Price Transparency: Closing the Healthcare “What Does it Cost?” Gap

It’s a common “chicken or the egg” conundrum in healthcare practices. A patient or a payer is considering a procedure wants to know how much that procedure will cost, but the medical practice hems and haws.

Their typical response: “it depends.” And while it does depend, there are ways to get around this conundrum.

What happens when a potential patient calls your office and asks to make an appointment? If yours is like most medical clinics, your front desk staff will ask a very common question: “What insurance do you have?”

But, what if they don’t have healthcare insurance or self-insure? According to the Congressional Budget Office, about 31 million Americans did not have health insurance in 2020. With the impact of the pandemic, that number is likely higher today. Beyond the uninsured, 94 million Americans (60% of the U.S. workforce!) are employed by self-insured employers. 

The opportunity to serve the un- or underinsured.

Many health consumers choose to “pay as they go” or may have their own small business. A rapidly growing number of people with healthcare insurance coverage often have very high deductible health plans (HDHPs) or Health Savings Accounts (HSA’s) these days meaning that many are, in essence, paying as they go. This also means they are expecting a convenient shopping experience.

And, like most consumers who are paying for something, these patients and potential patients obviously want to know what the service they’re considering will cost. That works pretty well in most consumer transactions.

You want to build or remodel a home; you get a bid from a contractor. You want to buy a washer and dryer; you search for the best price. You want to buy…pretty much anything, with the notable exception of healthcare services, and an obvious question is going to be: “What does it cost?”

Unfortunately, in healthcare, consumers continue to struggle to get an answer to that very basic question.


Because in healthcare, most practices are traditional fee-for-service, insurance-based practices.

Are you literally turning business away?

And therein lies the conundrum. Because most practices simply can’t tell them what their services will cost. They’ll come up with all sorts of seemingly logical reasons why they can’t, like “I won’t know until I actually perform the procedure how long it will take or what additional services you might need…”

Yet contractors don’t really know how long it will take them to build a house or how many unexpected issues they may encounter along the way. Yet, based on experience, labor, and materials costs, they can provide a reasonable and informative estimate–with standard contingencies for unforeseen circumstances. Your practice really isn’t that unique after all. You should be able to answer when someone asks: “What does it cost?”

Failure to answer this very basic question means that many providers are literally turning away patients—and their money. Fortunately, we can help you find the answers. We’ve solved this issue for providers by creating packages based on symptoms to allow patients to get a doctor’s expert opinion and diagnosis with a recommended treatment plan.

Taking the leap into direct pay.

Not only can healthcare services pricing be transparent, CMS is mandating pricing transparency. At HealthMe, we’ve anticipated these developments, researched public and private markets nationwide, and created patient-centric healthcare packages that represent common diagnoses and treatment plans for each specialty using transparent pricing. These healthcare packages allow patients to better understand exactly what their doctor’s visit costs and what services are included.

Communicated in clear, understandable language, these packages are based on best practice guidelines leading to quality healthcare at a fair price. They generally include a visit with the doctor and simple diagnostic studies that are often ordered in the workup of a condition such as basic diagnostic testing, labs, EKGs, x-rays, etc.  

Our proprietary matching algorithm of CPT codes to patient-centric packages offers you over 300 options of packages that best fit your services. Package options include everything from basic office visits to surgery bundles and after-care.

Learn more about how HealthMe works for providers here




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