How to use this information
Use this site to see the range of payments made for a health care service by insurance plans offered by employers in our state. You can then check with your own health plan to see what you might pay for a procedure and how it compares. This will help you decide if you are obtaining a good value.
These payment amounts are only one of the things to consider about the cost of your care. The number of services you receive also affects the total cost. In addition to cost, there are other things you should consider when choosing a provider, including the quality of the care, the relationship you have with your care giver, the convenience of the care, and other factors only you can decide.
The amount you will pay out-of-pocket for a health care service depends on the details of your health plan coverage. Please talk to member services at your health plan for specific out-of-pocket amounts you might be asked to pay. The contact information for the member services department of your health plan is on your insurance card.
The payment we report, called an “allowable” amount, is an amount agreed to by the health care provider and the health plan. Many factors influence this amount including the size of the medical group, the cost of doing business in that region of the state, the number of uninsured or underfunded patients seen by the provider, the amount of medical education and training provided by the group, the degree to which the provider has invested in new technology or additional staff to improve patient care, and the types of patients the medical group sees.
Methodology
In this measure, we present the payments for 105 common health care services. The payments we report are for services provided in physician offices, not in hospitals. Four large health plans in Minnesota provided the data for this measure: Blue Cross Blue Shield of Minnesota, HealthPartners, Medica and Preferred One. These were the amounts paid in 2008 for people who received their insurance coverage through their employer and not those on a government program such as Medicare or MinnesotaCare.
When visiting a physician’s office, each service has a different payment. In treating a sore throat, for example, there will separate payments for:
• The physician’s time to examine the throat, ask questions about symptoms, order tests and prescribe medication if needed.
• The clinic staff member’s time to swab the throat and perform a laboratory test to check whether the infection is caused by streptococcal bacteria (strep throat).
In this measure, each of those payments is reported separately.
Does Higher Cost Mean Higher Quality?
Health care that costs more isn’t always better. For example, patients who live in states with higher Medicare spending are less likely to get inexpensive but important health care services like flu vaccines, mammograms or eye exams for patients with diabetes.
Why Does This Matter?
Today, many consumers have health coverage with deductibles. This coverage requires consumers to pay, for example, from $300 to $10,000 out-of-pocket for services before the health plan pays. This measure provides basic information for all consumers. Even consumers who only pay a co-payment for an office visit or don’t pay for services directly may worry about prices. They know that higher health care costs eventually lead to higher health insurance premiums.
