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divider Understanding Your Medical Cost Estimate

Understanding Your Medical Cost Estimate

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The information that you receive from this site is an estimate of what you may be responsible for paying for medical services that you receive from an out-of-network provider. While this estimate is based on the extensive data we have related to the fees providers in your area bill for healthcare services, a variety of variables may influence the exact amount that you will have to pay for services that you receive out-of-network.

Provider-related variables that can influence your out-of-pocket costs

For a variety of reasons, different providers charge different amounts for the same service. For example, a provider’s fees may be based on the number of years he or she has been in practice, or whether he or she is board-certified or has received other special training or designations. As a result, the provider you choose to see may bill more or less than the fee that our site estimates is common in your region, and this will impact both the amount of reimbursement you receive from your health plan and the amount you owe your provider.


Health plan-related variables that can influence your out-of-pocket costs

Other factors that will influence how much you have to pay relate to the design of your insurance plan. For example, you may need to pay an annual deductible before your insurer will begin reimbursing you for care that you receive. Your insurer may also reimburse your out-of-network expenses according to a formula that is different from the one we have built into our website. Our website allows you to change some of the variables included in the reimbursement formula to obtain a more personalized estimate. To do so, you will need to know the details of your health insurance policy. Some ways of getting these details are listed below.

It is important to understand that your actual costs may vary based upon factors specific to your providers and your plan. FAIR Health is not determining, developing or establishing an appropriate fee or reimbursement levels for any procedure or service. All of our estimates are being provided for informational purposes only. FAIR Health does not determine what is a "reasonable and customary" or UCR charge. That determination is made by your plan.


Where to go for more information

There are a variety of ways for you to get more detailed information on what your out-of-pocket expenses might be.


Ask your employer

Your employer's benefits group should be able to give (or find) the coverage type and percentile you need to utilize this website to its full potential.

Contact member services from your insurance company

Most healthcare providers have member areas of their websites, online question forms, and in some cases live chats with customer service representatives. You can also call the phone number listed on the back of your insurance card.