Let’s say there’s a patient named Maya that’s not feeling well. Maya usually tries to avoid going to the doctor’s office, but in this case her symptoms are pretty bad and she wants to see a doctor just to be safe.

Maya searches for family doctors in her area. She finds that some doctors are much more expensive than others, even for a simple checkup.

• Prices can vary widely across different providers. It’s not uncommon for some providers to charge 3 or 4 times the amount as other providers in the same area. ^[1]
• Research has shown that higher prices do not typically correlate with a higher quality of care. ^[2]

She reads through reviews from other patients, and finds a handful of doctors that are both affordable and have glowing recommendations from their patients.

Next, Maya checks her insurance to see if these providers are in-network with her health insurance plan. By going to a doctor that’s in-network, Maya will usually get a discount on the full price of being treated.

• Insurance plans typically offer an average discount between 30% - 45%, depending on the insurance provider. ^{[3, 4]}
• The discounted rate will be different for every insurance plan and every healthcare provider (hospital, urgent care, physician, etc).
• Discounted rates are usually not published by insurance companies, and are not currently available in the Price Tool.

Maya calls the family doctors that are in-network with her plan, and one is available to see her the following day. Woohoo! Maya schedules the appointment and sees the doctor the next day.

A few weeks later, Maya gets the bill in the mail. Maya’s insurance has already paid a portion of the bill and she will have to pay the remaining balance out-of-pocket. The amount that Maya has to pay will depend on the details of her insurance plan. Maya sets this amount aside, and calls the doctor’s office to pay her portion of the bill.

• The amount that a patient will have to pay out-of-pocket for a specific medical bill will depend on their health insurance plan’s deductible, coinsurance, applicable copays, and out-of-pocket maximum.