How to Achieve Healthcare Cost Transparency

Updated: Aug 11

By Medical Bill & Claim Resolution (MBCR) | Submitted On June 13, 2015


It's no secret that medical billing is complex and specialized. In fact, it has always been interesting at how difficult it appears to be to find out what a medical procedure costs - because there are many factors that contribute to that cost.

The internet can provide a range but often, the reality can be quite different because each patient presents different conditions. It seems like it should be as easy as finding out the price of a root canal, a new set of brakes or even a car. But, it's not.

Now, though, as the medical landscape changes, we are bearing more of our health care costs than ever. For example, a recent report from the Commonwealth Fund suggested that 21% of adults with healthcare insurance spend 5% or more of their income on out-of-pocket healthcare costs. This means that doctors are increasingly getting asked about how much they charge for a procedure they recommend.

Driven by these changes, many providers are working to improve cost transparency. The Healthcare Financial Management Association (HFMA) even has a task force working on this issue.


Who's in the Know? For starters, you can request an estimate from your healthcare provider. Who at your doctor's office is responsible for providing cost information? Is it the billing department, a customer service area, a concierge, coders? Providers need to decide and then make sure those responsible for disseminating cost information have access to relevant data so the figures provided are accurate. According to the HFMA, the objective is to provide timely and meaningful cost information in advance of receiving services.


It's Complicated When doing due diligence on prices from multiple sources, which is becoming increasingly common for healthcare services, complications can arise because if only gross estimates are used, they do not take into consideration the allowed amount from insurance plan benefits which can significantly impact the costs.

Another reason for the complications is that procedure costs can vary according to patient conditions. Understand too that an estimate is only an estimate. What is black and white are your in/out-of-network individual/family deductibles, co-insurance, and co-pays.

It is also recommended to speak with your insurance plan directly to verify any coverage guidelines for your procedure before it occurs. This will help to prevent any surprises your doctor's office may have overlooked.


An Ally In the quest for medical cost transparency, under the Affordable Care Act, hospitals are required to list standard charges for items and services and make those lists available to patients. This just a beginning but it has prompted healthcare facilities to begin focusing on transparency which in turn will improve healthcare patient experience.


MBCR understands the challenges in receiving a medical bill and successfully resolving a health insurance claim issue. Learn more at www.medicalbillandclaimresolution.com.


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