Get essential information on costs for thousands of procedures.
Would you like a cost and quality comparison between providers?
Need help starting the process or simply have a question?
Contact a DirectPath Advocate for assistance.
1-866-253-2273 option 3 for "cost research"
Monday-Friday 7:00 a.m. - 6:00 p.m. Central Time
About Advocacy and Transparency at DirectPath
Our health care advocates help employees navigate the health care system and become better, more informed consumers. We assist employees and their family members with questions about their health care coverage as well as flexible spending accounts (FSAs), health reimbursement accounts (HRAs) and health savings accounts (HSAs).
We make sure your insurance is working the way it’s meant to. Access to knowledgeable and experienced advocates who can help you shop for your health care, answer benefit questions, locate in-network providers, and resolve claims issues helps you make better decisions about your care and enables your employer to reduce administrative and health care costs.
You can’t be a true health care consumer if you don’t know how to “shop” for health care. Our advocates provide you with up to three options for a medical test or procedure, along with quality and cost data, enabling you to make informed decisions about where to find cost-effective care. Armed with this critical information you can, on average, save $400 out-of-pocket per request and your employers save more than $1,400 per request.
Requesting a cost and quality comparison (transparency) report
- Contact a DirectPath Advocate by calling 1-866-253-2273, option 3 to start the process for requesting research and a cost and quality comparison report. Our Advocates are available Monday-Friday 7:00 a.m. - 6:00 p.m. Central Time.
- Once the request is received, an Advocate will work with you to:
- Provide up to three options for a medical test or procedure, along with quality and cost data (note: provided via a Transparency Report). Advocates can shop for any procedure, anywhere in the country.
- Provide true insight into the costs of medical procedures and will educate you on the differences between your options.
- Upon request, an Advocate can help you schedule your procedure and get medical records transferred.
- You're now enabled to make informed decisions about where to find cost effective care.
About DirectPath
DirectPath is an industry leader in employee engagement, health care transparency and compliance for Fortune 1000 employers.
Our customers experience significant ROI on their benefits investments through increased employee participation, management of ERISA and ACA regulations, and reduced cost through benefits plan management technology.
How We Estimate Cost and Quality
DirectPath has partnered with FAIR Health, an independent nonprofit that collects data for and manages the nation’s largest database of privately-billed health insurance claims, to provide our members with a tool to estimate health care costs in their geographic area.
Here you can learn more about their data.
- Collecting data. FAIR Health collects health care claims data from health plans and plan administrators. This tells them how much doctors are charging, and how much insurers are paying, for people’s care. They test the data to make sure the data are reliable.
- Organizing data by geozip. FAIR Health organizes the claims data by geozip—a geographic area, usually based on the first three numbers of a zip code. Grouping the charges by geozip helps make sure that the costs represent what providers charge in a specific area.
- Cost estimates. Different providers are generally free to charge different prices for the same service. FAIR Health organizes 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 (or “allowed”) rates. The “allowed amount” is FAIR Health’s estimate of what an insurer may pay your in-network provider for a service. The results are organized into percentiles for each geozip. For example, the 80th percentile “allowed amount” for a certain service means that they estimate 80 percent of payors paid that amount or less for the service.
- FH® Total Treatment Cost. Treating complex conditions like type 2 diabetes can involve a lot of different services, supplies, tests and medications. This website provides estimates of the typical overall cost you can expect to pay for all components of caring for certain chronic conditions (like asthma) and event-based procedures (like knee replacement).
- The FH Total Treatment Cost estimates include all of the costs for your medical care from the time you get sick or injured until you are better, or when your treatment is over. For chronic conditions, estimates include the typical services for the condition over the course of one year. To create each estimate, we first identify the most commonly performed services associated with each condition or procedure. Then we estimate the cost for each of the services associated with the condition or procedure, and multiply that amount by the number of times patients usually receive each service. We combine all the estimated charges for the number and type of services in a typical treatment cost to give you an estimate.