Peace of Mind with Price Certainty
When you go shopping, whether that be for a pair of shoes or a new mattress, you expect to know the price of the item you’re buying before you checkout. So why is it that when you go to a doctor’s appointment, you’re not sure if it will cost you $25 or $250? Healthcare is one of the most complicated industries in the United States.
There are a lot of different players when it comes to pricing medical services. Prices will vary based on your coverage and deals negotiated between facilities and your health plan. That is why the same service done at two different places could cost different amounts. It all comes down to negotiated rates. Insured employees also don’t typically pay for the entire cost of a medical service. They pay either a flat fee (called a copay) or they pay a portion of the cost (called coinsurance). Those amounts are dependent on the person’s health insurance through their employer.
It’s frustrating to not know how much a medical service will cost. And with the affordability crisis, some people just can’t risk a steep health bill, instead choosing to delay care in order to not go into debt. No one should have to choose between their health and their bank account. Cost information should be available for everyone. And, luckily, the industry is heading in the right direction.
The Hospital Price Transparency Rule
Today, most people have to wait until they receive their Explanation of Benefits (EOB) in the mail to know just how much they owe the hospital or doctor’s office. EOBs break down how much your insurance will cover and how much you still owe your provider. They’re confusing, lengthy, and can come as quite a shock when you don’t know the price of the service in the first place.
However, after The Hospital Price Transparency Rule went into effect on January 1st of 2021, hospitals are now required to provide standard charges and negotiated rates for medical services to the public. According to the rule, this transparent pricing information needs to be available online in a consumer-friendly and machine-readable format. The idea behind pricing transparency is that it gives everyone the ability to make informed decisions on the cost and quality of their healthcare. However, providers are still only able to give an estimated range of costs.
Price Transparency vs Price Certainty
Even before the Health Price Transparency Rule, there were other health plans in the industry offering their members price transparency. But what does that actually look like?
Price Transparency
Price transparency means that cost and pricing information for a product or service is made available and understandable to the public. Price transparency helps people compare cost and quality and helps drive competition between products. It also exists in most consumer goods. If you’re thinking about buying a new phone, you will probably want to compare models, and maybe even carriers, to weigh your options.
In healthcare, price transparency isn’t so cut and dry because of the complexities of the industry. It is not as straightforward to price a healthcare service as it is to put a price tag on a phone. This is because prices are often set prospectively, and it is difficult to predict the level of care a person will need when they seek a medical service. That being said, in the healthcare industry, price transparency refers to showing people a cost estimate or a range of what a service could cost. It’s a step up from being completely in the dark when it comes to receiving healthcare, but it still leaves a lot of room for uncertainty.
Price Transparency
Price certainty, on the other hand, refers to a fixed price point for goods and services. In the healthcare industry, price certainty tells you exactly what a medical service will cost before you even book an appointment or fill a medication. No cost estimates, no unexpected charges, no additional fees – what you see is what you get. And when you’re able to see the exact price of a medical service in advance, you can plan for that expense.
Price Certainty with Coupe
Unlike other health plans in the industry, Coupe is able to offer price certainty to its members. Coupe’s unique plan design does not use deductibles, which allows Coupe to offer one price tag (copay) for a covered service. These copays are predetermined and tiered to align with the quality of the in-network provider you choose, where higher quality providers have a lower copay.
If, for example, you’re seeking a primary care office visit, you will see different copays for differently tiered providers. Green providers (Tier 1) might only cost $20, while a primary care visit with a yellow (Tier 2) provider could cost $25. Red (Tier 3) providers may cost $45 for the same primary care visit. Regardless of the provider you choose to see, you will only ever be billed the copay amount listed in your search tool for the services you received at that appointment.
Static Copays
Copays are determined based on the contracted rate between the carrier and the employer’s benefit design strategy, which outlines which medical services will be covered under your plan. Because Coupe offers static copays that never change, you don’t have to worry about add-ons or upcharges. Continuing with the example above, let’s say you scheduled your primary care appointment with your Green (Tier 1) provider for a flat fee of $20. Once at the appointment, your doctor orders some routine lab work that you are able to do that same day at that facility. The lab work is going to be bundled into the $20 copay you saw in your member portal. It’s not an additional charge because of Coupe’s door-to-door service policy. This means that every service you receive once you walk in the door is covered under the original copay you saw in your member portal. That is how Coupe is able to provide not just price transparency, but price certainty as well.
Peace of Mind
With fixed copays and door-to-door service bundles, your Coupe health plan is designed to bring clarity to one of the most confusing industries in America. Coupe took the guesswork and
estimates out of medical bills so that when you get your statement at the end of the month, you’ll know exactly what to expect.
Are you getting the most out of your Coupe health plan? Would you like to save more? If you’re not seeing a Tier 1 provider already, reach out to a Health Valet at healthvalet@coupehealth.com or 1-833-749-1969. They’ll help you find a provider that fits your needs.