ALLIANCE FOR MEDICAL PRICE TRANSPARENCY

     Healthcare is the only industry in America where we consume the service without having any idea of the cost.

     Half of Americans say they’ve delayed or skipped medical care due to cost, and 58% say they’d shop around for medical procedures if pricing information was available.

     Medical debt is the most common cause of bankruptcy in the U.S.

     Price shopping in healthcare is difficult because medical care, terminology and pricing is complex. 

     Providers set pricing, which is unregulated and can be wildly variable. 

     Insurance companies’ revenue is a percentage of healthcare costs.  This means that they may have little incentive to help their customers shop for the most competitive pricing — perhaps even the opposite.  

     Consumers rarely ask for or have the ability to see pricing upfront before consuming health care. 

The Centers for Medicare & Medicaid Services (CMS) requires all hospitals to make all their pricing transparent on their websites, however these prices are still difficult to access and understand.

All healthcare providers in Oklahoma are required by law to publish cash-pay pricing information, but many either don’t comply or make it hard to find.

AMPT works with Turquoise Health who collects pricing data from the machine readable files (MRF) and patient estimator tools (PET) on hospital websites

AMPT supports the development, maintenance and marketing of  like MedPal.health, a website committed to delivering healthcare pricing in a more transparent and understandable format. The ability to compare pricing prior to consuming healthcare makes care more accessible and affordable.

     "Cash pay" or "self pay" simply means that the patient pays with cash, check or credit card and not based on an insurance plan. Now we get to the confusing part:

     Hospitals have different rates for each specific test, exam or procedure that they will list on their rate sheet called a “Chargemaster”. That is usually the highest price. They will then negotiate with insurance companies another rate that is lower than the “Chargemaster price”, and each insurance company may have a different rate for each of their different plans. This is where insurance companies let their customers know that they have procured significant cost savings for their customers with the “Negotiated price”.

     The “Cash-Pay price” can oftentimes be significantly lower than both the Chargemaster price and the Negotiated price. This can be a very attractive and more affordable option for people without insurance, or those that might have a high deductible plan or that will not likely reach their deductible. 

     AMPT focuses on cash pay pricing because the pricing is more defined,  understandable and relatable for the uninsured and underinsured population that is most vulnerable to medical debt and bankruptcy.  

     Trying to determine insurance pricing of healthcare with the dozens of plans and their associated copays, deductibles, etc. is much more complex due to all of these variables.