Oscar Health Cost Estimator Tool Aims to Increase Price Transparency

Oscar Health has launched an updated cost estimator tool to increase price transparency around healthcare costs and help members plan for their medical bills in advance.

“Since day one, Oscar has been focused on building a system of healthcare that is centered around providing a seamless and straightforward member experience,” Mario Schlosser, co-founder and chief executive officer of Oscar Health, said in the press release.

“We believe that individuals deserve control and choice when it comes to their coverage and care and that no one should face financial harm as a result of unknown medical costs. This tool is one way we can ensure more cost transparency and give our members agency when it comes to their unique health journeys.”

More than half of Oscar members reported that they would want to know their potential medical costs upfront and 20 percent said that they have concerns about being able to afford care, according to the payer.

The cost estimator tool generates a price estimate by first predicting all of the claims that could stem from the provider and service combination. The tool then selects the claim that best coincides with the member’s deductible, out-of-pocket spending maximum, and other health plan components.

According to Oscar Health, the estimates are more accurate and current than typical appraisals because they are personalized and do not rely on predefined service bundles and general historical claims to produce an average cost for a service.

Oscar Health members can access the cost estimator tool through their health insurance account either on their computer or smartphone, making it easier for members to receive timely estimates. They can receive cost estimates for visits and services that they received at a primary care office, specialist office, imaging center, ambulatory surgery center, clinic, or outpatient hospital.

The health plan has made a Spanish version of the tool available as well, which could help reach more members and improve access for those who may have limited English proficiency.

As of September 2021, Oscar Health serves 594,000 members and offers Medicare Advantage plans, individual and family health plans, and small group plans.

In addition, the payer launched a virtual primary care program to provide members with free telehealth services. Oscar Health recently expanded the program and made it available to Cigna + Oscar health plan members as well.

The improvements to Oscar Health’s cost estimator tool follow on the heels of the No Surprises Act, which aims to eliminate surprise medical billing by preventing out-of-network providers from billing patients more than in-network cost-sharing amounts.

Additionally, the surprise billing interim final rule states that an independent dispute resolution (IDR) entity must determine the price of a service if the payer and out-of-network provider cannot come to an agreement.

The price transparency rule from CMS also aims to increase awareness and transparency around healthcare costs by requiring payers to publish their rates for in-network services, out-of-network provider payments, historical rates for prescription drugs, and cost-sharing information for certain services.