Medi-Share FAQs

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Medi-Share Value FAQs

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Searching For Providers

Why did Medi-Share Value partner with Healthcare Bluebook*?  

  • The Medi-Share Value program is designed to empower members to identify the provider in their area with the best price and inpatient quality, and equip them to negotiate their own pricing. Healthcare Bluebook makes this possible by exposing the truth about price and quality variation through an intuitive, easy to use platform. Knowing price and quality before receiving care can save you hundreds or even thousands of dollars and ensure that you receive the best possible care.
  • Did you know that prices for the same procedure can vary by over 500%, depending on the facility you choose? Healthcare providers may be good at one procedure but perform poorly at others. For inpatient procedures, Healthcare Bluebook makes it easy to see quality scores by facility, provider, and procedure. You can also save money on hundreds of the most common medical services and procedures by showing you the cost ranges in your area, and providing you with a selection of Fair Price* providers.

What is the Fair Price*?

  • Through our partnership with Healthcare Bluebook*, the Fair Price* provides visibility into a price range or estimate that a person can expect to pay by being a wise healthcare consumer: someone who does basic research to determine which facilities offer the best price for a specific service. The Fair Price* is an approximation of the reasonable amount you should expect to pay for a medical service. It’s calculated from an independent nationwide database of medical payment data and customized to your geographic area.
  • For services that include more than one provider (for example, surgery), separate Fair Price* amounts may be shown for facility, physician, and anesthesiologist. o Certain procedures also indicate when Notification is required so the Navigation Team can support members with costly and complex care. For additional information about the Navigation Team please refer to the Navigation Team FAQ section.

How do I find a Fair Price* provider or procedure?

  • Finding a Fair Price* provider or procedure is easy. When using Healthcare Bluebook*, type in a search term and select the procedure you are looking for from the search results. You can also search by provider or specialty. The price page loads after you select a procedure or specialty.
  • Review the price range in your area and find the local Fair Price* for your service. Prices are color coded so you can easily identify cost ranking. Green indicates that the price is at or below the Fair Price*, yellow is slightly above the Fair Price*, and red is the highest.
  • The Navigation Team supports costly and complex care that includes more than one provider because separate self-pay estimates should be obtained for facility, physician, and anesthesiologist.
  • For additional information about the Navigation Team please refer to the Navigation Team FAQ section.

How do I get the Fair Price?

  • First, using Healthcare Bluebook* located in the Member Center, select providers or facilities that are of a Fair Price* and high quality (quality rankings are listed only for inpatient procedures).
  • Then, you simply tell your Provider you are a self-pay patient and request a self pay discount. You can also ask for a Good Faith Estimate. Under the No Surprises Act, providers are required to include all relevant charges in the Good Faith Estimate. Providers are familiar with offering self-pay discounts to uninsured patients. Your provider’s self-pay rate or Good Faith Estimate should fall within the Fair Price* range displayed for that provider or procedure.
  • If your procedure is expensive or complicated, Healthcare Bluebook* will prompt you to notify the Navigation Team so we can support you. For example, doctors often perform procedures at multiple facilities, so we’ll help you navigate getting to a high-quality facility that offers a Fair Price*. We can also help you evaluate and secure a Good Faith Estimate for relevant procedures. The No Surprises Act protects patients from being billed more than $400 over the Good Faith Estimate.
  • For additional information about the No Surprises Act, please refer to the CMS website at https://www.cms.gov/nosurprises o For additional information about the Navigation Team please refer to the Navigation Team FAQ section.

How are Fair Prices* determined?

  • Healthcare Bluebook* has a proprietary analytics system that is used to evaluate the allowed amounts (or discounted amounts) from medical claims and pricing and includes a variety of data sources to provide members with very accurate pricing information for healthcare services in their market. The system is used to develop the Fair Price* and provider rankings in markets across the country.

Does lower price mean lower quality?

  • Not in most cases. Many times, providers with lower costs actually have higher quality because they specialize in doing a certain type of procedure. In fact, complications like infections actually increase cost, so higher cost can actually be caused by poor quality. Using Healthcare Bluebook*, it’s easy to see which facilities offer the highest quality at the lowest costs because cost and quality rankings are provided side-by-side. For additional information about quality, please refer to the Searching Inpatient Quality FAQ section.

Are there penalties for not obtaining a Fair Price*?

  • The Fair Price helps members make cost-effective decisions. Members are  expected to select a Fair Price* provider as indicated by the tool, whenever  possible. Charges submitted for sharing will be assessed to determine if charges  are reasonable in light of the Healthcare Bluebook* results. Failure to utilize the  Fair Price* may result in sharing being limited to the Fair Price* indicated.

What if there isn’t a Fair Price* provider in my area?

  • In smaller cities or more rural settings, there might not be a Fair Price* (green) facility in your immediate area due to the fact that there are very few providers in the area. In this situation, you might need to travel a bit to find a Fair Price* provider. If you search for a procedure and do not see facilities listed, you can still use our Fair Price information to ensure you don’t overpay.
  • Don’t see a particular provider or your search results do not include cost indicators? You can always call and ask your provider for a self-pay price estimate. Compare the provider’s price estimate to Healthcare Bluebook’s* Fair Price to determine whether or not the provider’s price is in the fair range.
  • When there is no identified Fair Price provider for your service or there is no identified Fair Price provider within 60 miles of your location, the Navigation Team will work with you to identify options. In this case, limitations may apply.
  • For additional information about the Navigation Team please refer to the Navigation Team FAQ section.

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