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Pratter Frequently Asked Questions (FAQ)

Are Pratter’s prices listed accurate?

Can Pratter.us help me find affordable medical care?

What does the medical cost listed on Pratter represent?

Are the medical prices listed on your website guaranteed? If so, for how long?

How often are medical costs updated on Pratter.us?

Do the medical costs listed represent the total cost for a medical test or procedure?

Is Pratter publishing health insurance company reimbursement rates for medical care?

Does Pratter have quality ratings to go along with its medical costs?

I found a medical facility with a price for a test that I can afford. How do I go about getting it done and making it a reality?

Where did Pratter get its hospital prices for medical tests and procedures?

If I have health insurance, and if I stay in network, does it really matter what a medical facility charges for a medical test?

Can I negotiate my cost for a medical test? If so, what’s the best way to do it?

What do I do if my doctor wants me to go to an expensive medical facility for a test and I know I can get it done for much less elsewhere after searching on Pratter?

What if my doctor tells me that he or she prefers that my imaging study be performed at an expensive in network medical facility and it otherwise won't be made available to him or her on the computer system unless I go to the expensive facility?

What if my doctor tells me that he or she prefers that my blood work be performed at an expensive in network medical facility and it otherwise won't be made available to him or her on the computer system unless I go to the expensive facility?

I cannot find a medical test or procedure result in my state. Why?

My health insurance company has a cost estimator tool. Isn't this good enough?

 

 

Are Pratter’s prices listed accurate?
Pratter’s primary purpose is to help consumers find affordable health care options within their family budgets. Our costs are updated annually but depending on the time of year, may or may not represent the actual cost at that time but instead a cost very close to it. Nonetheless, if an MRI is $5,000 at one location and $500 at another location, Pratter is not so concerned about getting an exact price for the consumer as it is in saving consumers money. If the $5,000 MRI increased 3% from last year, Pratter’s teaching point is that there is an MRI option available for about $500. All medical facilities are welcome to upload their costs via are Pratter portal to better serve their communities with known pricing. A medical facility that does so is provided an orange Pratter price tag guarantee icon next to search results, the ultimate piece-of-mind pricing for consumers.

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What does the medical cost listed on Pratter represent?
Answer: The actual charge by the medical facility.

The charge matters because the higher the charge amount, the more likely your final medical bill will be higher too. The consumer with a high deductible plan will pay out-of-pocket, for example, the first $5,000 for medical care. So would you want a $500 MRI charge or a $5,000 MRI charge because both prices are readily available in most large cities?

The charge also matters because if your insurance company denies your claim that charge just became your medical bill. If you do not have health insurance that charge is your medical bill. If you are out-of-network for medical care, commonly you will have to pay 40% of an out-of-network charge in comparison to a 20% in network coinsurance charge.

You should also note that the hospitals charge for a test is the same whether or not you have health insurance. If you are fortunate enough to have good health insurance, hopefully it will cover all or some of your medical care. If it only covers a portion of your care, as a consumer you need to be aware of your financial responsibility before the time of purchase in order to avoid a financial crisis.

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Are the medical prices listed on your website guaranteed? If so, for how long?
Answer: “Yes” if the medical facility has an orange Pratter price tag guarantee icon next to it. Medical facilities that provide Pratter with its costs to enhance medical cost transparency for members of its community are rewarded with this icon. The Pratter price tag guarantee is the ultimate and piece of mind for the educated consumer – no hidden costs. Of course, at first, there are not many facilities listed with this guarantee but we expect this list to grow significantly after each of you calls your hospital and surgery center CEOs to urge them to place their costs on here for you.

“No” for the vast majority of listings. Pratter is not a medical provider. Therefore, we cannot guarantee costs for care that we don’t provide. A hospital can guarantee it’s owns costs. With this stated, Pratter’s medical charge listings represent those reported to each state as required by law or as posted in various formats by state agencies or as collected by medical bill analysis. Our listings therefore are either completely accurate or slightly outdated but eminently qualified to help you determine where to receive affordable medical care. You will quickly figure out which medical facilities can bankrupt you and which ones are fair.

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How often are medical costs updated on Pratter.us?
Answer: Once a year. Please note that at the beginning of each calendar year in January or February (ie once a year), the medical industry standard is to update medical charges. Therefore, prices listed are good for one calendar year at a time and usually change by each March. For the medical facilities with prices already listed, it is their responsibility to update their charges to best serve their communities. Every single hospital listing has received a Pratter invitation to provide and update costs. To this day, not a single one has cooperated. Again, those medical providers that willingly provide their fees will be listed with the orange Pratter price tag guarantee icon. There are some non-hospital entities that have complied.

It is always recommended that you call your health insurance company to confirm an out-of-pocket price for a test, assuming it is a covered service, at your desired medical facility. You most definitely still need the hospital, surgery center or blood center charge on Pratter.us so that you know what your maximum financial pain could be before you receive your care.

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Do the medical costs listed represent the total cost for a medical test or procedure?

Answer:
Blood work. The medical cost listed is for the blood test ordered. The cost listed only does not include the phlebotomy fee (blood draw), often about $10 to $15.

Imaging studies. The medical cost listed is for the medical facility fee. This is by far the largest fee. The radiologist interpretation fee is not included.

Elective medical procedures (e.g. colonoscopy or carpal tunnel surgery). The medical facility fee (the largest fee) is included. The anesthesiologist fee and medication fee are not included unless there is an orange Pratter price tag guarantee icon next to the procedure listing cost.

This is the most difficult outpatient category of care to collect a total cost. For example, a screening colonoscopy has a fee for the medical facility (hospital or surgery center), a gastroenterologist fee, a GI surgical tray fee, an anesthesiologist fee and an anesthesia drug fee. Pratter knows all too well consumers want a price tag for care without any hidden costs. While we work toward that goal for you, use Pratter.us for a comparison of the available costs in order to rank the least to most expensive options. This will help you shop smart for affordable care even thought the total price tag might not be available.

Know that you have options when it comes to receiving your medical care including hospitals, surgery centers, independent imaging centers, independent lab centers and private practice physicians. Know that this is the order of the most expensive to the least expensive places to receive medical care.

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Is Pratter publishing health insurance company reimbursement rates for medical care?
Answer: No – Pratter is not in the insurance business. We know that you do not care what a health insurance company pays for a lumbar spine MRI. We know that you care about what you have to pay for a lumbar spine MRI. In today's high deductible plan era, most often you will have to pay more than an insurance company for the same care. It may not be fair but until Pratter has millions of members on its platform, individually you do not have much bargaining clout.

In the future, Pratter does aspire to collect and publish the insurance reimbursement rates (what they pay a hospital for your care), because that is the fair price that you should have to pay as a maximum out-of-pocket but it doesn't work like this for now. Please be patient while we work to provide you this cost data too.

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Does Pratter have quality ratings to go along with its medical costs?
Answer: Not yet. We are first and foremost a medical cost transparency company. We do not aspire to be a “me too” company as there already other companies out there that have quality ratings.

Pratter states that for blood work and imaging studies – forms of outpatient medical care where no doctor is involved, that a quality rating is not needed. Often, the same medical equipment is used for these tests so pricing should not vary by over 1,000%. Pratter also notes that when two hospitals in the same city charge 300% different for the same blood work and imaging using the same equipment that such charge differences are not justified. In such instances, the more expensive hospital is saying "my same medical equipment is 300% better than yours."" Quality ratings are desired for the category of elective medical procedures.

Pratter understands that value is defined by cost plus quality. We want to help provide a

quality rating for elective medical procedures. We do plan on collaborating with a third party vendor for quality ratings and pairing them with our cost listings. This large undertaking will take some time.

Like medical costs, unless a hospital agrees to release data, quality ratings generated by healthcare consulting companies cannot be listed. Also, most of these healthcare quality consulting companies use "black box" techniques for determining a quality rating. In other words, they do not share with consumers or even doctors the factors and weighting of them that go into a quality rating which greatly limits the usefulness of such ratings.

Consumers will be entitled to such information, in addition to cost, much sooner than later headed into the future. Once consumers pay out-of-pocket, they have a right to know.

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I found a medical facility with a price for a test that I can afford. How do I go about getting it done and making it a reality?
Answer: Please go to our blog from our homepage and view our "Smart Shop" step-by-step instructions for purchasing blood work, imaging studies and elective medical procedures. We make it simple for you. There is no need to be intimidated. Pratter is with you every step of the way!

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Where did Pratter get its hospital prices for medical tests and procedures?
Answer: State agencies collect and house medical cost data for some states. OH costs listed are based on information noted within each hospital’s website. PA data obtained from various techniques including PHC4. 35 of 50 states have some form of medical transparency law. In general, the laws indicate or suggest that this cost data is to be made user friendly and be made available to the public. To the contrary, Pratter has found that it requires the skilled eyes of an experienced physician and further skilled and experienced in the area of medical billing in order to decipher and make user friendly the data you get to view! This has been a monstrous task by a team of medical billers and IT professionals.

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If I have health insurance, and if I stay in network, does it really matter what a medical facility charges for a medical test?
Answer: YES! Please realize that if you decide to get a lumbar spine MRI, for example, in network through your health insurance company, the negotiated contract rate for each hospital or other medical facility is different. For example, within the same city, even after an insurance company negotiated discount, a lumbar MRI might be $500 at Medical Facility A, $1,500 at Medical Facility B and $3,000 at Medical Facility C. Medical price matters – it pratters! If you have a $5,000 deductible, where you go will determine whether you keep an extra hard-earned $2,500 in your pocket versus giving it away to an expensive medical facility.

If you assume (and many do), that because you have health insurance that the cost of a medical test is the same at any medical facility in network – think again. This level of service is not made to available you even though you pay thousands of dollars each year to the health insurance company.

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Can I negotiate my cost for a medical test? If so, what’s the best way to do it?
Answer: Seldom can a medical cost be negotiated upfront. As medical cost transparency increases with time and Pratter, there will be less of a need for upfront negotiation as cost effective medical facilities are made known. Instead of attempting to negotiate with an expensive facility, you will just choose another more cost efficient one.

If you receive an expensive medical bill and you do not have health insurance, you need to know that the fair price for a medical test is the price reimbursed by an insurance company to the hospital for that test. If a lumbar spine MRI bill is $3,000 and that seems expensive to you (and it is), find a family member or a friend with health insurance and ask him or her to call his or her health insurance company to see what amount he or she would have to pay out-of-pocket if he or she had a lumbar spine MRI at that same facility if his or her high deductible was not met. You may well find the answer to be $1,000. This $1,000 is considered the fair market value as a hospital will generate 90% or better of its revenue through commercial insurance reimbursements. Therefore, when speaking with the billing department, tell them you are willing to pay the same $1,000 considered as payment in full from local health insurance companies. Many facilities will permit you to set up a monthly payment program at this dollar amount.

Pratter’s principle is that the fair market value of a medical test or procedure is the typical health insurance company reimbursement to the medical facility. The medical charge to a patient furthermore should not be set any higher than that reimbursement rate, particularly when individuals who do not have the financial assets of a health insurance company cannot afford to pay more than the insurance company.

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What do I do if my doctor wants me to go to an expensive medical facility for a test and I know I can get it done for much less elsewhere after searching on Pratter?
Answer: It's your hard earned dollar! This is the culture change needed in America. As much as we all ask for generic drugs to save big money, we next need to recognize that a hospital-employed physician is told by his or her administrator to send you to their expensive medical facilities. Instead, you should ask for other cost effective options and check for options on Pratter.us.

Hospital administrators have believed for the past 20 years that if they buy the doctor, they control the doctor and the patient flow through their hospital system. Such a physician may refer you for a $5,000 test that is available locally to you at only $1,500 elsewhere.

You are now a consumer with money out-of-pocket spent on your medical care. You tell the doctor where you would like to have the test done. This is not being disrespectful to your doctor. This is being a smart consumer and since you are paying the bill, the customer is always right.

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What if my doctor tells me that he or she prefers that my imaging study be performed at an expensive in network medical facility and it otherwise won't be made available to him or her on the computer system unless I go to the expensive facility?
Answer: That’s not true. It’s your hard earned dollar and your decision where you receive your medical care. You can choose to have your imaging performed at a hospital or at a freestanding imaging facility. Either entity will provide you with one free copy of your images on a disc for you to give to your doctor for review. Several freestanding imaging centers have software that interfaces with hospital electronic medical record (EMR) systems. For those that do not interface, a typed imaging study report from a radiologist can simply be scanned into an EMR.

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What if my doctor tells me that he or she prefers that my blood work be performed at an expensive in network medical facility and it otherwise won't be made available to him or her on the computer system unless I go to the expensive facility?
Answer: You can choose to have your blood work performed at a hospital or at a freestanding clinical laboratory. Freestanding clinical labs can interface with most Electronic Medical Record (EMR) systems. If they do not do so, your blood work result can be easily be scanned into the EMR.

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I cannot find a medical test or procedure result in my state. Why?
Answer: We do have blood work and urine studies for all states except ND and HI. We are working hard to get medical costs for all states. For now you can help us by calling your local hospital and surgery center CEOs and state the following: “Hello, my name is_____________. My out-of-pocket medical costs have become very high. Please place all of your medical costs for outpatient care on www.pratter.us so that I can make certain that I can afford my medical care at your facility. Thank you.” By doing the above, next time you log on to www.pratter.us, you will be able to perform a local search on outpatient medical costs. We thank you in advance for your help.

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My health insurance company has a cost estimator tool. Isn't this good enough?
Answer: No! Your health insurance company will never tell you what the hospital charge is for a medical test or procedure. You need to know this number for two reasons. First, if your claim is denied, that hospital charge just became your medical bill. Second, if you health insurance company decides that your medical care was out-of-network, you get stuck with a 40% coinsurance, meaning 40% of that charge they won't tell you about, instead of the most customary 20%.

In addition, health care cost estimators are inaccurate. The founders of Pratter have nightmare stories of how far off their medical care prices were when the explanation of benefits (EOB) came in the mail in comparison to the false, much lower estimates via the online tools of different carriers. You are best served by letting Pratter's concierge service assist you in a three way call with your insurance company for an accurate out-of-pocket cost.

Lastly, most of these estimators provide only cost ranges. You are the consumer and you deserve to know the exact price you will have to pay – not a range. Did you ever go to the grocery store or gas station and find out they give you a range of what you will have to pay when you leave? We didn't think so. You should expect better service and that’s where Pratter steps in where nobody else is willing.

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