March Issue
March 04, 2014

How to estimate out-of-pocket medical expenses

Author: By Sue Klug
Source: NYSUT United

People often pay a $15 or $20 co-pay for services billed by participating providers, but may incur substantial out-of-pocket expenses for non-participating providers or out-of-network services.

Some health insurers have lowered reimbursement levels for non-participating providers by changing from the usual and customary fee method to a calculation based on the Medicare fee schedule.

Although providers may accept the Medicare fee schedule for Medicare beneficiaries, they can bill non-Medicare patients for significant amounts in excess of the fee schedule allowance.

As an informed consumer, how do you find out how much a procedure may cost before you incur expenses?

FAIR Health Inc. is an independent not-for-profit organization that collects data from insurance companies nationwide. At, you can estimate charges for medical and dental procedures by geographic area. You can estimate out-of-pocket costs by using the various methodologies and compare this to the method your insurer uses. Consumers can also access a glossary and other health insurance resources.

If you have questions about how your health insurance plan reimburses out-of-network costs, please contact the customer service department of your health insurance company. The telephone number is usually on your identification card.