Shop for Care FAQs and Methodology
Why does CIVHC release health care price information?
Last Updated: July 12, 2018As administrator of the Colorado All Payer Claims Database (CO APCD), the state’s most comprehensive health care claims database, and as part of the legislative intent of the CO APCD, Center for Improving Value in Health Care (CIVHC) provides facility-specific price and quality information for free via www.civhc.org as a...
Where does the data come from?
Last Updated: July 12, 2018The price information comes from billing data that health insurance payers submit to the Colorado All Payer Claims Database (CO APCD). CIVHC administers the CO APCD on behalf of the Colorado’s Medicaid agency and turns the information, which includes actual paid amounts, into actionable data for consumers and other stakeholders....
How can I use the Shop for Care information?
Last Updated: July 12, 2018You can use this information to get a general understanding of the difference in price and quality for imaging services and other common procedures across facilities in Colorado. The information is intended to help you identify facilities that you would like to explore further. It is important to note that...
What if I don’t have insurance or I have Medicaid (Health First Colorado) or Medicare?
Last Updated: July 12, 2018The prices included in this report reflect prices being paid for by commercial insurance (Aetna, Anthem, Cigna, Humana, etc.) companies and their members. However, the information can be used as a starting point to understand what you might expect to pay if you were responsible for the entire portion of...
Why should I care about the total price if I have insurance?
Last Updated: July 12, 2018As a consumer of health care, it’s important to pay attention to the total price being paid by you and your insurance company, even if you have a low co-pay and deductible plan. Health insurance premiums are established annually based on how much was spent on health care in previous...
Does the price listed reflect all of the bills I might receive?
Last Updated: July 12, 2018Imaging Procedures: Prices listed on the “Imaging Procedures” tab only reflect prices related to the facility portion of your visit and does not include any bills you may receive from your health care provider. To understand what additional costs you may have in addition to the facility fee for imaging...
How did you decide which services to display?
Last Updated: July 12, 2018The services currently available were selected based on high volume services being performed in Colorado. Across the state, these imaging, preventive and other services are performed regularly, providing enough information to be able to report at the individual facility level. In addition, many of these procedures might be planned in...
What year and payer type do these reports represent?
Last Updated: July 12, 2018This release includes 2020 calendar year commercial claims for Imaging procedures and 2019 for Other Procedures, from nearly 40 commercial health insurance payers, representing the majority of commercially-insured Coloradans. CIVHC plans to update this information annually to reflect the most recent full calendar year of claims available in the Colorado...
What year and payer type do these reports represent?
Last Updated: July 12, 2018This release includes 2020 calendar year commercial claims for Imaging procedures and 2019 for Other Procedures, from nearly 40 commercial health insurance payers, representing the majority of commercially-insured Coloradans. CIVHC plans to update this information annually to reflect the most recent full calendar year of claims available in the Colorado...
What does the 5-digit “CPT” number after the imaging procedure represent?
Last Updated: July 12, 2018The five-digit numbers on the procedures drop-down on the imaging tab reflect the Current Procedural Terminology (CPT) codes that corresponds with the imaging service name. Providers submit CPT codes to health insurance companies to indicate what services were performed in order to get paid. If you are not sure what...
What does the 5-digit “CPT” number after the imaging procedure represent?
Last Updated: July 12, 2018The five-digit numbers on the procedures drop-down on the imaging tab reflect the Current Procedural Terminology (CPT) codes that corresponds with the imaging service name. Providers submit CPT codes to health insurance companies to indicate what services were performed in order to get paid. If you are not sure what...
How are the “average price” and “price range” calculated?
Last Updated: July 12, 2018Average Prices in the report reflect the median (or “middle”) price paid across all commercial payments in the CO APCD. For example, if payments to one facility were $10, $20, $30, $40, and $50, the median would be $30, or the middle price. The “Price Range” reflects the typical range...
How are the “average price” and “price range” calculated?
Last Updated: July 12, 2018Average Prices in the report reflect the median (or “middle”) price paid across all commercial payments in the CO APCD. For example, if payments to one facility were $10, $20, $30, $40, and $50, the median would be $30, or the middle price. The “Price Range” reflects the typical range...
What does it mean if the “average price” is the same as the “price range”?
Last Updated: July 12, 2018Facilities with an Average Price that equals both the low and high end price range have very little, if any, fluctuation in prices being paid by commercial insurers.
Why aren’t all facilities shown for all procedures?
Last Updated: July 12, 2018CIVHC uses the Centers for Medicare & Medicaid Services (CMS) minimum threshold rule requiring that facilitie CIVHC uses the Centers for Medicare & Medicaid Services (CMS) minimum threshold rule requiring that facilities have eleven or more of the same service represented in the dataset in order to release results. Some...
Why Isn’t There Patient Experience and Hospital Quality Information for All Facilities?
Last Updated: July 12, 2018Only certain types of hospitals serving a minimum number and type of patients are required to submit data to the Centers for Medicare & Medicaid Services (CMS) for public reporting, leaving some facilities without a patient experience rating. In the upcoming years, CIVHC plans to work with imaging centers, ambulatory...
Where Do the Patient Experience and Overall Hospital Quality Star Ratings Come From?
Last Updated: July 12, 2018The Patient Experience star rating produced by CMS and used in this report is based on the results of a survey (Hospital Consumer Assessment of Healthcare Providers and Systems) that is administered to adult patients across medical conditions between 48 hours and six weeks after discharge and is not restricted...
Why don’t you have additional quality information available?
Last Updated: July 12, 2018The Centers for Medicare & Medicaid Services (CMS) has developed a five-star hospital rating system to make it easier for consumers to choose hospitals based on their quality. CMS collects, summarizes and publishes this information to help patients make decisions about where to get health care and to encourage hospitals...
Will CIVHC be releasing price information for more services?
Last Updated: July 12, 2018Yes, CIVHC will continue to publicly release price and quality data on a named facility basis for additional health care services and procedures for services with adequate volume in the database. At a minimum, we plan to update the data annually when there is enough run out of claims data...
How are the imaging prices calculated?
Last Updated: February 11, 2019Imaging prices include the member liability (what the patient was responsible for) and the health insurance plan paid amount for the specific Current Procedural Terminology (CPT) code reflected. Only payments related to the facility fee for the procedure (CPT code) are included in the price displayed. Prices do not include...
How are the “Other Procedures” prices calculated?
Last Updated: February 11, 2019Services on the “Other Procedures” tab are calculated using software called PROMETHEUS. PROMETHEUS software calculates full “episode” prices that include all services that typically occur before, during and after the service. Prices in this part of the report include all professional, facility and ancillary fees that were paid during the...
What is PROMETHEUS?
Last Updated: February 11, 2019PROMETHEUS is a method of calculating prices using the complete “episode” of care that covers all patient services related to a single illness or condition – before, during and after care is provided. Covered services are based on commonly accepted clinical guidelines or expert opinions that define the best methods...
Should I Expect to Pay the Entire “Average Price”?
Last Updated: June 29, 2020The average price estimates the price you and your health insurance plan might pay combined. The prices are calculated using payments made across all commercial health insurance plans in Colorado. For specifics on what you would pay based on your specific insurance plan, contact your health insurance company directly. If...
Why Don’t You Show Prices for Medicare and Medicaid?
Last Updated: June 29, 2020Medicare and Medicaid, both public payers included in the Colorado All Payer Claims Database, have a more consistent payment structure across providers, so not as much price variation exists as with the commercial payers. The value of the Shop for Care tool is for patients with commercial or no insurance...
What Does the “Percent Procedure Price” Reflect in “Other Procedures”?
Last Updated: June 29, 2020The percent procedure price is the percent of the total episode price that gets paid for services separated into categories of before, during and after a procedure. The majority of the costs are typically associated with the actual procedure itself and reflect payments for the facility fee, provider fees, and...