Price Comparison Tools
MyMedicalShopper™ provides comprehensive price transparency through five key components that work together to give members complete pricing information.
Why Price Transparency Matters
Healthcare price transparency is now federally mandated through the Transparency in Coverage Rule and No Surprises Act. TALON's price comparison tools help members navigate complex pricing while ensuring compliance for employers. Non-compliance can result in penalties of $100 per member per day.
Core Price Comparison Features
MyMedicalShopper™ provides comprehensive price transparency through five key components that work together to give members complete pricing information:
- Includes likely additional procedures
- Prevents cost differences of 2x to 10x
- Accounts for provider billing practices
- More accurate than primary procedure cost alone
- Current deductible status
- Plan-specific copays and coinsurance
- Real-time benefit accumulators
- Network status pricing differences
- Provider specialization for specific procedures
- Objective, quantifiable quality measures
- Volume and outcome-based scoring
- Not based solely on patient reviews
- In-network provider identification
- Special pricing arrangements
- Out-of-network cost implications
- Real-time network status updates
TALON's Pricing Model
To ensure accurate pricing, TALON automatically ingests seven key data elements from three categories:
Data Integration Sources
- Groups
- Eligibility
- Plan Design
- Member Claims
- Accumulators
- Machine-Readable Files
- Special Pricing Arrangements
- Historical Claims (22B+ claims)
Price Comparison Example
The following example demonstrates how the same MRI procedure can have vastly different costs depending on the provider chosen:
Key Insight
This example shows how the same MRI can cost anywhere from $480 to $6,800 out-of-pocket. The highest quality score doesn't always mean the best value for the member.
Helping Members Use Price Tools
Common Member Questions
"Why are the prices different from what my doctor quoted?"
Explanation: Provider offices often quote only the professional fee, while TALON's Encounter Estimate includes facility fees, anesthesia, and other ancillary costs that are typically charged separately. This gives a more complete picture of total costs.
"How accurate is 'Your Cost'?"
Explanation: Your Cost is calculated using real-time benefit information and is highly accurate. It accounts for current deductible progress, plan design, and network pricing. However, final costs may vary slightly based on additional services ordered during the visit.
"What does ProScore mean?"
Explanation: ProScore measures how specialized a provider is for specific procedures based on objective criteria like volume and outcomes. A higher ProScore indicates greater specialization, but members should balance quality with cost and convenience.
Best Practices for Member Support
- Emphasize Total Cost: Help members understand that Encounter Estimate prevents surprise bills by showing the complete expected cost
- Explain Network Benefits: Clearly communicate the significant cost savings available through in-network providers
- Quality vs. Cost Balance: Guide members to consider both ProScore and cost when making decisions
- Encourage Comparison Shopping: Remind members that prices can vary significantly for the same procedure
- Mobile Accessibility: Inform members they can access price comparisons on their phone while at the doctor's office
Important Reminder
Always encourage members to verify network status and pricing with their provider before scheduling procedures, as information can change. The price comparison tools provide estimates based on the most current available data.