Shop for Care

Prices vary based on your insurance company. Facilities (hospitals, imaging centers, surgery centers, etc.) can have one price for one insurance company, a different price for another, and a still another price for people with no insurance.

The tool gives an average total price, not the amount you will pay if you have insurance. If you have private health insurance, Health First Colorado (Medicaid), or Medicare, contact them directly to understand what you will have to pay.

It’s still important to pay attention to the total price even if you are not paying all of it. Your health insurance premium – the amount you pay every month – is set every year based on how much your insurer spent on health care the year before. The choices you make today could affect your future premiums.

The prices in the tool show what private insurance companies (Aetna, Anthem, Cigna, Humana, etc.) paid. It gives you some idea of what you might expect to pay if you had to pay the whole cost. It is a starting place for a conversation with a hospital or other facility about costs. Contact the hospital or facility directly to ask about your costs. Many places will give you a discount if you don’t have insurance, so be sure to ask.

The prices include the total payment made to the facility, including the amount the insurance company’s paid and the amount patients paid as a co-pay or deductible. But it doesn’t include payments for doctor fees, labs or any other services that may have been included – just the price the facility is paid.

We included services that many Coloradans use so we have enough information to report an average price. We focus on procedures and services that are often planned in advance so consumers have time to shop for the best options.

That five-digit number is what a facility will use to let health insurance companies know what service you had and is the basis for how the claim gets paid. It’s good to know what code will be used, if possible, because it’s the way both providers and insurance companies refer to a service. Contact your doctor or health care provider if you don’t know your specific code.

We add price and quality data for a health care service when we have enough claims at enough facilities for that service.

The prices in Shop for Care come from billing data that private health insurance companies submit to the Colorado All Payer Claims Database (CO APCD). The database includes claims from Medicare and Medicaid, but the Shop for Care tool has only claims paid by private insurance companies. People with high-deductible plans or no insurance are more likely to pay rates similar to private insurance rather than Medicare or Medicaid rates.

The average price listed in the tool is the median – or the middle – price paid for the service. For example, if a facility was paid $10, $20, $30, $40, and $50 for a service, the median would be $30, the price in the middle.

The price range gives you a typical low and high payment for the service. (We take out very high and very low payments and report the range in prices at the 25th and 75th percentile.) You might notice that sometimes the average price is the same as the price range. That means the facility was paid about the same price for the service all the time, from all insurance companies.

The patient experience rating comes from a survey called the Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS. The survey is given to adult patients between 48 hours and six weeks after leaving the hospital.

The overall hospital quality rating comes from data hospitals report to the Centers for Medicare and Medicaid Services (CMS) for the Hospital Inpatient and Outpatient Quality Reporting programs. The data is summarized into a single star rating for each hospital. You can visit the CMS website for more information about the star ratings.

Only certain facilities that serve a minimum number and type of patients are required to report quality data to CMS. We are planning to work with imaging centers, ambulatory surgery centers, physician offices and other types of facilities to get quality data from other facilities.

The five-star rating system makes it easier for consumers to choose hospitals based on quality. CMS is now looking at other ways to share quality information with consumers. When we have this data, we’ll share it with you.

Due to Colorado law, Shop for Care only includes services done in hospitals, surgery centers, and imaging facilities not doctor’s offices owned solely by doctors. We include any facility with at least 11 insurance claims for the service or procedure during the last full calendar year. If you need price information for a facility that’s not listed, contact your health insurance company or the facility for more information. You can also contact us at info@civhc.org.