Top Three Reasons for Getting a Healthcare Estimate

June 28, 2018

You can use the free FAIR Health Cost Lookup Tool to find out what thousands of healthcare procedures might cost you. Why would you want to get a medical or dental cost estimate? Here are the top three reasons people use the Cost Lookup Tool:

  1. Planning costs for a family member or relative. It can be helpful to have a good idea ahead of time what a healthcare procedure might cost you. That way, you or your loved one can plan and budget for the expense in advance. You’re also less likely to be surprised by a bill that’s higher than you expected.
  2. Negotiating costs with a provider. Your estimate shows the typical price in your area for healthcare services. If your provider (such as a doctor or hospital) is charging more than the estimate, you may want to discuss this with the provider. You might be able to negotiate a lower price. Consider negotiating costs if you have no health insurance or if you’re thinking of using an out-of-network provider.
  3. Deciding whether to go out of network. Costs can be much higher if you go to someone who isn’t in your health plan’s network of providers. But, there can be good reasons for going out of network. For instance, you may want more choices than you can get in your network. An estimate will show you how much more you may pay than if you stay in network.

Use the Cost Lookup Tool to Make Estimating Easy

It’s easy to use the FAIR Health Cost Lookup Tool. Start by selecting either “Medical Costs” or “Dental Costs” on the FAIR Health Consumer home page.

When you choose “Medical Costs,” you’ll be asked whether you have insurance and where your provider is located. Then you’ll be asked what type of care you need. You can enter a procedure code or keyword. Or, you can choose between “Medical” (single procedure) or “Episode of Care” estimates.

An episode of care is a bundle of services for a certain condition (like asthma or diabetes) or a complex procedure (like hip replacement). For instance, if you have your hip replaced, you’ll need anesthesia, lab tests, imaging and other services.

For a chronic, or ongoing, condition, an episode of care includes all the services you’ll likely need in a year. For a complex procedure, an episode of care runs from the time your symptoms start until all your treatments end. An episode of care estimate can give you a better idea of the total amount you’ll end up paying than a single-procedure estimate.

Out-of-Network/Uninsured or In-Network Care

When you get your estimate results, you’ll see two prices: out-of-network/uninsured and in-network. The out-of-network/uninsured price is an estimate of how much you’ll have to pay if you don’t have health insurance. It’s also what you may have to pay if you have insurance but your providers don’t take your insurance. If your plan includes an out-of-network benefit, you may only have to pay a certain portion of that amount. Click on “See out-of-network reimbursement” to see what a typical plan will pay and what your out-of-pocket cost might be. For more information, see our article In-Network and Out-of-Network Care.

The in-network price is an estimate of how much the episode will cost if you have health insurance, and your provider takes your insurance. The price includes both your insurer’s share of the cost and your share.

Getting Dental Cost Estimates

To get a dental cost estimate, select “Dental Costs” on the home page. As with medical estimates, you’ll enter your location and a procedure or keyword. Or, you can choose a care category (like “Fillings”). Your results will show you the out-of-network/uninsured cost estimates for dental procedures in your area.