Frequently Asked Questions (FAQs)
What is Pratter?
Pratter is a medical cost transparency and savings company offering health care cost-saving solutions through a suite of IT products and fee-based consulting services.
What does “Pratter” mean?
Pratter means “price matters”. The price of medical care matters because 80% of working Americans don’t meet their deductible, so the cost of care comes right out of their purses or wallets. Worse yet, many Americans who can’t afford the cost of care will avoid getting care altogether.
What is Pratter’s mission?
Pratter’s mission is to help millions save billions on routine medical care. Our goal is to offer tools and databases that help working Americans access affordable care near their home, workplace or when traveling or vacationing anywhere in the U.S.
Who can benefit from Pratter?
Pratter’s IT platforms offer benefits to both self-funded plans and the group benefits professionals who serve them:
- Self-funded plans interested in taking advantage of the tremendous cost-saving value their lower-cost, in-network providers offer over higher-cost, in-network providers for routine outpatient care.
- Self-funded plans interested in fulfilling their ERISA fiduciary responsibility to monitor and account for all costs associated with the plan.
- Independent TPAs, PEOs, insurance/financial services firms, online benefits platforms interested in offering a fresh and differentiating service to their clients and prospects.
- Christian shares/share programs interested in saving money on routine outpatient care.
- Benefits advisors/consultants who see the value of the Pratter in helping their clients save money on routine outpatient care.
What kind of medical care is searchable on the Search and Save Engine?
Pratter’s core strategy is to focus on four categories of routine care: 1) blood work, 2) imaging (CTs and MRIs), 3) surgery center care (upper and lower GI scopes, carpal tunnel releases and cataract surgery) and 4) urgent center care. Nearly 600 of the most common outpatient care items are searchable on our website and serve as the basis for savings at the health plan design level.
What are Pratter’s core offerings?
Pratter offers three IT platforms:
Search and Save Engine: a searchable database of over 600 routine outpatient procedures. The user can view highest-to-lowest charges (retail rate) by provider and the claim allowables (real discounted price paid) using Medicare or network-specific data. The Pratter Report: our flagship platform. The Pratter Report is the most revealing of any medical cost transparency report on the market. The Report allows plan fiduciaries to see for the first time what’s really going on with their medical spend. The Pratter Report creates an “aha!” moment within seconds. Money Map: a low-cost care “locator” tool that uses Google Maps and Google markers to display the locations of lower-cost, in-network outpatient facilities for the care we all need: blood work, imaging, outpatient surgery and urgent care.
Why did Pratter develop Money Maps?
Money Map was developed to provide health plan members with a quick and nearly effortless way to locate lower-cost, in-network providers while avoiding the crushing costs (often 1,000% more) charged by the higher-cost providers for the same routine outpatient procedure in-network.
Pratter recognizes that getting busy and easily-distracted plan members to utilize helpful tools is challenging. In developing Money Map, we borrowed from the solutions developed by retirement plan sponsors, vendors and consultants. Unlike other “transparency” tools, Money Map isn’t based on the faulty premise that you can change unmotivated and easily distracted plan members into engaged “shoppers” of something they don’t even understand. Retirement plans learned this lesson 20 years ago.
We keep it simple. Just Tap the Map ® to display vetted, pre-screened lower-cost, in-network providers for a given procedure (see FAQ 8). Higher-cost providers and providers who don’t meet Pratter’s screening criteria are excluded. This is no different than the investment option selection process for a group retirement plan.
How does a medical provider qualify for Pratter’s Money Map?
Pratter was founded by doctors. These aren’t just any doctors, but ones who are experts in medical billing and own a medical billing company. Pratter has used its cost database to help determine which providers qualify for its Money Maps.
Pratter’s trained expert medical billers have called every single Money Map provider under cover and asked pertinent questions regarding their billing practices. For example, although an in-network urgent care center might use emergency room billing codes and charge $2,000 for a 15-minute visit, it does not meet Pratter’s strict Money Map criteria.
Pratter has multiple proprietary check boxes that must be checked before a provider can make it to our Money Maps.
What kind of savings can be expected using Money Map?
Money Map providers generally save a plan approximately 60% compared to non-Money Map in-network care providers within the same care category.
You can trust us as the authoritative source for affordable access to in-network care in your neighborhood and across the U.S.
What about rural areas with limited options for healthcare?
While our medical cost savings and transparency solutions are available in all 50 states, certain rural areas may limit our utility. In this type of setting, using our claims database of one billion Medicare claims with a Medicare reference-based pricing (RBP) health plan is the way to go.
How does Pratter motivate plan members to use Money Map?
Money is the answer. Money motivates. Pratter works with health plans to waive co-pays and coinsurances for care at Money Map providers. If this option is not available, members can get paid to receive care with our reusable Visa Cash Reward card, in partnership with ADP. The organization saves big money on the medical provider facility fee and the member makes money when a portion of the savings is shared. It’s a win-win!
How is Pratter priced?
Pratter is offered on a per-employee/member-per-month (PEPM or PMPM) payment for service model. Pratter will also enter into a sharing of savings arrangement based on certain criteria and metrics as defined by Pratter.
Where does Pratter get its medical cost data?
From each self-insured organization that has requested the Pratter Report. To generate a Pratter Report, each self-insured employer/membership organization provides us with its de-identified (privacy compliant) medical claims cost data. Under the Employee Retirement Income Security Act (ERISA) federal law of 1974, self-insured organizations must manage both the retirement and health benefit. The only way to manage the healthcare spend is to review it the Pratter way. The cost data we onboard creates the network effect. And this network continues to grow.
Pratter also has a contract with the federal government where it has procured approximately 1.8 billion medical claims and deemed one billion of them to be of high quality for use on our IT platforms.
What makes Pratter different from other so-called medical cost savings and transparency companies?
Pratter is made up of physicians, medical billers, IT software experts, finance experts and mathematicians all with a passion for serving others. We are a mission-driven company. Additionally, our three IT Platforms (see FAQ 5) are complementary by design. Whether used separately or in combination, Pratter can provide comprehensive plan-level and plan member-level solutions. By remaining independent of all health insurance companies, we stand alone in the market without a financial conflict of interest for those we serve.
How does Pratter differ from cost estimator tools offered by the insurance companies?
Pratter differs in three ways:
Cost estimator/cost transparency tools offered by the insurance companies skirt the very problem they created: 1,000% pricing variance for the same in-network procedure. Their tools offer no more than a partial work-around. Consider the following:
- Some insurance cost estimator/price transparency tools exclude surgery centers because they compete with hospitals. Some hospitals with dominant “market power” will only sign a contract with an insurance company if they exclude the independent surgery centers located within their market. This limits the search results because the lower-cost surgery centers are excluded.
- Insurance companies need hospitals - not surgery centers - to maximize revenue and profitability.
- Why do insurance company tools only provide “estimates” when they wrote the contracts with the hospitals - which included exact pricing on all care items?
Insurance companies tout “transparency”, but what generally happens when a self-insured organization asks for electronic copies of the very medical bills it paid?
Pratter is 100% independent. We do not sign business affiliation agreements (BAA) or non-disclosure agreements (NDA) with carriers that deliberately place restrictions on what we can disclose to our members about their medical spend. We are 100% loyal to our members. The true medical cost transparency we provide for the sole benefit of our members is not associated with a financial conflict of interest.
Does Pratter affect my relationship with my primary care physician or when I need emergency care?
No. Pratter never wants to interfere with the relationship you have with your primary care physician or your physician providing cancer care, open heart surgery or brain surgery, or when you need life-saving emergency care. Pratter focuses on outpatient (outside the hospital) routine medical care.
Please carefully note that health care and health insurance are two different entities. Health insurance is for a catastrophe. Go anywhere you want for a serious health condition. Pratter is about the routine care needs that affect all households.
What happens if I need help finding a low-cost provider on Money Map or help with Search and Save?
You can call our 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 generally offer the best in cost-effective, quality care.