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Helping Texans Compare & Understand Their Health Care Options

Health Care Pricing

Here are some tips on how to get the best care for your money.

Note: If you want to estimate provider prices without insurance, you can skip to the section called Estimating Prices When You Don’t Have Coverage.

Prices Will Vary

The cost of the same surgery can be very different from one hospital to another.  This is the case with all providers, including doctors and specialists.  Studies have shown that higher prices don’t mean higher quality medical care.

Providers Set Their Own Prices

Doctors, hospitals, and other providers decide how much they will bill for a given service.  If you don’t have insurance, choosing the provider with the lowest billed amount can save you money.  However, if you have insurance, choosing the provider with the lowest billed amount doesn’t always mean you will pay less.

Insurers and HMOs Negotiate Different Discounts with Providers

Insurers and HMOs negotiate lower prices with their in-network providers.  For example, if an in-network provider normally charges $5,000 for a surgery, an insurer or HMO may negotiate a reduced price of $2,500.

If you haven’t met your deductible for the year, the negotiated price will mean you pay less out of pocket.  If you only have to pay coinsurance, the amount you pay will be based on the negotiated amount  rather than the higher billed amount.

Next section: Estimating Prices with Coverage

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Last updated: 10/06/2015