CIVHC Shop for Care: FAQs
How are prices set for health services?
Last Updated: March 6, 2023Prices 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.
How much of the price should I expect to pay? Should I expect to pay the whole price?
Last Updated: March 6, 2023The price you will pay depends on your insurance plan, if you have one. Different plans ask you to pay more or less of the total price depending on your deductible (the amount you pay before insurance starts paying), co-pays (amount you pay for a service) or coinsurance (percent of...
I want to make sure I get the best care. Should I choose the place with the highest price?
Last Updated: March 6, 2023A higher price doesn’t mean better care. Use the “Quality” column in the tool to look at quality as well as price.
Will Shop for Care tell me how much I have to pay for a health service? Should I expect to pay the average price?
Last Updated: March 7, 2023Not necessarily. Shop for Care can help you see differences in price and quality for health services at different facilities in Colorado. But the amount you pay will depend on what kind of health insurance you have, if any.
How should I use Shop for Care if I have health insurance or other coverage, like Medicare or Medicaid (Health First Colorado)?
Last Updated: March 7, 2023The 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...
How should I use Shop for Care if I have no health insurance?
Last Updated: March 7, 2023The 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...
What do the prices include? Does the price reflect all bills I may receive?
Last Updated: March 7, 2023The 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...
How did you decide which services to include?
Last Updated: March 7, 2023We 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.
I noticed that the tool includes a five-digit code after the name of service. What is that?
Last Updated: March 7, 2023That 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...
I don’t see the service I’m looking for. Do you plan to add prices for more services?
Last Updated: March 7, 2023We add price and quality data for a health care service when we have enough claims at enough facilities for that service.
Where does the price data in the tool come from?
Last Updated: March 7, 2023The 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...
What year is the price data for?
Last Updated: March 7, 2023This tool includes claims paid by nearly 40 private insurers for calendar year 2022.
How are the “average price” and “price range” calculated?
Last Updated: March 7, 2023The 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...
Where do the quality ratings come from?
Last Updated: March 7, 2023The 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...
I don’t see quality data for all facilities. Why is it missing for some?
Last Updated: March 7, 2023Only 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.
I wish the tool gave more information about quality. Can I get more information?
Last Updated: March 7, 2023The 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.
Why doesn’t the tool show all facilities for all procedure?
Last Updated: May 1, 2024Due 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...