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Finding your in-network rate file
Most individual and group health plans are required to make these files publically accessible and locatable through their website. If you have Medicare (including Medicare Advantage), Medicaid, or a very old insurance plan (pre-2011), there is a good chance there are no files for you. Here are link to the sections of the largest health insurers' websites that contain their respective plan rate files:
If you're having trouble finding your file, try searching online for the name of your company along with "Transparency in Coverage". If that doesn't work, try the company name with "machine readable files". Technically, companies who self-fund their health plans (most employers over 500+ people) should be posting links to their health plan transparency files on their website, however most are not. If you aren't able to easily search for your plan file, the next best thing would be to contact your benefits department at your employer and speak to whoever handles the health plans. They should have received the link to this file and can pass it on to you. While you're at it, encourage them to post it publicly on the company's website - they may be legally required to do so (more info here).
Confused? You're in good company - shoot a message to openprices at alexlucky dot me explaining your situation and we'll do our best to help you find the information you need.
Smaller insurers
What's an in-network rate file?
As part of the Transparency in Coverage regulation finalized in November 2020, health insurance providers are required to disclose the negotiated rates they have with their networks. Plans and providers began making this data publically accessible in machine-readable files starting on July 1, 2022, updating them roughly every 30 days. You can read more about it on the Centers for Medicare & Medicaid Services website
Most plans and insurers chose to upload their rates in the JSON format. Since these files are freely available on the public internet, anyone can download them and see the contracted rates for all providers in a given plan's network.
Normally, these are very large files that are not easy to view or make sense of for the average consumer. The goal of OpenPrices is to make it easier to find these files and use them to make consumer decisions.
Limitations
This tool can only show you in-network rates on a single plan, negotiated on a fee-for-service basis.
This tool does not yet support in-network rate files where the providers are stored in a separate file - however, this appears to be uncommon.
Additionally, the program averages prices across all modifiers and service codes. These averages may not accurately reflect the price you'd pay, as the modifiers or specific service code on your bill for a given procedure can significantly alter the final price. As a result, we can't guarantee that the prices you see here will be the same as the ones for the specific modifiers your claim is processed with. Please proceed with caution.