Your Guide to Understanding Healthcare Costs
We understand this may be a stressful time. Whether you're facing a new diagnosis, planning a procedure, or trying to make sense of a confusing bill, we're here to help. This guide is designed to be simple and straightforward. Take your time reading through it, and remember - you don't have to figure everything out at once.
TrueCostMD helps you see what healthcare services actually cost. We gather pricing information that hospitals and insurance companies are now required to make public, and we present it in a way that's easy to search and understand.
This guide will walk you through everything step by step.
Important: Please Read
The prices shown on TrueCostMD are estimates based on publicly available data. They are meant to help you understand typical costs and compare options.
Your actual costs may be different based on your specific insurance plan, deductibles, copays, the exact services you receive, and other factors.
Always verify pricing directly with your healthcare provider and insurance company before making decisions. Use our information as a starting point, not as a final answer.
What's in This Guide
1. Understanding Your Medical Bills
Medical bills can be confusing. They often contain codes, abbreviations, and charges that are hard to understand. Let's break down the key parts you'll typically see.
The Basics of a Medical Bill
Most medical bills have these main sections:
Patient Information
Your name, address, date of service, and account number. Always check that this is correct.
Service Description
A list of what was done — tests, procedures, medications, room charges, etc. Each item usually has a code next to it.
Charges
The amount billed for each service. This is often called the "list price" or "chargemaster rate" — it's rarely what you'll actually pay.
Insurance Adjustments
If you have insurance, you'll see discounts or "adjustments." This is the difference between what was charged and what your insurance agreed to pay.
What Insurance Paid
The amount your insurance company paid to the provider.
Your Responsibility
The amount you owe. This includes your deductible, copay, or coinsurance.
Understanding Medical Codes
You'll often see codes on your bills. Here are the most common types:
CPT Codes (5 digits, like 99213)
These describe specific medical procedures or services. For example, 99213 is a standard office visit. You can search for these codes on TrueCostMD.
ICD Codes (like J06.9)
These describe your diagnosis — the reason for your visit. They help explain why a service was needed.
HCPCS Codes (like J1234)
These are used for medications, supplies, and some services not covered by CPT codes.
Tip: If you see a code on your bill that you don't understand, you can search for it on TrueCostMD or simply search the web for "CPT code" followed by the number. This will tell you what service was billed.
2. How to Use TrueCostMD
Searching for healthcare prices on TrueCostMD is straightforward. Here's how to do it:
Go to the Search Page
From our home page, you'll see a search box at the top. This is where you'll enter what you're looking for.
Enter Your Search
You can search in several ways:
By procedure name: "MRI" or "knee replacement" or "colonoscopy"
By CPT code: "99213" or "27447"
By general description: "blood test" or "X-ray"
Filter Your Results
After searching, you can narrow down results by:
Location: Enter your city or ZIP code to find prices near you
Insurance plan: Select your insurance to see negotiated rates
Provider type: Hospital, clinic, or specific healthcare system
Review the Results
For each result, you'll see:
Provider name: The hospital or facility
Negotiated rate: What your insurance has agreed to pay for this service
Insurance plan: Which plan this rate applies to
Billing code: The specific code for this service
Remember: The prices you see are "negotiated rates" — the amount your insurance company has agreed to pay the provider. Your out-of-pocket cost depends on your deductible, copay, and coinsurance. If you haven't met your deductible, you may owe more.
3. Comparing Prices You Find
One of the most valuable things you can do with TrueCostMD is compare prices between different providers. Here's how to make sense of what you find:
Why Prices Vary
You may be surprised to see that the same procedure can cost very different amounts at different places. This is normal, and there are several reasons:
• Facility type: Hospitals often charge more than outpatient surgery centers
• Location: Prices vary by city and region
• Insurance negotiations: Different insurers negotiate different rates with the same provider
• Facility fees: Some locations add extra fees for using their space
What to Look For
When comparing prices, pay attention to:
• Make sure you're comparing the same thing: Check that the CPT codes match
• Check if it's in-network: Out-of-network providers may cost you much more
• Look at the total picture: A lower price isn't always better if it means longer travel or less convenient scheduling
• Consider quality: Price is one factor, but quality of care matters too
A Helpful Approach
Before a planned procedure, search for the CPT code on TrueCostMD, note the price range you see, and then call a few providers to ask: "What is your negotiated rate with my insurance for CPT code [number]?" This helps you verify the information and find the best option for you.
4. Reconciling Your Bills with Our Data
After you receive care, you can use TrueCostMD to check whether the charges on your bill seem reasonable. Here's how:
Step 1: Gather Your Documents
You'll need:
• Your itemized bill (you can request this from the provider's billing department)
• Your Explanation of Benefits (EOB) from your insurance company
• Your insurance card (to know your plan name)
Step 2: Identify the Codes
Look at your itemized bill and find the CPT codes for each service. They're usually 5-digit numbers. Write these down along with the charge for each one.
Step 3: Search on TrueCostMD
For each CPT code, search on TrueCostMD. Filter by your insurance plan and the provider where you received care (if available). Note the negotiated rate shown.
Step 4: Compare
Create a simple comparison. You can use paper or a spreadsheet:
| CPT Code | Service | Bill Amount | TrueCostMD Rate | Difference |
|---|---|---|---|---|
| 99213 | Office visit | $150 | $125 | +$25 |
| 36415 | Blood draw | $30 | $28 | +$2 |
Step 5: Understand the Differences
Small differences are normal and can happen because:
• Prices may have changed since our data was last updated
• Your specific plan may have slightly different rates
• Additional modifiers may apply to your specific situation
Large differences (more than 20-30%) are worth investigating — see the next section.
Important: The prices on TrueCostMD are the "negotiated rates" - what your insurance agrees to pay the provider. This is different from what you personally owe. Your portion depends on whether you've met your deductible, your copay amount, and your coinsurance percentage. Check your EOB to understand your specific responsibility.
5. What to Do If Something Looks Wrong
If you notice charges that seem too high, services you don't remember receiving, or other problems, don't panic. Billing errors are common, and you have options.
Common Billing Errors to Watch For
• Duplicate charges: Being billed twice for the same service
• Incorrect codes: A more expensive procedure code used instead of the correct one
• Services not received: Charges for things that didn't happen
• Wrong patient information: Someone else's charges on your bill
• Out-of-network billing: In-network providers incorrectly billed as out-of-network
Steps to Take
1. Request an itemized bill
Call the provider's billing department and ask for a detailed, itemized bill showing every charge and code.
2. Review your medical records
You have the right to request your records. Compare what's documented with what's billed.
3. Call the billing department
Explain what you've found and ask them to review. Keep notes of who you spoke with and when.
4. Contact your insurance company
If the provider isn't helpful, call your insurance. They can review claims and advocate on your behalf.
5. File a formal dispute
If you can't resolve it, you can file a formal dispute with both the provider and your insurance company in writing.
6. Seek outside help
Consider contacting a patient advocate, your state's insurance commissioner, or a medical billing advocate if you need additional support.
Remember: You have the right to question your bills. Providers and insurance companies have processes to handle disputes. Be cautious paying a bill you believe is incorrect until you've had a chance to investigate.
6. Understanding Our Data
We want to be transparent about how our pricing information works and what limitations exist.
Where Our Data Comes From
TrueCostMD collects pricing data from the machine-readable files that hospitals and insurance companies are required to publish under federal price transparency rules. We process these files and make them searchable for you.
This data represents the negotiated rates between insurers and healthcare providers — the actual agreed-upon prices, not the inflated "list prices" you often see on initial bills.
Important Limitations
Data is added as we receive and process it
We continuously add new data from healthcare providers and insurers. If you don't find what you're looking for, it may be because we haven't processed that data yet. Check back later or contact us.
Not all providers and plans are included
While we're always expanding our coverage, we may not have data for every provider, every insurance plan, or every geographic area.
Prices can change
Healthcare prices are renegotiated periodically. The rates we show reflect the most recent data we have, but prices may have changed since then.
Your specific costs will vary
The negotiated rate is what your insurance pays the provider. Your personal cost depends on your plan's deductible, copay, coinsurance, and whether you've met your out-of-pocket maximum.
How to Use This Information Wisely
• Use it as a starting point: Our data helps you understand typical costs and compare options
• Always verify: Before making decisions, confirm pricing directly with your provider and insurance
• Ask questions: If something doesn't match, ask your provider to explain the difference
• Keep records: Document any price quotes you receive in writing
7. Getting Help
We're here to support you. If you have questions or need assistance, here are your options:
A Final Word
Navigating healthcare costs can be overwhelming, especially when you're dealing with health concerns. Take it one step at a time. Use this guide as a reference whenever you need it.
Our goal is to help you feel more informed and confident when making healthcare decisions. You deserve to know what things cost, and we're here to help make that possible.
Disclaimer
TrueCostMD provides healthcare pricing information for educational and informational purposes only. We are not a healthcare provider and do not provide medical advice. The pricing data shown is derived from publicly available sources and may not reflect current prices, your specific insurance plan, or the final cost of services you receive. Always verify pricing directly with your healthcare provider and insurance company before making healthcare decisions. Your actual costs will depend on many factors including your insurance coverage, deductibles, copays, coinsurance, and the specific services provided. TrueCostMD is not responsible for billing disputes or discrepancies between our data and actual charges.