Short articles that explain what you need to know: from bills to your rights
Short articles that explain what you need to know: from bills to your rightsRead more »
Websites that can make your busy health life a little easier
Websites that can make your busy health life a little easierRead more »
If your insurer won't pay for a healthcare service, you can “appeal”
How to review your medical bill
Dental Coverage for Children
After Hours Number: 1-855-809-4073
Hours of Operation:
Monday – Saturday 8am – 8pm
MetroPlus Health Plans, in partnership with FAIR Health, is pleased to bring you this free medical cost estimator. You can use this tool to help you estimate your doctor visit fees, lab test expenses, and more; making it easier than ever to manage your healthcare costs.
FAIR Health is a national independent, not-for-profit corporation whose mission is to bring transparency to healthcare costs and health insurance information through comprehensive data products and consumer resources.
What Is The Relationship Between MetroPlus And FAIR Health?
MetroPlus Health Plan strives to provide the best resources for our members and potential members. After several reviews of vendors, we realized that the FAIR Health service provided a combination of benefits and resources that will guide people towards making smart health care decisions. MetroPlus decided to contract with FAIR Health to provide this treatment cost calculator.Back to Top
How Will This Website Help Me Make Decisions About Health Insurance?
MetroPlus is pleased to provide this website to help educate participants and potential enrollees about the health insurance reimbursement system. The site includes numerous articles and videos that explain how health insurance plans work and how to plan in advance for your share of health care costs. In addition, the site enables you to estimate the costs, by location, for thousands of specific medical procedures. The cost lookup feature illustrates how much you can expect to pay if you are uninsured or if you are considering seeking care outside of your plan’s provider network. Use this website in conjunction with MetroPlus plan information to help you select the plan that is right for you. And, once you have enrolled, come back often. The information and cost estimates can help make you a smarter consumer of health care services.Back to Top
What is FAIR Health?
FAIR Health's mission is to help you understand your healthcare costs and health coverage. We are an independent, national, nonprofit organization known for providing fair and neutral information to all those we serve, including consumers like you.
We are able to provide reliable information about healthcare costs because each year health insurers around the country send us over 2 billion healthcare claims, which are added to FAIR Health's database of more than 28 billion claims. We use information from those claims to estimate what providers charge, and what insurers pay, for providing healthcare to patients all across the country. We make this information available to consumers, researchers, businesses and many other users. Learn more by visiting our company website at fairhealth.org.Back to Top
Why was FAIR Health created?
FAIR Health was created in 2009, after the New York State Office of the Attorney General investigated potential conflicts of interest in the methods that health insurers were using to set reimbursement for patients who received care from out-of-network providers (doctors or other health providers that do not contract with the patient's health insurer). The case was settled with health insurers that do business in New York State. The settlement agreements focused on bringing fairness and transparency to the out-of-network reimbursement system.
FAIR Health was created as part of this settlement and charged with establishing and overseeing an independent database with cost data for billions of billed medical and dental services and procedures. We use that database to power this free website.Back to Top
Where does FAIR Health get its cost data?
We collect healthcare claims data from health plans and plan administrators for all 50 states, Washington, DC, Puerto Rico and the US Virgin Islands. This data tells us how much doctors are charging, and how much insurers are paying, for people's care. We organize the claims data we receive by geozip—a geographic area, usually based on the first three numbers of a zip code.
From these data, we provide three kinds of cost information:
Charge estimates. Different providers are generally free to charge different prices for the same service. We organize these charges into percentiles, from lowest to highest. For example, if a provider's price is in the 80th percentile for a certain service, that means 80 percent of the fees billed by other providers for the same service were that amount or lower.
In-network rates. The in-network rate is FAIR Health's estimate of what an insurer may pay your in-network provider for a particular service. To estimate this, FAIR Health determines the ratio between what providers charge and how much insurers pay for certain categories of medical services. We apply those ratios to the charges in our database for services within those categories. The results are organized into percentiles for each geozip. For example, the 80th percentile in-network rate for a certain service means that we estimate 80 percent of payors paid that amount or less for the service.
Provider-specific charges. In New York State, FAIR Health reports what some specific providers in your area typically charge for 100 commonly performed procedures. We looked at physicians, physical therapists, chiropractors, acupuncturists and other providers in New York State. We identified those services that appeared most frequently in our database; were most commonly provided out of network; and/or were most searched for by consumers. We excluded some preventive screening procedures because health plans typically cover them for free. Additional services will be added in the future.
How does FAIR Health make sure that its data are reliable?
FAIR Health's in-house experts in statistics, economics and technology carefully follow a rigorous, multi-step process to check that the data are valid and reliable. Only valid data are added to the FAIR Health database. Learn more about our process here.
The medical and dental charge estimates on this website are based on the FAIR Health database and reflect 12 months of claims. The charge estimates are kept current with updates twice a year.Back to Top
Does FAIR Health set “usual, customary and reasonable” (UCR) rates for insurers?
No. FAIR Health offers benchmark charge data that some insurers may use to help inform their rates for out-of-network reimbursement. FAIR Health does not set UCR rates or out-of-network reimbursement rates for insurers. Although some insurers may choose to use our data (usually combined with other information) to determine UCR, these decisions are made solely by insurers based on their internal policies.Back to Top
Who serves on the FAIR Health Board of Directors?
The FAIR Health Board of Directors comprises recognized leaders in the fields of medicine, healthcare policy, law, consumer advocacy, technology, education, medical research and business. They serve without compensation and adhere to rigorous conflict-of-interest policies.Back to Top
Consumer Website Tools Available through This Website
What will I find on this website?
This website is here to help both insured and uninsured people make decisions about healthcare. The cost lookup tool shows you what medical and dental care cost in your area. At this time, we have cost estimates for:
Thousands of medical and dental services (professional fees);
Medical supplies (e.g., diabetes supplies, walkers, canes, vision supplies, hearing aids);
Ambulance rides; and
Services done in a facility (e.g., hospital or ambulatory surgery center).
The educational resources help you choose a health plan, pick a doctor, understand your healthcare bills, negotiate prices with your provider, appeal your plan's payment, plan your costs in advance and more.
This website allows you to search for:
How much you might pay for a medical or dental service if you're uninsured.
Out-of-network costs that you may pay if you go to doctors who are not in your health plan's network.
For in-network costs, you can estimate how much you may have to pay for doctors in your health plan's network if you haven't met your deductible.
Costs and other information about episodes of care. Educational videos explain the many different services, supplies, tests and medications involved in treating complex conditions like diabetes or procedures like knee replacement. Our cost estimator can show you the overall cost you can expect to pay for everything you need during these 25 “episodes of care,” both for in-network and out-of-network care.
The basics of health coverage, from the differences among plan types to how a deductible works and more. Health insurance is very complicated, but our educational articles, videos and glossary terms can help you better understand how health insurance works.
Where to get help. We provide links to health-related organizations that can help you.
Some of the features and content of this website may look familiar to you if you've previously visited FAIR Health's award-winning national consumer website or used our mobile apps. You can get our cost information on your phone by downloading our FH® Cost Lookup mobile app in English and Spanish from the App Store and Google Play. We also provide nationwide cost lookup tools in English (fairhealthconsumer.org) and Spanish (consumidor.fairhealth.org).
We've also created new features and educational content especially for New Yorkers. This website offers a new healthcare planning tool developed by FAIR Health for New York State residents, with support from the not-for-profit New York State Health Foundation. It features information on local physicians and other healthcare providers who can provide some of the healthcare services or procedures found on this website. You also can compare providers by price and certain practice features, such as the number of years they've been in practice, their location, the hospitals they work at and their training. In the future, the site will also feature quality and cost information for certain commonly performed hospital procedures for hospitals in Westchester, Syracuse, Albany and Buffalo, New York.
Who can use this website?
Insured and uninsured people can use this website. It may be of particular use to people managing a deductible, wanting to learn more about health insurance or looking for access to one of the 25 episode of care cost bundles. Before you receive care, you can use the site to plan your costs. After you receive care, you can use it to negotiate payment or support appeals.
Do the medical cost estimates apply to people who are covered by Medicare, Medicaid or other government programs?
No. The cost estimates generally apply only to those who are covered by private insurance or who are uninsured. These cost estimates do not apply to those who are covered by government programs such as Medicare, Medicaid or Tricare.
However, these cost estimates may be useful to you if you have coverage under a government program, but you are getting care that is not covered by that program. For example, Medicare does not cover most dental services. If you have Medicare and you need to see a dentist, you can find out how much you may pay. The information on the site can also help you evaluate a Medicare Advantage plan that requires you to pay more for services outside of the plan's network.
Note: Some private insurers (i.e., non-government) use Medicare rates to set out-of-network reimbursement, which means that the insurer will pay some percentage or multiple of what Medicare would have paid for the services. This is not the same as being covered by Medicare. If your insurer refers to Medicare rates in this way, you can use this website to estimate your medical out-of-pocket cost: on the cost results page, selecting the appropriate option under the “Estimated Reimbursement” dropdown section under “Adjust Charge.”
I searched for a cost estimate and got "N/A." What does it mean?
If you see N/A (Not Available) after searching for a cost estimate, this means that we cannot provide at this time a cost estimate for the procedure code in the geographic area you searched.Back to Top
Why does the website limit the number of searches I can conduct?
This website is for consumer use. It is expected that in most cases, consumers will be able to meet their needs before reaching the search limits: When looking up medical costs, search up to 20 medical codes per week. Entering a zip code and a medical procedure code (or choosing a procedure from the menu) counts as one medical search.
When looking up dental costs, search up to 20 dental codes per week. Entering a zip code and dental procedure code (or choosing from the menu) counts as one dental search.
Search limits are reset at the end of the weekly search period to enable consumers to estimate costs for additional codes.
FAIR Health uses a computer's IP address to track searches. If you use a computer whose IP address is shared throughout an office, library or other organization, you may reach the limit before you have personally conducted the maximum amount of searches. If you are a consumer and feel you have been inappropriately blocked, please e-mail us at email@example.com.
For information on licensing FAIR Health data for healthcare professionals and commercial businesses, contact firstname.lastname@example.org.Back to Top
Licensing/Linking to this Website
I would like to link to your website from my organization's website. How can I learn more?
FAIR Health welcomes organizations to link to our website and download materials for consumer use.
FAIR Health is a not-for-profit organization that relies in part on license fees to support its work. When consumers use our site, we incur fees from third parties. For that reason, links to fairhealthconsumer.org for commercial purposes require a license agreement and nominal fees. Commercial purposes include, but are not limited to, links established by providers or third-party payors in connection with participation on state or federal health benefit exchanges.
FAIR Health also licenses educational material, videos and cost lookup tools for use on organization websites and for other uses. Please contact email@example.com to learn more.Back to Top