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Before You Get Care
In the past, it was hard — if not impossible — to know what you would be charged for a medical service or treatment before you received care.
New rules mean you’ll have visibility into your costs in advance of treatment. Make sure you take advantage of available tools and resources before seeking care.
Health Plan ID Card
Your health plan ID card is intended to give you quick and easy access to cost-sharing information. The following information must be listed on any physical or electronic insurance identification card issued to participants:
  • Deductibles
  • Out-of-pocket maximums
  • A customer service telephone number and Internet website address
This law does not require that insurance plans issue paper ID cards to members.
Provider Directory

A provider is a licensed doctor, hospital, facility or other health care professional that provides services to you. Each network has a listing of participating providers in a “provider directory.” These directories are available in paper form or online. New rules require that carriers keep their provider directory up-to-date so that you don’t end up with a surprise bill from an out-of-network provider that you thought was an in-network provider.

Provider directories must be updated every 90 days. They need to be available on the carrier’s website and include the following details:

  • Name
  • Address
  • Specialty
  • Telephone number
  • Digital contact information

New protections say that if you relied on information from a provider directory that has been proven to be outdated when a more current directory was not available to you, the provider must limit their billing to in-network cost sharing.
Price Comparison Tool
Know your costs BEFORE you get care!

When you’re getting ready to make a big purchase — comparing products and their price tags is key. But in the past it was almost impossible to do that upfront research before obtaining health care, even though these services are so very important and sometimes very costly.
However, recent laws* make it much easier to do this research before you get care.

Price Comparison for Services by Health Plan

Effective January 1, 2023, federal law requires all health plans to develop new or expanded price comparison tools to help you see what health care services will cost before you get care. This means you can request a personalized estimate of your out-of-pocket costs for specific items and services so you can calculate and compare your costs in advance of treatment or service:

  • As of January 1, 2023, the law requires showing estimates of 500 items, services and prescription drugs.
  • Starting with plan years on and after January 1, 2024, the law requires showing estimates of all covered items and services including prescription drugs.

You’ll be able to find this information in one of three ways: 1) through an online self-service tool on your carrier’s website, 2) by calling your carrier, or 3) in paper form upon request from your carrier.

You’ll be able to access the same type of information you typically get on your Explanation of Benefits, like the provider’s fees, the plan’s negotiated rates, and your portion of the costs in terms of copays, deductibles, and/or coinsurance. Only now you can get this information before you get care which will help you compare prices and better estimate what your out-of-pocket costs will be for a given service.

*The details above reflect requirements as mandated by both the Consolidated Appropriations Act and Transparency in Coverage Final Rule.

Price Comparison at Hospitals

Each U.S. hospital is required to provide clear, accessible pricing information online about the items and services they provide, such as x-rays, outpatient visits, lab tests, and more. Contact your hospital for more information about their shoppable services. Learn more.

Start to cost compare now!

Check out the price comparison tool(s) available from our carrier(s) below. 
UMR
Cigna
Not Using Insurance
The law has protections for those who don’t have insurance or choose not to use it. If you or someone you know is in this situation, you can let your health care provider know this. The provider must then give you a good faith estimate of expected charges. In most cases, you must receive this estimate when you ask for it at least three business days in advance of your care. If your bill is at least $400 more than this estimate, you can dispute your bill. Learn more.
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