Good faith estimates enable price-conscious shopping vs. price-unaware shopping
By by Barry Clark · Oct 26, 2023
The United States is a consumer-driven economy. Inflation, the stock market, and the gross domestic product are, at their core, driven by spending.
On a personal level, we are inundated with marketing overload via television, radio, internet, social media, smartphones, billboards, etc. And search engines, along with the recent onslaught of artificial intelligence, often seem to predict our shopping interests with uncanny accuracy.
With all of this being true, most of this marketing and promotion often tries to mask the actual cost of a purchasing decision. That $10 lunch quickly becomes $14.50 after tax and tip. The $50 concert ticket is actually $65 after add-on fees. I’ve rented a car for $29 a day that cost $54 after all the required add-ons. Auto dealers try to sell based on the monthly payment and not on the actual bottom line total price. Each of us could add examples of this strategy of sellers masking or dodging the bottom-line price.
Our health care provider choices are no different. The health care industry has historically made it a core business strategy to not share pricing, or to at least make it downright difficult and nail-biting to obtain solid pricing information.
Medical providers' ability to stick with the “don’t share prices” business model is slowly eroding due to negative consumer sentiment, competitive pressure, and government action. This article is about one aspect of government action that you can use to your advantage as a cash-pay Samaritan Ministries member: good faith estimates.
Federally mandated rules allow self-pay individuals to obtain a pre-service good faith estimate as part of the No Surprises Act. This topic was highlighted in the September 2022 Samaritan Ministries newsletter article entitled Powerful new tools for health care cost containment. That article says that
… providers must provide patients an estimate of the cost of their procedure upon request and are then required by law to bill a final price within $400 of that original estimate. Now you can find prices ahead of time and make an informed purchasing decision.
Now indeed! The first step to making an informed medical provider decision is having solid pricing data to be able to compare options. The remainder of this article gives specific how-to steps to factor solid pricing information into your health care decision process via the good faith estimate process:
Find a good faith estimate
Access the website of the hospital or physician/provider group you are considering. Access their transparent pricing portal. The name of this feature and the menu choices may vary by provider website. Here’s one example of navigation that is quite common:
- Go to the provider’s home page
- Select something along the lines of "patient information”
- Select something like “transparent pricing and estimates” or “price estimates.”
- Launch the tool that displays a query entry screen of information needed to obtain a good faith estimate.
Note 1: Many providers’ online tools provide price estimates for the most common procedures and ask you to email or call for procedures and conditions not listed. Also, some providers do not have an online tool, and either direct you to a toll-free number or a form to complete.
Note 2: The effort to obtain a good faith estimate, although not overly time-consuming nor difficult, is probably not worth our members’ time for bills less than $250 and primary care expenses. It is, however, well worth your time for most non-recurring care situations.
Is it a fair price?
OK, you’ve completed step 1. Now you are in possession of a pre-procedure or pre-service good faith estimate. But is the price a fair price? How do you know that this provider is a high-value, price-competitive choice for you as an individual health care consumer and as a good steward of your fellow Samaritan Ministries members’ Share dollars? See the next step.
Evaluate the estimate
Evaluate the good faith estimate price by accessing the Healthcare Bluebook tool on your Samaritan Dashboard:
- From the Dash homepage, select Health Resources from the left sidebar menu.
- Launch the Healthcare Bluebook™ website.
- The Healthcare Bluebook site allows searches by hospital/facility, provider/doctor, and by medical procedure.
- In our example, you have a provider for whom you’ve obtained a good faith estimate.
- Search for that provider. If you don’t get a hit on your query, do a procedure search based on your ZIP code.
- Is your provider a green-priced provider? If not, is there another green-priced provider that may be an acceptable alternative?
- Work through the results: You may want to request a good faith estimate from an alternate provider listed on the Healthcare Bluebook site.
We can help!
Assistance is available from Healthcare Bluebook and Samaritan. You can:
- Call the Healthcare Bluebook toll-free number at (855) 286-3663 for direct assistance.
- Send an email to the Samaritan Ministries Provider Relations Department. We are available to help you choose a fair-priced provider and to assess if the good faith estimate you obtained is a good value choice.
By utilizing the good faith estimate process, you have solid information to help you make informed medical provider decisions. You also have the Healthcare Bluebook tool to validate if the estimate is a fair price. And you have access to assistance from us to navigate the process.
So, use the good faith estimate option to navigate your health provider choices!