Transparency in Coverage for members

Everyone wants to make informed decisions about their health and find quality options that fit their budget. When you use your HealthPartners insurance, we can help you understand provider costs, estimate your out-of-pocket expenses and more. So the next time you see your doctor, you can focus more on your health and think less about what you’ll pay.

Health care is different than other products and services. That’s because there isn’t always a set cost for everyone, and it can be hard to predict exactly what kind of care you’ll need before you get it. Even if you have insurance, these and several other factors impact what you’ll finally pay out of pocket.

We recommend keeping the below three things in mind when considering your health care options:

One of the easiest ways to save money on your care is by going to an in-network provider. That’s because we’ve pre-negotiated reduced prices with these hospitals, clinics and pharmacies to help our members save money.

The easiest way to find an in-network provider or determine if your current doctor is covered is to search your network through your online account.

During an emergency, you might not have time to pick an in-network provider. But don’t worry – emergency care (no matter where you get it in the United States) is always covered at in-network levels. For follow-up care after an emergency, be sure to use in-network providers for the best coverage.

Even if they’re all in network, different providers may charge different rates for the same service or the same medicine. Those rates can also be influenced by where you get care or fill a prescription – for example, you may pay less when you visit the doctor’s office versus the emergency room, or when you have outpatient surgery at a specialty center versus inpatient surgery at a hospital.

If you have time, shopping around before your appointment, procedure, test or pharmacy visit is the best way to estimate costs and decide where to go. Most HealthPartners members can get an estimate online to make price comparison easier.

Cost isn’t the only reason to shop around for health care – it’s just as important to consider provider quality to prevent complications that may require more treatment in the future. You also want to be sure you’re getting the right value for your money.

When available, you’ll see cost and quality ratings on a four-star scale when you search your network. These ratings are based on extensive analysis of data, patient outcomes and much more. Combined with a cost estimate for your personal situation, cost and quality ratings can help you get the best sense of what you’ll pay and the level of care you can expect.

The Transparency in Coverage rule from the U.S. Departments of Health and Human Services, Labor, and Treasury requires health insurance issuers offering non-grandfathered health insurance coverage in the individual and group markets and group health plans to publicly disclose price information for covered items and services.

Please note:

• For price information on specific procedures or services, eligible members should use our cost estimators. The provider rates in the files below are not specific to a member’s benefit plan out-of-pocket cost.
• The files below are very large and in formats that are impractical for direct consumer use. The goal of the Transparency in Coverage rule is to give researchers and third-party developers the comprehensive data they need to create solutions that help people understand the costs associated with health care, make better price comparisons and choose the care that’s right for them.

These files include applicable in-network rates for certain HealthPartners networks, including rates from contracted network partners. Posted rates include negotiated rates, claims-derived amounts for providers who are reimbursed on a discount from billed charges and underlying fee schedule rates where reimbursement is based on another methodology.

This file includes historical payments to, and billed charges from, non-contracted providers. Rates are displayed only for providers with 20 or more claims to HealthPartners during the previous three-month reporting period.