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Pratter Frequently Asked Questions (FAQs)

Outpatient fixed commodity market medical care costs make up 80% of a company’s medical spend. Of that, the top 12 to 15 procedures make up 50% to 60% of the spend. We leverage self-insured data - it goes two places: 1) medical cost savings analysis to monitor 600 most common outpatient medical cost items in a fixed commodity market and 2) pratter.us to search and save by zip code (charges and claim allowables). 

Pratter reduces the massive in-network pricing variation for over 600 procedures in the categories of blood work, imaging studies and elective medical procedures. We target these high cost items and revise targets via quarterly savings analyses. 

By reducing in network pricing variation, a union with 350 employees can save $500,000 another one with 16,000 members can save $12,000,000, a county with just under 2,000 employees as well as a private sector employer with 3,300 employees can save $3,500,000.

a.  Financial incentives.  For low deductible plans, we target high cost care items, with a money incentive. Our message: “your employer values you so much that they believe you deserve to get paid to receive your medical care.”

b. www.pratter.us search and save money by zip code for those inclined and computer literate.

c. Cost Concierge Service. Call and let them do the search for you and point out financial incentives, if available.

d. Pratter Savings Cards, serving as “cheat sheets’ of low-cost providers in-network for those providers with high deductibles and labeled with dollar amount financial incentives for the categories of blood work, imaging studies and elective medical procedures for those employers with low-deductibles. 

e. Formal communications program. Large employers can use their own internal communications and marketing department. Small to large employers can use our third-party pass through vendor, The Benfield Group, a nationally known expert in employee engagement and communications.

Yes – if it is self-insured. We have demonstrated time and time again that due to significant in-network pricing variation that by analyzing an employer’s actual medical claims experience from the prior year that there is significant potential medical cost savings by reducing the employers in-network pricing variability. In addition, each employer cost data set helps create the network effect as all cost data is shared amongst all Pratter employer customers.

a. Pratter utilizes certain states medical cost transparency laws to gain access to public records that need deciphered, coded and imported into its database. The process in which this is done is taxing, streamlined and proprietary.

b. Pratter also provides third party average paid claim allowable by CPT code and by zip code for the entire United States for over a 1 billion per year third party medical claims database.

c. Self-insured employers. These medical bills have the exact price of care.  We make it easy for you to understand in our medical cost savings analysis and we make it easy for you to search on www.pratter.us by zip code.

d. We also partner with community hospitals and independent surgery centers to have them voluntarily display their pricing on our platform.  

Pratter has pricing for over 12,000 medical facilities across the U.S., including excellent blood work across the U.S. with cash and insurance pricing for LabCorp, Quest Diagnostics, Med Health Services, Walgreens and CVS Minute Clinics. Our strongest cost data sets are in Pennsylvania, West Virginia, Ohio, Massachusetts, Maryland, Wisconsin, Arizona and California.

a. Independence. We are not tied to BlueShield like our competitors. We all know what being or acting like a health insurance company has done to the cost of health care.

b. Pratter reveals what hospitals charge and what insurance companies pays. No one else does. Why? See #1 above.  Negotiated discounts are revealed forcing the market to do business in the open, aka disruptive, in a positive way.

c. Medical cost savings analysis. We show a potential medical cost savings report had you spent the lowest price for medical care in your region all the time. Sample attached. No one else does this because it would reveal their pricing and related secrets. 

d. Employer data. We get it and leverage it with 1) our savings analysis and 2) make it instantly searchable on pratter.us. No one else does this. This is real, actionable data without any insurance company restrictions since we are independent.

e. Community hospital and surgery center data. With a strong medical provider background, it is only natural that we partner with these medical providers of high value (low cost and high quality) to help them grow market share.  They are providing us their cost data.

Self-insured employers with 200 to 2,000 employees. Smaller self-insured companies feel the most pain due to skyrocketing health care costs and can act more quickly with our Pratter solution. Plus, they can provide us medical cost data for our database.  With this said, we can service larger clients and will be opportunistic.

Fully insured companies with 50 or more employees serve as our secondary target market. Once an employer reaches 50 employees, experience matters. The less spent on health care, the lower the insurance rate hike the next year.

No, not at this time, for the following reasons:

a. Health insurance companies, third party administrators (TPAs) and preferred provider organizations (PPOs) have already vetted all medical providers in their networks.  Pratter does not view its job to duplicate their effort and service.

b. There are already multiple medical quality rating companies out there. Pratter does not aspire to be a “me too” company in an area where there is no market growth and where its services are not needed.  Furthermore, the companies that are labeled as quality companies do not reveal their 50 or 100 factors they consider when rating quality nor do they disclose their weighting system for those 50 to 100 factors.  In other words, if you, as a consumer, think that getting a black box of unknown factors and weighting will provide you accurate quality ratings, think again. 

c. Pratter focuses on 600 fixed commodity outpatient medical care cost items. Blood work and imaging do not even require a physician to be performed and often the same machinery is used in multiple medical facilities in network with vastly different pricing.

d. Price will get you quality.  We believe cost will get you quality. If a hospital charges $6,000 for a medical test and another hospital charges $1,500 for that same medical test, the first hospital has to 1) explain why its medical care has 400% more quality and why we should pay for it, or 2) lower its price, or 3) lose market share.

e.  Elective medical procedures. Medical care, such as a carpal tunnel release or cataract surgery, can be performed safely in a surgery center or a hospital. We plan on having a 3rd party quality link for this portion of our business model but have struggled thus far to identify meaningful, object quality data deserving of the consumer and our website.

Pratter is a health care consumer company focused on pricing.  Medical costs have become so high that many working Americans no longer have access to affordable medical care.  We want to do one thing and one thing only better than anyone – address medical costs.

Their biggest barrier is themselves. They don’t want pricing transparency.  Let’s say you own a car dealership but don’t have to tell the car buyer whether that car is $30,000 or $50,000. Car buyers just keep signing away to agree to pay the secret price.  Morals aside, the dealership owner would undoubtedly be financially thrilled with this revenue model.

Furthermore, these large entities are very slow to act. Even if they chose to get involved with medical cost transparency, it would be highly unlikely that they could achieve what we have done already by comparing their costs to their competitors, nor would most want to have their costs compared if they were known.

The federal law is on our side: Public Health Service Act, Section 2718 of the Affordable Care Act. Bringing Down the Cost of Health Care Coverage.

(e) Standard Hospital Charges. Each hospital operating within the United States shall for each year establish (and update) and make public (in accordance with guidelines developed by the Secretary) a list of the hospital’s standard charges for items and services provided by the hospital, including for diagnostic-related groups established under section 1886 (d)(4) of the Social Security Act.

Pratter is significantly different and better and the cost tool estimators do not do what we do.

 Warning: don’t be fooled!  Think hard about the following points:

a. Why do insurance companies provide estimates when they are the ones who wrote and own the contracts with hospitals for pricing?! They wrote the contract with the exact dollar amount - so why the “wrong estimate?" 

b. Why do insurance companies provide ranges (e.g. $400 - $800; a big range for a test) when they are the ones who wrote and own the contracts with hospitals for pricing?! Do you buy anything else with a range? They wrote the contract with the exact dollar amount - so why the “big range?" 

c. NO hospital charges are included. The consumer needs the charge because 20% of claims are denied. And then that charge is the consumer’s bill. If the medical facility is out of network, then a 40% coinsurance of that high charge instead of an in network 20% is the consumer’s bill.  Pratter refers to this hospital charge (sticker price) as one half of the Holy Grail of cost transparency.

d. No insurance company payment (aka negotiated discount price) is included. If a health insurance company pays $900 for a lumbar spine MRI to Hospital X then consumer Y should pay $900 - and never more - but it doesn’t work like that now.  Pratter refers to this payment amount (aka fair market value price) as the other half of the Holy Grail of cost transparency.Self-insured companies pay for their employees’ health care. They deserve to know this fair price.

By hiding this fair market cost of care, the insurance company states they get to keep their “competitive advantage.” Translation: they are taking care of themselves - not you, the health plan bill payer, aka the employer and employee consumer.

e. Some exclude surgery centers. Why? Because they compete with hospitals and insurance companies need hospitals – not surgery centers - to insure bodies to generate big revenue.  This means that the insurance cost estimator tool has incomplete data and does not provide you with all in-network medical provider estimates.

f. They don’t include out-of-network providers. In many instances, it is worth big money to go out of network for consumers with high deductibles. Business is conducted to steer you where to go for care, and not necessarily in the best interest of your family budget.  This is especially true for “integrated” hospital systems – the word for when the insurance company and hospital are one and the same entity. In this circumstance, they want to keep your business in-house.

g. They have a limited number of medical procedures in their search engines, which are not as friendly, or procedure loaded, as Pratter.us.

We cover four (4) categories of elective medical care including 1) blood work, 2) imaging studies, such as x-rays, MRIs and CTs, 3) elective medical procedures, such as a colonoscopy or carpal tunnel surgery, and 4) doctor visits.

No. Pratter never wants to interfere with your primary care doctor relationship or with emergency care.  Pratter focuses on outpatient (outside the hospital) routine elective medical care.

You can call our 877 cost concierge service staffed by medical billers. They know how to direct you to save money. The most important cost savings tip is to receive medical care any place but the hospital. Independent (not hospital-owned) MRI/CT centers, blood work centers and surgery centers offer some of the best cost effective and quality care, i.e., value-based.

Right now, we have a business to business model providing an employee benefit to the employer, private and public sectors, helping all parties save money on health care.  

Yes. Since we focus on publishing the cost of medical care only, we are HIPPA compliant. We do not electronically request or maintain any names or diagnoses.  Our goal is to save you the most money on your medical care so that you have money for other important things in your life too.

Below is a statement from the government website (HHS.gov) which clearly states that there is no issue with releasing de-identified (legal term for no personal information) claims data.

De-Identified Health Information. There are no restrictions on the use or disclosure of de-identified health information.14 De-identified health information neither identifies nor provides a reasonable basis to identify an individual. There are two ways to de-identify information; either: (1) a formal determination by a qualified statistician; or (2) the removal of specified identifiers of the individual and of the individual’s relatives, household members, and employers is required, and is adequate only if the covered entity has no actual knowledge that the remaining information could be used to identify the individual.15