the nation, and referring physicians, patients, and employers are
beginning to recognize this. It is also becoming more widely understood that alternative facility types can have much lower cost
What services does Pricing Healthcare offer providers?
Here are a few of the services we offer healthcare providers willing to publish prices on our site
(contact us for more information):
Dedicated custom pages, open to the world
A unique, custom url to a provider's dedicated pages (i.e. pricingHealthcare.com/prices/FacilityName)
Pages are completely open & free to access, optimized for search engine traffic, and easily located by state and metro area on our site
Facilities determine prices, descriptions, which services are listed, and can update any of that information at any time, as often as needed.
All content changes are previewed and approved by the client before going live
Each dedicated facility page includes the facility's logo, contact info, a link to theh facility's website (optional),
easy-to-navigate categories and user-friendly procedure titles, custom descriptions with embedded links for each procedure (optional),
custom content (i.e. explaining all services provided and promoting the facility’s quality, service, awards, etc.),
who qualifies for the pricing and any disclaimers, what is and isn't included in the price
Facilities may list any applicable medical codes (some codes may be restricted to viewing by registered users only due to licensing terms)
Employer & consumer outreach and marketing
We provide targeted local, national, and international marketing for a facility, including press outreach, social media marketing,
organic search optimization, paid search ads targeted to nearby locales for services listed, and various other advertising channels
We locate and work with employers to send their local employees to your facility pages
We connect to employers by locating and working with multiple local, regional, and national TPAs with employer clients who have
covered lives in a facility's area
We work with other organizations, including labor unions and national groups of self-pay patients (i.e. health sharing ministries),
to promote facilities on our site
How does Pricing Healthcare bring new patients to listed providers?
We target a number of channels on behalf of providers to reach patients most likely to have an interest in paying direct for care.
TPA and employer outreach is our primary method. Self-insured employers are on the hook for an employee's entire medical bill, so they have a
great interest in lowering rates and giving their employees greater choice. We have a number of these we're talking to, and their interest is
accelerating. Our organic search optimization and paid search ads target those looking for cost information on specific procedures
listed by each facility. We add to that other forms of advertising, and we connect with relevant organizations to find those interested in direct-pay.
For a more broad reach, we also contact media and press in local markets, as well as nationally.
Pricing Healthcare brings awareness to a facility to a large audience, but we do not get in the way of relationships between
providers and patients. Patient scheduling and payment is done directly with the facility itself.
Why do employers have an interest in cash prices?
Lower rates, plain and simple
Self-insured employers have a very big interest in direct rates because they tend to be so much lower than what patients can get through insurance.
Some people are confused by this. Aren't insurance carriers supposed to be negotiating the best rates, leveraging the volume of their
plan holders? Here's why direct rates today are so much cheaper.
Direct pay rates are not the same as charged amounts
First, a little primer on payment types. American healthcare is set up to use third party payers (insurers), which has created a lot of
inefficiencies and gamesmanship in healthcare as a whole. Standard practice is for a
charge amount or list price to be set outrageously high by hospitals and other facilities, to give the illusion that insured rates
are heavily discounted, and to provide an incentive for patients to obtain insurance. Insurers are more likely than uninsured individuals
to pay for higher bills.
For several decades, facilities have had much lower rates for those few willing to pay cash up front. This is actually
the preferred way for providers to do business. With the risk of non-payment gone, the rate can come way down. Providers today are
spending so much money trying to collect from carriers and patients with deductibles, that getting paid up front
saves them a huge amount.
Insured rates keep rising
As large health systems grow, and there is more consolidation in the healthcare industry, insurance companies are losing their negotiating power.
Large systems have been increasing rates as their influence increases, sometimes by double or triple. And the insurance carrier, if it has
not already bought or been bought out by the health system, has little say in what prices should be.
94% of large employers and a majority of all employers have become self-insured over the last 15 years to cut costs (the employer
retains any margins otherwise kept by the insurer). And despite success in
lowering health benefit infrastructure costs, overall healthcare costs are still on the rise for them, around 4-8% annually, far outpacing inflation
(and employee wages). Last year 8% of total employee costs in the U.S. were for health benefits. A large reason for this is procedure
Insurance infrastructure is expensive on both sides of the transaction
A big part of healthcare costs for employers is still rooted in insurance. Being self-insured doesn’t mean independence from
insurance carriers. Self-funded employers spend large sums to rent insurance networks to get negotiated rates,
and pay hefty fees to TPAs to administer claims made more complicated by insurance (hundreds of dollars per claim).
Insurance-related costs are so high (estimated at 19 to 30% of total costs for care), that providers could actually charge more in a
direct-pay world than for the same procedure through insurance, and the employer would spend less overall.
Providers also have high costs (and rising) associated with insurance (administrative overhead for doctors and staff, complex
claims and billing, not to mention collections). Provider profit margins are higher and cash flow improves when someone pays direct,
even if the cash-pay sticker price for a procedure is lower than a rate negotiated through insurance.
A direct-pay platform lowers the price tag for employers, while reducing costs for and improving the morale and quality of providers.
Employers and providers across the country are already starting to get this
4% of large businesses are already going direct with some providers, with some employers seeing 25% reductions or more on surgical costs.
More than 33% of large businesses in the U.S. are considering adding direct options to employee health plans. The slowness in the
shift to direct-pay is due to the large amount of insurance-related obstacles and fear of rocking the boat. As more employers
work through this, the trend to go direct is accelerating.
Independent, low-cost providers have additional advantages
Monopolies or near-monopolies, in addition to being more expensive, are also traditionally less responsive to concerns over quality.
In fact, the highest quality facilities in the U.S., with a few exceptions, are the smaller, independent centers.
As employers search for lower-cost facilities, which are often independent and smaller in size,
some are concerned about sending too many employees and family members to a smaller facility and overwhelming it.
On the other hand, some employers may have only a few employees in an area, giving them too little clout to negotiate lower rates directly
with a provider. Both kinds of employers are very interested in Pricing Healthcare. We're able to bring more efficient facilities with lower rates
to our platform in every city in America. We also have the ability to add multiple independent providers in bigger
population centers to handle the volumes from large employers. In both cases, the providers on our site bring affordable rates
to employers, which are sometimes much lower than through insurance or even direct-contracted, narrow networks.
Because our prices are completely open (and usually bundled to include all relevant fees),
competitive factors can go to work to help rates stay low over time.
How much new traffic can a provider expect from listing on your site?
Because patient traffic depends on a provider's market, facility type, services offered, and a number of other factors,
this is difficult to answer. Having said that, we have TPAs and employers interested in direct pay in all 50 states.
We're also seeing growing direct consumer interest throughout the nation and internationally. Both employer and consumer use of direct-pay are
expected to increase tremendously in the coming years.
We do expect direct-pay patient growth for every facility in the first year. And as understanding of and utilization of our platform
increases over time, we expect much more significant growth in traffic in successive years, as some in this space have already experienced.
We are doing a variety of things to steadily drive more traffic to participating facilities well into the future.
How can a provider tell when a patient comes from Pricing Healthcare?
There are multiple ways a provider can measure patient traffic from Pricing Healthcare. Some of our clients list
a separate, dedicated phone line in their contact info. Others use new patient surveys or offer additional discounts to patients who mention
their pages on Pricing Healthcare.
Sites like ours are often tempted to force payment through the site in order to track every transaction, basically making the prices
proprietary, making the system more invasive, and limiting audience size to a narrow group. By choosing to make prices open and
available to everyone, we realize we may have some patients visit a provider that cannot be traced back to Pricing Healthcare. But we feel the
advantages to both providers and consumers are much greater.
Employee traffic is the easiest for providers to track, as payment is received from the employer directly. Employers choosing to
use direct provider-to-employer billing through Pricing Healthcare in the future will have all employee transactions tracked in our system.
Providers will also have access to this information.
What are the pros and cons of being the first provider listing prices in an area?
Providers considering signing up with us usually fall into one of two camps:
Those wanting to get in on the ground floor as an early participant, both to help make the marketplace a success and to be seen as a leader in the space.
Those wanting to benefit from direct-pay traffic to their facility, but only if a marketplace is running smoothly and there is little risk in the investment.
Providers in the first group receive more prominent publicity, boost their image as a leader in healthcare transparency, and receive
a significant discount for listing some of their prices on our site – a discount that extends for several years beyond the first year.
They get first access to TPAs and employers, who are likely to spend more of their time looking at the leaders in transparent pricing in their area.
Early provider clients are also helping shape our site, including being involved in user interface design,
user-friendly naming, best practice categorization, and various methods of clarifying what is and isn't included in bundled procedures.
Does the posting of rates just set a provider up to be undercut by other facilities?
We haven’t seen that in any of our markets, and we're pretty sure we know why. Patients are concerned
more about quality care that is affordable than getting the absolute cheapest rate. In fact, there's evidence they get nervous when
they can sense their care is being cheapened in a price war. This is even more obvious with employers. We haven’t seen a race to the bottom
or any efforts to try to wholesale undercut competition.
Once our site’s visitors see that a provider’s rates are reasonable, they tend to stop
looking much at the price and start digging into what reviews and quality information are available for the facility. This is why so much effort
is made by Pricing Healthcare to promote a facility’s service and quality record.
How does a provider coordinate the bundling of pricing with surgeons and anesthesiologists?
This is typically left up to the provider. Ownership and physician group relationships can vary greatly
from one facility to the next. Most of our clients take time coordinating in meetings or over email with one or more physician or anesthesiology
groups, both to ensure everyone's on board and to make sure everyone's comfortable with each bundled procedure's price, risk, and list of
included/excluded services. Several of our facility clients' administrators have offered their time to talk
to other facilities with questions about this. Let us know if you'd like their
Our facility has multiple physicians – how do we route new patients?
This is also typically left up to the provider. Some options include a round-robin referral, or including only
specific physicians initially in the bundled rate offering. Several of our facility clients' administrators have offered their time to talk
to other facilities with questions about this. Let us know if you'd like their
Is Pricing Healthcare's data useful for Medicare patients?
As 80% of Medicare-approved charges are paid for by the government, it would be unusual to pay less going direct
than through Medicare. However, some charges are not covered by Medicare, and more and more providers and facilities do not accept new
Medicare patients, making some high quality physicians and specialists out of reach. For all of these reasons, direct-pay options are beginning
to be taken more seriously by those who qualify for Medicare. Nothing prevents a Medicare patient from going outside the government insurance program
to pay directly for care. Self-pay rates are the same at our facilities regardless of a patient's coverage status. But for a patient
to get self-pay rates, Medicare will not reimburse for any portion of the cost.
Our facility/practice accepts Medicare – are we still allowed to post our rates?
Yes. Medicare doesn't allow any kind of financial inducement toward Medicare patients to come to a facility,
but cash rates and other listed prices don't offer such an inducement when the facility will not be filing Medicare claims for the procedure.
Nor does Medicare set restrictions on what you can charge to patients who are not eligible for Medicare, even when you accept
Medicare reimbursements for some patients. CMS regulations stipulate that providers opting-in to Medicare must limit prices
offered to Medicare-eligible patients to 115% of the Medicare allowable amount for nonparticipating providers (or 109.25% of the Medicare allowable rate).
However this is a gray area when bundling rates. Since there are no Medicare allowables for bundled procedures, providers seem to have
leeway on pricing them as they see fit. To our knowledge, none of our clients' cash prices go as low as 109% of Medicare, and only one of our clients
has ever opted out of Medicare altogether. None of our clients have ever run into issues with these regulations.
Will insured patients complain about rates that are lower for cash payers?
The vast majority of patients visiting our site are cost-conscious individuals and those with self-insured employers
who tend to be concerned about price because they or their company will be responsible for the entire cost. There is little interest from
patients with low-deductible insurance to search for healthcare prices.
Many of our clients still want to make sure there is no confusion for those few patients. We give them the option to clearly explain
on each of their pages that cash-pay rates only apply to those who don’t file claims with private insurance or Medicare.
Will insurance carriers and worker’s comp. groups complain if a provider posts lower cash rates than they have access to?
Almost every insurer in the country negotiates with each vendor separately. It's almost impossible therefore for them
to compare public bundled cash rates to what they're paying. In addition, direct payers who pay the full balance up front require almost no paperwork or costly regulatory oversight.
There is also no need for collections, nor any risk of underpayment with direct pay. This makes direct pay a very different product,
even though the medical procedure may be the same – hence the lower rate. Third party payers understand why they wouldn’t be offered similar rates,
even those few who may complain about it.
There has been increasing pressure on insurance carriers to retain as many lower-cost providers in their network as possible,
both because patients are concerned about shrinking networks (less choice for them) and because they need patients visiting lower-cost
facilities to meet their own financial targets.
Can any type of healthcare provider or facility post prices on this site?
Yes, just about every type of healthcare facility or provider can list their prices on our site, from the largest institutions
down to a one-person practice, medical or dental, mental health, etc., whether providing care in a physical facility or operating at customer residences or on the road.
We also allow facilities to list virtually any kind of healthcare services or procedures, including those which may be considered non-standard
and not covered by insurance. We expect the types of facilities represented on our site to continue to expand, in all areas of the country.
Is there a cost for providers to post prices on this site?
Yes, there is a small annual fee for facilities to host their prices on our site. Pricing is generally based on an
organization's physical patient traffic, with large hospitals in large metro areas near the top end of the fee structure and small practices in less
populated regions coming in toward the bottom. Discounts are available for multi-year contracts, for organizations posting rates for multiple facilities,
and for the earliest providers in an area to publish.
In addition to setup overhead and licensing fees, annual fees cover custom marketing and media outreach for the provider, both in their local markets
and nationally. We use search engine optimization, paid search engine ads, and our press and social media networks to promote a provider's prices
and their unique qualities to a wide audience. There are no hidden fees, and no transaction fees for consumers.
Transparency and an open marketplace tend to generate more trust and goodwill among patients toward provider organizations,
and bring more business to a provider. This is why it is the providers on our site who support the listings, not the consumers.
Most real-world marketplaces work the same way.
How does a provider go about listing prices with this site?
Providers interested in hosting part or all of their price lists with Pricing Healthcare can get started quickly with a few
simple steps. Contact us to be connected with a sales representative to begin the process.
Once a facility gives approval and puts together a simple spreadsheet of its services and prices, it typically
takes less then 2 days to generate a preview of the pages for the provider. Feel free to browse the pages of any of the facilities already on our
site to see how they're structuring their content and price list categories.
What procedures are the best to start with?
Although providers are free to publish as many or as few prices as they want right out of the gate,
for those just getting started it might be helpful to start with a shorter list of more commonly searched, high volume procedures.
These may be different for each provider depending on their specialties.
Contact us to find out the best procedures for your organization to start with.
How should a provider go about setting their posted rates?
Most of our providers set their rates based on their own criteria, including their costs, brand recognition,
non-tangibles, etc. Pricing Healthcare can offer guidance if desired.
Is Pricing Healthcare independent or part of some other entity?
Pricing Healthcare is privately held, independent, and not controlled or subsidized by any provider,
health system, insurance carrier, or government entity.
What advantages are there to registering on the site?
We are adding new facilities across the country every month, and we notify registered users when new pricing data is available.
Those who sign up also get access to all medical codes listed with procedures. An account is required for a patient to receive electronic statements
through Pricing Healthcare when direct-pay services are performed by providers on this site.
Patient advocates recommend the tracking of medical bills in some kind of electronic system. Pricing Healthcare makes this easy.