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ESTIMATE COSTS STEP 1 / MEDICAL Staying In-Network Staying In-Network If your provider takes your insurance Next Going Out-of-Network Going Out-of-Network. If your provider does not take your insurance Next Not Sure .If you don't know if your provider takes your insurance Next Uninsured Uninsured.If you don't have health insurance or if your insurance pays for providers who aren’t in your plan.. LOCATE HEALTHCARE PROVIDERS Healthfinder. Healthfinder is a government developed website offering information and tools on health promotion and disease prevention forconsumers.
ESTIMATE COSTS STEP 2 / DENTAL Enter the location where you will be receiving or have received dental care Use current location TYPES OF OUT-OF-NETWORK REIMBURSEMENT So, for example, if your insurer agrees to pay 130% of Medicare’s fee schedule for an out-of-network doctor’s visit, and Medicare’s rate is $100, your insurer will pay up to $130. But, if the provider charges $200 for that visit, you may need to pay the remaining $70 yourself. Remember, this isDENTAL PROCEDURE
Your request has been sent. One of our customer service reps will contact you shortly. OUT-OF-NETWORK DOCS AT IN-NETWORK FACILITIES If you are getting surgery, out-of-network providers may include radiologists, anesthesiologists, pathologists and surgeons helping your in-network surgeon. Your plan may not cover any out-of-network care, leaving you to pay the full cost. Or, they may cover part of the cost, but at a much lower rate than the provider charges. WHEN OUT-OF-NETWORK CARE CAN BE COVERED IN With prior approval from your insurer, you may be able to receive the care you need out-of-network and still pay only the lower, in-network rate. Different insurers take different approaches to requests for out-of-network care at in-network rates. You may have to make a formal request to your insurer, sometimes called an “appeal,” or send IF YOUR PLAN DOESN’T PAY (APPEALING A REIMBURSEMENT You can call your plan, visit your insurer’s website or read your plan documents or Explanation of Benefits (EOB). You have more than one chance to get your decision reviewed. In most cases, there are three levels of appeals: An internal review by your insurer. A second-level appeal to the insurer if PROTECTIONS FOR NEW YORK CONSUMERS: UNDERSTANDING YOUR OUT Summary. As of April 2015, state law gives New York consumers extra protections when shopping for health insurance. As a part of the law, insurers need to explain what out-of-network services they cover and how they decide what they will pay for out-of-network care, using the same standard so that you can easily compare different plans. WELCOME TO FAIR HEALTH Mission. FAIR Health's mission is to help you understand your healthcare costs and health coverage and to bring transparency to healthcare costs and insurance. We are an independent, national nonprofit organization known for providing fair and neutralinformation to all
ESTIMATE COSTS STEP 1 / MEDICAL Staying In-Network Staying In-Network If your provider takes your insurance Next Going Out-of-Network Going Out-of-Network. If your provider does not take your insurance Next Not Sure .If you don't know if your provider takes your insurance Next Uninsured Uninsured.If you don't have health insurance or if your insurance pays for providers who aren’t in your plan.. LOCATE HEALTHCARE PROVIDERS Healthfinder. Healthfinder is a government developed website offering information and tools on health promotion and disease prevention forconsumers.
ESTIMATE COSTS STEP 2 / DENTAL Enter the location where you will be receiving or have received dental care Use current location TYPES OF OUT-OF-NETWORK REIMBURSEMENT So, for example, if your insurer agrees to pay 130% of Medicare’s fee schedule for an out-of-network doctor’s visit, and Medicare’s rate is $100, your insurer will pay up to $130. But, if the provider charges $200 for that visit, you may need to pay the remaining $70 yourself. Remember, this isDENTAL PROCEDURE
Your request has been sent. One of our customer service reps will contact you shortly. OUT-OF-NETWORK DOCS AT IN-NETWORK FACILITIES If you are getting surgery, out-of-network providers may include radiologists, anesthesiologists, pathologists and surgeons helping your in-network surgeon. Your plan may not cover any out-of-network care, leaving you to pay the full cost. Or, they may cover part of the cost, but at a much lower rate than the provider charges. WHEN OUT-OF-NETWORK CARE CAN BE COVERED IN With prior approval from your insurer, you may be able to receive the care you need out-of-network and still pay only the lower, in-network rate. Different insurers take different approaches to requests for out-of-network care at in-network rates. You may have to make a formal request to your insurer, sometimes called an “appeal,” or send IF YOUR PLAN DOESN’T PAY (APPEALING A REIMBURSEMENT You can call your plan, visit your insurer’s website or read your plan documents or Explanation of Benefits (EOB). You have more than one chance to get your decision reviewed. In most cases, there are three levels of appeals: An internal review by your insurer. A second-level appeal to the insurer if PROTECTIONS FOR NEW YORK CONSUMERS: UNDERSTANDING YOUR OUT Summary. As of April 2015, state law gives New York consumers extra protections when shopping for health insurance. As a part of the law, insurers need to explain what out-of-network services they cover and how they decide what they will pay for out-of-network care, using the same standard so that you can easily compare different plans. LOCATE HEALTHCARE PROVIDERS Healthfinder. Healthfinder is a government developed website offering information and tools on health promotion and disease prevention forconsumers.
YOUR COSTS | FAIR HEALTH Cost Sharing. Health insurance protects you from paying the full cost of your care. But, you will likely still have to pay some money out of your pocket. Almost all plans call for “cost sharing”. That means your insurer pays for part of your care, and you pay for part. Planning Your Costs Based onMEDICAL PROCEDURE
Your request has been sent. One of our customer service reps will contact you shortly. IMMIGRATION AND HEALTH INSURANCE Contact them at Su Familia, the National Hispanic Family Health Helpline, at 866-Su-Familia (866-783-2645) or SuFamilia@hispanichealth.org . Your Action Plan: Getting Healthcare and Insurance Coverage as an Immigrant. If you’re an immigrant, hereare key steps to
DENTAL/ ORAL HEALTH
The American Dental Association (ADA) provides education on oral health topics from A-Z. It includes condition overview, patient FAQ’s, treatment options and educational videos. PREVENTIVE CARE AND WELLNESS SERVICES: COVERAGE AND COSTS Preventive and wellness services don’t need to be costly. Federal law requires many health insurance plans to provide certain screenings and other services for free. Even if not required, some insurers and employers provide such services because they make good business sense. Preventing disease often costs insurers less than treating it. GETTING COVERED FOR ALTERNATIVE MEDICINE Keep records of any contacts with the insurer, in case you have a claim dispute later. Certain types of alternative medicine may be more likely than others to be covered. A visit to a chiropractor, for example, may be covered, but a visit to a homeopath might not be. Sometimes a treatment will be covered for a specific use, but notother uses.
HAVING MORE THAN ONE HEALTH PLAN Coordination of Benefits. When you are covered by more than one health plan, there are rules about which plan pays what, known as “coordination of benefits.”. The rules vary among states and insurers. But, the general idea is that one plan will be primary, and the other one secondary. When a claim is filed, the primary plan willpay
DENTAL COVERAGE FOR RETIREES Dental insurance can help make sure you can afford the dental care you need as you get older. If you’re working, you may get dental coverage through your employer. But, once you retire, getting dental coverage may not be as easy. Starting at age 65, Americans can get health insurance from Medicare, a federal government program. PROTECTIONS FOR NEW YORK CONSUMERS: UNDERSTANDING YOUR OUT Summary. As of April 2015, state law gives New York consumers extra protections when shopping for health insurance. As a part of the law, insurers need to explain what out-of-network services they cover and how they decide what they will pay for out-of-network care, using the same standard so that you can easily compare different plans. WELCOME TO FAIR HEALTH Mission. FAIR Health's mission is to help you understand your healthcare costs and health coverage and to bring transparency to healthcare costs and insurance. We are an independent, national nonprofit organization known for providing fair and neutralinformation to all
ESTIMATE COSTS STEP 1 / MEDICAL Staying In-Network Staying In-Network If your provider takes your insurance Next Going Out-of-Network Going Out-of-Network. If your provider does not take your insurance Next Not Sure .If you don't know if your provider takes your insurance Next Uninsured Uninsured.If you don't have health insurance or if your insurance pays for providers who aren’t in your plan.. ESTIMATE COSTS STEP 2 / MEDICAL Enter the location where you will be receiving or have received medical care Use current location TYPES OF OUT-OF-NETWORK REIMBURSEMENT So, for example, if your insurer agrees to pay 130% of Medicare’s fee schedule for an out-of-network doctor’s visit, and Medicare’s rate is $100, your insurer will pay up to $130. But, if the provider charges $200 for that visit, you may need to pay the remaining $70 yourself. Remember, this is YOUR COSTS | FAIR HEALTH Cost Sharing. Health insurance protects you from paying the full cost of your care. But, you will likely still have to pay some money out of your pocket. Almost all plans call for “cost sharing”. That means your insurer pays for part of your care, and you pay for part. Planning Your Costs Based on OUT-OF-NETWORK DOCS AT IN-NETWORK FACILITIES If you are getting surgery, out-of-network providers may include radiologists, anesthesiologists, pathologists and surgeons helping your in-network surgeon. Your plan may not cover any out-of-network care, leaving you to pay the full cost. Or, they may cover part of the cost, but at a much lower rate than the provider charges.DENTAL PROCEDURE
Your request has been sent. One of our customer service reps will contact you shortly. IF YOUR PLAN DOESN’T PAY (APPEALING A REIMBURSEMENT You can call your plan, visit your insurer’s website or read your plan documents or Explanation of Benefits (EOB). You have more than one chance to get your decision reviewed. In most cases, there are three levels of appeals: An internal review by your insurer. A second-level appeal to the insurer if PREVENTIVE CARE AND WELLNESS SERVICES: COVERAGE AND COSTS Preventive and wellness services don’t need to be costly. Federal law requires many health insurance plans to provide certain screenings and other services for free. Even if not required, some insurers and employers provide such services because they make good business sense. Preventing disease often costs insurers less than treating it. WHEN OUT-OF-NETWORK CARE CAN BE COVERED IN With prior approval from your insurer, you may be able to receive the care you need out-of-network and still pay only the lower, in-network rate. Different insurers take different approaches to requests for out-of-network care at in-network rates. You may have to make a formal request to your insurer, sometimes called an “appeal,” or send WELCOME TO FAIR HEALTH Mission. FAIR Health's mission is to help you understand your healthcare costs and health coverage and to bring transparency to healthcare costs and insurance. We are an independent, national nonprofit organization known for providing fair and neutralinformation to all
ESTIMATE COSTS STEP 1 / MEDICAL Staying In-Network Staying In-Network If your provider takes your insurance Next Going Out-of-Network Going Out-of-Network. If your provider does not take your insurance Next Not Sure .If you don't know if your provider takes your insurance Next Uninsured Uninsured.If you don't have health insurance or if your insurance pays for providers who aren’t in your plan.. ESTIMATE COSTS STEP 2 / MEDICAL Enter the location where you will be receiving or have received medical care Use current location TYPES OF OUT-OF-NETWORK REIMBURSEMENT So, for example, if your insurer agrees to pay 130% of Medicare’s fee schedule for an out-of-network doctor’s visit, and Medicare’s rate is $100, your insurer will pay up to $130. But, if the provider charges $200 for that visit, you may need to pay the remaining $70 yourself. Remember, this is YOUR COSTS | FAIR HEALTH Cost Sharing. Health insurance protects you from paying the full cost of your care. But, you will likely still have to pay some money out of your pocket. Almost all plans call for “cost sharing”. That means your insurer pays for part of your care, and you pay for part. Planning Your Costs Based on OUT-OF-NETWORK DOCS AT IN-NETWORK FACILITIES If you are getting surgery, out-of-network providers may include radiologists, anesthesiologists, pathologists and surgeons helping your in-network surgeon. Your plan may not cover any out-of-network care, leaving you to pay the full cost. Or, they may cover part of the cost, but at a much lower rate than the provider charges.DENTAL PROCEDURE
Your request has been sent. One of our customer service reps will contact you shortly. IF YOUR PLAN DOESN’T PAY (APPEALING A REIMBURSEMENT You can call your plan, visit your insurer’s website or read your plan documents or Explanation of Benefits (EOB). You have more than one chance to get your decision reviewed. In most cases, there are three levels of appeals: An internal review by your insurer. A second-level appeal to the insurer if PREVENTIVE CARE AND WELLNESS SERVICES: COVERAGE AND COSTS Preventive and wellness services don’t need to be costly. Federal law requires many health insurance plans to provide certain screenings and other services for free. Even if not required, some insurers and employers provide such services because they make good business sense. Preventing disease often costs insurers less than treating it. WHEN OUT-OF-NETWORK CARE CAN BE COVERED IN With prior approval from your insurer, you may be able to receive the care you need out-of-network and still pay only the lower, in-network rate. Different insurers take different approaches to requests for out-of-network care at in-network rates. You may have to make a formal request to your insurer, sometimes called an “appeal,” or send 300+ SHOPPABLE SERVICES This procedure code is not available in Shoppable Services cost lookup, please try Medical Cost lookupMEDICAL PROCEDURE
Your request has been sent. One of our customer service reps will contact you shortly. GLOSSARY | FAIR HEALTH a procedure that can visually examine a joint, such as the knee, hip, wrist or shoulder. The physician inserts a rigid or flexible tube with a tiny camera, called an arthroscope, under the skin to diagnose and/or repair joint problems. Asthma. A chronic lung disease that inflames and narrows the airways in the lungs. IF YOUR PLAN DOESN’T PAY (APPEALING A REIMBURSEMENT You can call your plan, visit your insurer’s website or read your plan documents or Explanation of Benefits (EOB). You have more than one chance to get your decision reviewed. In most cases, there are three levels of appeals: An internal review by your insurer. A second-level appeal to the insurer if EXPERIMENTAL TREATMENTS AND CLINICAL TRIALS Clinical trials. In other cases, an experimental, or investigational, treatment may be just what you want. For example, you may have tried standard treatments without success. You may want to take part in a clinical trial—a study in humans—of a promising new treatment. Tostart looking for
NEGOTIATING YOUR COSTS Step 2 If you have not already used the website’s cost lookup tool, use it now. Step 3 Contact your provider’s billing office and discuss the difference between their charge and the FAIR Health cost estimates. Step 4 Ask if the provider can match either one of the cost estimates from this website. Step 5 Be open to discussion. GETTING COVERED FOR ALTERNATIVE MEDICINE Keep records of any contacts with the insurer, in case you have a claim dispute later. Certain types of alternative medicine may be more likely than others to be covered. A visit to a chiropractor, for example, may be covered, but a visit to a homeopath might not be. Sometimes a treatment will be covered for a specific use, but notother uses.
HAVING MORE THAN ONE HEALTH PLAN Coordination of Benefits. When you are covered by more than one health plan, there are rules about which plan pays what, known as “coordination of benefits.”. The rules vary among states and insurers. But, the general idea is that one plan will be primary, and the other one secondary. When a claim is filed, the primary plan willpay
SURPRISE BILLING
Insurance Basics: Surprise Billing. NY State of Health is New York´s official online healthcare Marketplace. Individuals, families and small business owners in New York can use NY State of Health to compare health plans, and join the one that best meets their needs. By law, consumers living in New York State have certain protections when PROTECTIONS FOR NEW YORK CONSUMERS: UNDERSTANDING YOUR OUT Summary. As of April 2015, state law gives New York consumers extra protections when shopping for health insurance. As a part of the law, insurers need to explain what out-of-network services they cover and how they decide what they will pay for out-of-network care, using the same standard so that you can easily compare different plans. WELCOME TO FAIR HEALTH Mission. FAIR Health's mission is to help you understand your healthcare costs and health coverage and to bring transparency to healthcare costs and insurance. We are an independent, national nonprofit organization known for providing fair and neutralinformation to all
ESTIMATE COSTS STEP 1 / MEDICAL Staying In-Network Staying In-Network If your provider takes your insurance Next Going Out-of-Network Going Out-of-Network. If your provider does not take your insurance Next Not Sure .If you don't know if your provider takes your insurance Next Uninsured Uninsured.If you don't have health insurance or if your insurance pays for providers who aren’t in your plan.. ESTIMATE COSTS STEP 2 / MEDICAL Enter the location where you will be receiving or have received medical care Use current location LOCATE HEALTHCARE PROVIDERS Healthfinder. Healthfinder is a government developed website offering information and tools on health promotion and disease prevention forconsumers.
TYPES OF OUT-OF-NETWORK REIMBURSEMENT So, for example, if your insurer agrees to pay 130% of Medicare’s fee schedule for an out-of-network doctor’s visit, and Medicare’s rate is $100, your insurer will pay up to $130. But, if the provider charges $200 for that visit, you may need to pay the remaining $70 yourself. Remember, this isDENTAL PROCEDURE
Your request has been sent. One of our customer service reps will contact you shortly. OUT-OF-NETWORK DOCS AT IN-NETWORK FACILITIES If you are getting surgery, out-of-network providers may include radiologists, anesthesiologists, pathologists and surgeons helping your in-network surgeon. Your plan may not cover any out-of-network care, leaving you to pay the full cost. Or, they may cover part of the cost, but at a much lower rate than the provider charges.DENTAL/ ORAL HEALTH
The American Dental Association (ADA) provides education on oral health topics from A-Z. It includes condition overview, patient FAQ’s, treatment options and educational videos. WHEN OUT-OF-NETWORK CARE CAN BE COVERED IN With prior approval from your insurer, you may be able to receive the care you need out-of-network and still pay only the lower, in-network rate. Different insurers take different approaches to requests for out-of-network care at in-network rates. You may have to make a formal request to your insurer, sometimes called an “appeal,” or send PROTECTIONS FOR NEW YORK CONSUMERS: UNDERSTANDING YOUR OUT Summary. As of April 2015, state law gives New York consumers extra protections when shopping for health insurance. As a part of the law, insurers need to explain what out-of-network services they cover and how they decide what they will pay for out-of-network care, using the same standard so that you can easily compare different plans. WELCOME TO FAIR HEALTH Mission. FAIR Health's mission is to help you understand your healthcare costs and health coverage and to bring transparency to healthcare costs and insurance. We are an independent, national nonprofit organization known for providing fair and neutralinformation to all
ESTIMATE COSTS STEP 1 / MEDICAL Staying In-Network Staying In-Network If your provider takes your insurance Next Going Out-of-Network Going Out-of-Network. If your provider does not take your insurance Next Not Sure .If you don't know if your provider takes your insurance Next Uninsured Uninsured.If you don't have health insurance or if your insurance pays for providers who aren’t in your plan.. ESTIMATE COSTS STEP 2 / MEDICAL Enter the location where you will be receiving or have received medical care Use current location LOCATE HEALTHCARE PROVIDERS Healthfinder. Healthfinder is a government developed website offering information and tools on health promotion and disease prevention forconsumers.
TYPES OF OUT-OF-NETWORK REIMBURSEMENT So, for example, if your insurer agrees to pay 130% of Medicare’s fee schedule for an out-of-network doctor’s visit, and Medicare’s rate is $100, your insurer will pay up to $130. But, if the provider charges $200 for that visit, you may need to pay the remaining $70 yourself. Remember, this isDENTAL PROCEDURE
Your request has been sent. One of our customer service reps will contact you shortly. OUT-OF-NETWORK DOCS AT IN-NETWORK FACILITIES If you are getting surgery, out-of-network providers may include radiologists, anesthesiologists, pathologists and surgeons helping your in-network surgeon. Your plan may not cover any out-of-network care, leaving you to pay the full cost. Or, they may cover part of the cost, but at a much lower rate than the provider charges.DENTAL/ ORAL HEALTH
The American Dental Association (ADA) provides education on oral health topics from A-Z. It includes condition overview, patient FAQ’s, treatment options and educational videos. WHEN OUT-OF-NETWORK CARE CAN BE COVERED IN With prior approval from your insurer, you may be able to receive the care you need out-of-network and still pay only the lower, in-network rate. Different insurers take different approaches to requests for out-of-network care at in-network rates. You may have to make a formal request to your insurer, sometimes called an “appeal,” or send PROTECTIONS FOR NEW YORK CONSUMERS: UNDERSTANDING YOUR OUT Summary. As of April 2015, state law gives New York consumers extra protections when shopping for health insurance. As a part of the law, insurers need to explain what out-of-network services they cover and how they decide what they will pay for out-of-network care, using the same standard so that you can easily compare different plans. LOCATE HEALTHCARE PROVIDERS Healthfinder. Healthfinder is a government developed website offering information and tools on health promotion and disease prevention forconsumers.
YOUR COSTS | FAIR HEALTH Cost Sharing. Health insurance protects you from paying the full cost of your care. But, you will likely still have to pay some money out of your pocket. Almost all plans call for “cost sharing”. That means your insurer pays for part of your care, and you pay for part. Planning Your Costs Based onMEDICAL PROCEDURE
Your request has been sent. One of our customer service reps will contact you shortly.PROVIDER NETWORKS
You can usually find a directory of your network on your plan’s website. If you visit providers outside your plan’s network, you will likely have higher costs, for two reasons. First, these providers have not contracted with your insurer, and may charge more than what your insurer pays. Second, your plan may require higher copays GETTING COVERED FOR ALTERNATIVE MEDICINE Keep records of any contacts with the insurer, in case you have a claim dispute later. Certain types of alternative medicine may be more likely than others to be covered. A visit to a chiropractor, for example, may be covered, but a visit to a homeopath might not be. Sometimes a treatment will be covered for a specific use, but notother uses.
MENTAL AND EMOTIONAL HEALTH Our mental health is a vital part of our overall well-being. It affects how we think, how we feel, and how we act. That’s why it’s important to take our mental and emotional health as seriously as our physical well-being. If we don’t get the help we need, conditions like depression, anxiety, bipolar disorder, schizophrenia, drug and HAVING MORE THAN ONE HEALTH PLAN Coordination of Benefits. When you are covered by more than one health plan, there are rules about which plan pays what, known as “coordination of benefits.”. The rules vary among states and insurers. But, the general idea is that one plan will be primary, and the other one secondary. When a claim is filed, the primary plan willpay
IF YOUR PLAN DOESN’T PAY (APPEALING A REIMBURSEMENT You can call your plan, visit your insurer’s website or read your plan documents or Explanation of Benefits (EOB). You have more than one chance to get your decision reviewed. In most cases, there are three levels of appeals: An internal review by your insurer. A second-level appeal to the insurer if PROTECTIONS FOR NEW YORK CONSUMERS: UNDERSTANDING YOUR OUT Summary. As of April 2015, state law gives New York consumers extra protections when shopping for health insurance. As a part of the law, insurers need to explain what out-of-network services they cover and how they decide what they will pay for out-of-network care, using the same standard so that you can easily compare different plans. ANESTHESIA REIMBURSEMENT The patient was in a location with a conversion factor of $70. The anesthesia charge will be: (Base units + time units + modifying units) x Conversion factor = Anesthesia charge. (7 base units + 5 time units + 0 modifying units) x $70 = $840 charge. Your Action Plan: KnowBefore You Go.
WELCOME TO FAIR HEALTH Mission. FAIR Health's mission is to help you understand your healthcare costs and health coverage and to bring transparency to healthcare costs and insurance. We are an independent, national nonprofit organization known for providing fair and neutralinformation to all
ESTIMATE COSTS STEP 1 / MEDICAL Staying In-Network Staying In-Network If your provider takes your insurance Next Going Out-of-Network Going Out-of-Network. If your provider does not take your insurance Next Not Sure .If you don't know if your provider takes your insurance Next Uninsured Uninsured.If you don't have health insurance or if your insurance pays for providers who aren’t in your plan.. LOCATE HEALTHCARE PROVIDERS Healthfinder. Healthfinder is a government developed website offering information and tools on health promotion and disease prevention forconsumers.
TYPES OF OUT-OF-NETWORK REIMBURSEMENT So, for example, if your insurer agrees to pay 130% of Medicare’s fee schedule for an out-of-network doctor’s visit, and Medicare’s rate is $100, your insurer will pay up to $130. But, if the provider charges $200 for that visit, you may need to pay the remaining $70 yourself. Remember, this is YOUR COSTS | FAIR HEALTHMY FAIR HEALTHFAIR HEALTH ONLINEFAIR HEALTH PRICINGHEALTH FAIR IDEAS Cost Sharing. Health insurance protects you from paying the full cost of your care. But, you will likely still have to pay some money out of your pocket. Almost all plans call for “cost sharing”. That means your insurer pays for part of your care, and you pay for part. Planning Your Costs Based on ESTIMATE COSTS STEP 2 / DENTAL Enter the location where you will be receiving or have received dental care Use current location OUT-OF-NETWORK DOCS AT IN-NETWORK FACILITIES If you are getting surgery, out-of-network providers may include radiologists, anesthesiologists, pathologists and surgeons helping your in-network surgeon. Your plan may not cover any out-of-network care, leaving you to pay the full cost. Or, they may cover part of the cost, but at a much lower rate than the provider charges. WHEN OUT-OF-NETWORK CARE CAN BE COVERED IN With prior approval from your insurer, you may be able to receive the care you need out-of-network and still pay only the lower, in-network rate. Different insurers take different approaches to requests for out-of-network care at in-network rates. You may have to make a formal request to your insurer, sometimes called an “appeal,” or send IF YOUR PLAN DOESN’T PAY (APPEALING A REIMBURSEMENT You can call your plan, visit your insurer’s website or read your plan documents or Explanation of Benefits (EOB). You have more than one chance to get your decision reviewed. In most cases, there are three levels of appeals: An internal review by your insurer. A second-level appeal to the insurer if PROTECTIONS FOR NEW YORK CONSUMERS: UNDERSTANDING YOUR OUT Summary. As of April 2015, state law gives New York consumers extra protections when shopping for health insurance. As a part of the law, insurers need to explain what out-of-network services they cover and how they decide what they will pay for out-of-network care, using the same standard so that you can easily compare different plans. WELCOME TO FAIR HEALTH Mission. FAIR Health's mission is to help you understand your healthcare costs and health coverage and to bring transparency to healthcare costs and insurance. We are an independent, national nonprofit organization known for providing fair and neutralinformation to all
ESTIMATE COSTS STEP 1 / MEDICAL Staying In-Network Staying In-Network If your provider takes your insurance Next Going Out-of-Network Going Out-of-Network. If your provider does not take your insurance Next Not Sure .If you don't know if your provider takes your insurance Next Uninsured Uninsured.If you don't have health insurance or if your insurance pays for providers who aren’t in your plan.. LOCATE HEALTHCARE PROVIDERS Healthfinder. Healthfinder is a government developed website offering information and tools on health promotion and disease prevention forconsumers.
TYPES OF OUT-OF-NETWORK REIMBURSEMENT So, for example, if your insurer agrees to pay 130% of Medicare’s fee schedule for an out-of-network doctor’s visit, and Medicare’s rate is $100, your insurer will pay up to $130. But, if the provider charges $200 for that visit, you may need to pay the remaining $70 yourself. Remember, this is YOUR COSTS | FAIR HEALTHMY FAIR HEALTHFAIR HEALTH ONLINEFAIR HEALTH PRICINGHEALTH FAIR IDEAS Cost Sharing. Health insurance protects you from paying the full cost of your care. But, you will likely still have to pay some money out of your pocket. Almost all plans call for “cost sharing”. That means your insurer pays for part of your care, and you pay for part. Planning Your Costs Based on ESTIMATE COSTS STEP 2 / DENTAL Enter the location where you will be receiving or have received dental care Use current location OUT-OF-NETWORK DOCS AT IN-NETWORK FACILITIES If you are getting surgery, out-of-network providers may include radiologists, anesthesiologists, pathologists and surgeons helping your in-network surgeon. Your plan may not cover any out-of-network care, leaving you to pay the full cost. Or, they may cover part of the cost, but at a much lower rate than the provider charges. WHEN OUT-OF-NETWORK CARE CAN BE COVERED IN With prior approval from your insurer, you may be able to receive the care you need out-of-network and still pay only the lower, in-network rate. Different insurers take different approaches to requests for out-of-network care at in-network rates. You may have to make a formal request to your insurer, sometimes called an “appeal,” or send IF YOUR PLAN DOESN’T PAY (APPEALING A REIMBURSEMENT You can call your plan, visit your insurer’s website or read your plan documents or Explanation of Benefits (EOB). You have more than one chance to get your decision reviewed. In most cases, there are three levels of appeals: An internal review by your insurer. A second-level appeal to the insurer if PROTECTIONS FOR NEW YORK CONSUMERS: UNDERSTANDING YOUR OUT Summary. As of April 2015, state law gives New York consumers extra protections when shopping for health insurance. As a part of the law, insurers need to explain what out-of-network services they cover and how they decide what they will pay for out-of-network care, using the same standard so that you can easily compare different plans. FAIR HEALTH CONSUMER ACCESS A Look Back at 2020 on the FAIR Health Consumer Website. In 2020, FAIR Health added several COVID-19 resources to its free, award-winning consumer website fairhealthconsumer.org. The resources make the site even more useful in these challenging times. Other highlights of 2020 can be found here in the FAIR Health Consumer year-end statistics for GLOSSARY | FAIR HEALTH a procedure that can visually examine a joint, such as the knee, hip, wrist or shoulder. The physician inserts a rigid or flexible tube with a tiny camera, called an arthroscope, under the skin to diagnose and/or repair joint problems. Asthma. A chronic lung disease that inflames and narrows the airways in the lungs. GETTING COVERED FOR ALTERNATIVE MEDICINE Keep records of any contacts with the insurer, in case you have a claim dispute later. Certain types of alternative medicine may be more likely than others to be covered. A visit to a chiropractor, for example, may be covered, but a visit to a homeopath might not be. Sometimes a treatment will be covered for a specific use, but notother uses.
PROVIDER NETWORKS
You can usually find a directory of your network on your plan’s website. If you visit providers outside your plan’s network, you will likely have higher costs, for two reasons. First, these providers have not contracted with your insurer, and may charge more than what your insurer pays. Second, your plan may require higher copays NEGOTIATING YOUR COSTS Step 2 If you have not already used the website’s cost lookup tool, use it now. Step 3 Contact your provider’s billing office and discuss the difference between their charge and the FAIR Health cost estimates. Step 4 Ask if the provider can match either one of the cost estimates from this website. Step 5 Be open to discussion.NARROW NETWORKS
Health plans negotiate the price of medical services with certain doctors, hospitals, labs, pharmacies and other providers so the plan, and you, pay a lower cost. These providers are in your plan’s “network.”. If you visit providers who are not in your network,you may have to
DENTAL/ ORAL HEALTH
The American Dental Association (ADA) provides education on oral health topics from A-Z. It includes condition overview, patient FAQ’s, treatment options and educational videos. PREVENTIVE CARE AND WELLNESS SERVICES: COVERAGE AND COSTS Preventive and wellness services don’t need to be costly. Federal law requires many health insurance plans to provide certain screenings and other services for free. Even if not required, some insurers and employers provide such services because they make good business sense. Preventing disease often costs insurers less than treating it. PROTECTIONS FOR NEW YORK CONSUMERS: UNDERSTANDING YOUR OUT Summary. As of April 2015, state law gives New York consumers extra protections when shopping for health insurance. As a part of the law, insurers need to explain what out-of-network services they cover and how they decide what they will pay for out-of-network care, using the same standard so that you can easily compare different plans. DENTAL COVERAGE FOR RETIREES Dental insurance can help make sure you can afford the dental care you need as you get older. If you’re working, you may get dental coverage through your employer. But, once you retire, getting dental coverage may not be as easy. Starting at age 65, Americans can get health insurance from Medicare, a federal government program. Skip to main content __ES EN
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ESTIMATE YOUR
HEALTHCARE EXPENSES. GET ESSENTIAL INFORMATION ON COSTS FOR THOUSANDS OF PROCEDURES AND LEARN INSURANCE BASICS . Look up a Medical Cost Search for a Medical Cost Look up a Dental Cost Search for a Dental Cost__
Get to know this site through this INFORMATIVE VIDEO GET ESSENTIAL INFORMATION ON COSTS FOR THOUSANDS OF PROCEDURES AND LEARN INSURANCE BASICS . Look up a Medical Cost Search for a Medical Cost Look up a Dental Cost Search for a Dental Cost__
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ARLENE'S STORY Researching asthma cost gives Arlene a breather See Arlene's Story Play*
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BILL'S STORY Understanding your bill and seeing costs before treatment See Bill's Story Play*
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STEVE'S STORY Doing the legwork on physical therapy costs See Steve's Story Play*
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ANNIE'S STORY Getting strong footing when researching your medicalcost
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DAN'S STORY Learning what the bite may be for your dental visit See Dan's Story Play*
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MARIA'S STORY Making sure pregnancy costs are what you expect See Maria's Story Play*
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DOUG'S STORY Treating diabetes with cost insights See Doug's Story Play*
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CARL'S STORY Getting a handle on the cost of cancer treatment See Carl's Story Play*
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ANDY'S STORY Making sure arthritis procedures don’t become a pain inthe neck
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RALPH'S STORY Researching your root canal cost when Medicare doesn’tcover dental
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YOUR COSTS
If your insurer won't pay for a healthcare service, you can“appeal”
YOUR BILL
How to review your medical billDENTAL COVERAGE
Dental Coverage for Children FAIR HEALTH'S ESTIMATES ARE BASED ON OUR COLLECTION OF 29 BILLION HEALTHCARE CLAIMS FOR 10,000+ SERVICES IN ALL AREAS OF THEU.S.
* About FAIR Health
* How We Estimate Cost and Quality* For New Yorkers
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Mission
About Our Data
Awards and RecognitionMISSION
FAIR Health's mission is to help you understand your healthcare costs and health coverage and to bring transparency to healthcare costs and insurance. We are an independent, national nonprofit organization known for providing fair and neutral information to all those we serve, including consumers like you. We are able to provide reliable information about healthcare costs because each year health insurers around the country send us over a billion healthcare bills, which are added to FAIR Health's database of more than 29 billion claims. We use information from those claims to estimate what providers charge, and what insurers pay, for providing healthcare to patients all across the country. We make this information available to consumers, researchers, businesses and manyother users.
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ABOUT OUR DATA
Our cost estimates are based on claims for medical and dental services paid for by private insurance plans, including the country's largest insurers. Our database includes more than 29 BILLION PRIVATE HEALTH CARE CLAIMS and 20 BILLION MEDICARE CLAIMS for 10,000 SERVICES in all areas of the United States, dating back to 2002. We receive about 1.7 BILLION new records each year. These claims represent a large portion of the population—approximately 150 million patients from all 50 states, the District of Columbia, Puerto Rico and the US Virgin Islands. FAIR Health uses this powerful data to create a reliable picture of healthcare costs around the country, and locally. To keep our cost information current, we ask our contributors to send us new records regularly throughout the year, and we update the cost data on this website twice each year. In addition to creating tools for consumers, we share information with doctors, hospitals, health plans, employers, researchers, policy makers and others to help them make informed decisions related to healthcare and its costs. A testament to the fairness and reliability of our data, New York, Connecticut, and many other states have adopted FAIR Health's cost information as the guidepost in laws protecting consumers, and for many other purposes.__ Back to Top
AWARDS AND RECOGNITION FAIR Health strives to make sure that our website, mobile app and other resources help consumers like you find the information you need. We are proud of the recognition that our consumer site has received. Consumer rights groups and the healthcare industry have given a number of awards to our easy-to-use website, mobile app and other resources that help consumers find useful and reliable information. The awardsinclude:
2018 EHEALTHCARE LEADERSHIP AWARDS * Mark Gothberg eHealthcare Organizational Commitment Award * Best Overall Internet Site * Best Internet Home Page * Best Mobile WebsitePREVIOUS AWARDS
* eHealthcare Leadership Awards from 2012 to 2017 (2018 is the seventh year in a row FAIR Health received this honor) * 2016 _Employee Benefit News_ Dig|Benefits Technology InnovatorAward
* _Kiplinger's Personal Finance_ 2016 Best List for Best Health CareCost Estimator
* One of AppPicker's best healthcare apps of 2014 * Cited in URAC's 2013 Best Practices in Health Care Consumer Engagement and Protection * Included in the Agency for Healthcare Research and Quality (AHRQ), US Department of HHS 2014 QualityTool list on AHRQ Health Care Innovations Exchange * Featured and honored at the 2012 White House Summit on Smart Disclosure as an Innovator in Consumer Transparency__ Back to Top
Here you can learn more about our data, how we estimate healthcare costs in a geographic area near you, and how we decide what to include on our website. We have consulted with leaders in the healthcare field to make sure that our methodologies follow best practices and our data and tools are the best that they can be.*
GETTING OUR DATA. We collect healthcare claims data from health plans and plan administrators. This tells us how much doctors are charging, and how much insurers are paying, for people's care. We test the data, to make sure that the data are reliable.*
ORGANIZING DATA BY GEOZIP. We organize the claims data we receive by geozip—a geographic area, usually based on the first three numbers of a zip code. Grouping the charges by geozip helps make sure that the costs represent what providers actually charge in a specific area.*
COST ESTIMATES. Different providers are generally free to charge different prices for the same service. We organize these charges into percentiles, from lowest to highest. For example, if a provider's price is in the 80th percentile for a certain service, that means 80 percent of the fees billed by other providers for the same service were that amount or lower.*
IN-NETWORK (OR “ALLOWED”) RATES. The “allowed amount” is FAIR Health's estimate of what an insurer may pay your in-network provider for a particular service. To estimate this, FAIR Health determines the ratio between what providers charge and how much insurers pay, for certain categories of medical services. We apply those ratios to the charges in our database for services within those categories, and the results are organized into percentiles for each Geozip. For example, the 80th percentile “allowed amount” for a certain service, means that we estimate 80 percent of payors paid that amount or less for theservice.
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PROVIDER-SPECIFIC CHARGES. FAIR Health reports what some specific providers in your area typically charge for 100 commonly performed procedures. We looked at physicians, physical therapists, chiropractors, acupuncturists and other providers in New York State, and we identified those services that appeared most frequently in our database; were most commonly provided out-of-network; and/or were most searched for by consumers. We excluded some preventive screening procedures because health plans typically cover them for free. Additional services will be added in the future. We identified providers who performed a common service at least the average number of times compared to other providers in your Geozip. From that group, we randomly ordered providers and practices to include on this website. We looked at the claims in our database for those selected providers to identify the range of prices charged for common services, and the most common price that the provider charged for those services, over the course of one year. If there are two equally common prices for a provider, we use the most recent. Provider-specific charges are not included for all providers and practices in your area. Your provider may not be listed on this website for a number of reasons, including: * Your provider did not submit claims to any of the contributors to our database (remember, our data come from health plan claims); * Your provider performed the service fewer times than the average provider in your Geozip; * The service may not be covered by your health plan, and so your provider does not submit claims to your plan for it; * Your provider asked not to be listed on this site; * Your provider's practice does not accept insurance; or * Your provider's specialty is not one of the common specialties included on our website at this time. FAIR Health features provider-specific information for 100 procedures that are commonly performed in New York State by physicians, physical therapists, chiropractors, acupuncturists and other providers. We chose these 100 because they were the procedures that were most common in the FAIR Health database; the procedures that are most commonly done in an out-of-network setting; and the procedures that consumers search for the most. We will be adding more procedures in the future.*
QUALITY METRICS FOR INDIVIDUAL PROVIDERS AND PRACTICES. Our goal is to share information about provider characteristics that will be meaningful to consumers. We asked consumers through focus groups and surveys what type of information they would like to know when choosing a healthcare provider. We then selected information about individual providers that consumers said would be useful, collected from the Centers for Medicare & Medicaid Services (CMS) National Plan and Provider Enumeration System (NPPES) file and the CMS Provider File, and included it on this website. Information about quality metrics is described in the Quality section.*
COSTS FOR EPISODES OF CARE. Treating complex conditions like diabetes can involve a lot of different services, supplies, tests and medications. This website provides the typical overall cost you can expect to pay for all components of 25 “episodes of care.” The episodes of care estimates include the total cost for all of your medical care from the time you get sick or injured until you are better, or when your treatment is over. To create each episode, we first identify the most commonly performed services in each episode. Then we estimate the cost for each of the services in the episode, and multiply that amount by the number of times patients usually receive each service in an episode. We combine all the estimated charges for the number and type of services in a typical episode to give you an estimate for the total cost of care. HOSPITAL INFORMATION FOR NEW YORK STATE: This website offers information about some hospitals in four locations in New York State (Albany, Buffalo, Syracuse and Westchester): * HOSPITAL-SPECIFIC CHARGES. FAIR Health reports what hospitals typically charge for 20 commonly performed outpatient procedures. FAIR Health chose these procedures by identifying those services that appeared most frequently in our database, were most commonly provided out of network and/or were most searched for by consumers. * HOSPITAL-SPECIFIC QUALITY METRICS. FAIR Health also offers information on quality measures that can help you decide which hospital is best for you and your family. These measures are described in detail in the Quality section of this website.__ Back to Top
We know you are visiting this website because you need simple, clear answers to questions about healthcare costs and health insurance for yourself or your family. You've come to the right place. This website is a healthcare cost planning tool developed by FAIR Health for New York State residents. FAIR Health created this website with support from the not-for-profit New York State Health Foundation. Some of the features and content of this website may look familiar to you if you've visited FAIR Health's award-winning national consumer website or used our mobile apps. We've also created new features and educational content especially for New Yorkers. THIS WEBSITE is here to help both insured and uninsured New Yorkers make decisions about healthcare. The cost lookup tool shows you what medical and dental care cost in your area and the educational resources help you choose a health plan, pick a doctor, understand your healthcare bills, negotiate prices with your provider, appeal your plan's payment, plan your costs in advance, and more. This website allows you to search for: * HOW MUCH YOU MIGHT PAY FOR A MEDICAL OR DENTAL SERVICE if you areuninsured.
* OUT-OF-NETWORK COSTS that you may pay if you go to doctors who are not in your health plan's network. * FOR IN-NETWORK COSTS, you can estimate how much you may have to pay for doctors in your health plan's network if you have not met yourdeductible.
* COSTS AND OTHER INFORMATION ABOUT EPISODES OF CARE. Educational videos explain the many different services, supplies, tests and medications involved in treating complex conditions like diabetes or procedures like knee replacement. Our cost estimator can show you the overall cost you can expect to pay for everything you need during these “episodes of care”. Educational videos also offer overviews of each of the 25 episodes for which this website provides costinformation.
* QUALITY INFORMATION ABOUT PROVIDERS NEAR YOU WHO PERFORM CERTAIN COMMON PROCEDURES LIKE HIP REPLACEMENTS OR CARDIAC CARE. Each entry provides estimates of how much you might pay if you seek care from providers WHO ARE IN YOUR HEALTH PLAN'S NETWORK IF YOU HAVE NOT YET MET YOUR PLAN'S DEDUCTIBLE. You can also compare providers by price and certain practice features, such as the number of years they've been in practice, their location, the hospitals they work at, andtheir training.
* QUALITY METRICS FOR HOSPITALS. Our goal is to share information that describes how a hospital performs on certain quality measures. We selected information about hospitals from the NYS Health Profiles website, which is operated by the New York State Department of Health. We also selected specific metrics from the Centers for Medicare & Medicaid Services. More information about using quality metrics to make decisions about your care is presented in the Quality section. * THE BASICS OF HEALTH COVERAGE, from the differences between plan types, to how a deductible works, and more. Health insurance is very complicated, but our educational articles, videos and glossary terms can help you better understand how health insurance works. * WHERE TO GET HELP. We provide links to health-related organizations that can help you. The site also features quality and cost information for certain commonly performed hospital procedures for hospitals in Westchester, Syracuse, Albany and Buffalo, New York. You can get our cost information on your phone by downloading our FH® Cost Lookup mobile app in English and Spanish from the AppStore and Google Play. We also provide nationwide cost lookup tools in English (www.fairhealthconsumer.org ) and Spanish (consumidor.fairhealth.org).
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What is FAIR Health? How was FAIR Health created? What does the FAIR Health database include? What is the YouCanPlanForThis.org website? How did FAIR Health select the procedures for which to offer provider-specific information? How were healthcare providers selected to be listed on this website? Why am I not included on the website as a listed provider? How did FAIR Health decide which types of information to share about providers? Where does this information come from? Does FAIR Health endorse any of the healthcare providers or practitioners who are listed on this website? Does FAIR Health offer products for healthcare providers? WHAT IS FAIR HEALTH? FAIR Health is a national, independent, not-for-profit organization dedicated to bringing transparency to healthcare costs and health insurance information through data products, consumer resources and health systems research support. FAIR Health oversees the nation's largest collection of private healthcare claims data, which includes a repository of over 29 billion billed medical and dental procedures that reflect the claims experience of over 150 million privately insured individuals, and separate data representing the experience of more than 55 million individuals enrolled in Medicare. Certified by the Centers for Medicare & Medicaid Services (CMS) as a Qualified Entity, FAIR Health receives all of Medicare Parts A, B and D claims data for use in nationwide transparency efforts. FAIR Health licenses its privately billed data and data products—including benchmark modules, data visualizations, custom analytics, episodes of care analytics and market indices—to commercial insurers and self-insurers, employers, hospitals and healthcare systems, government agencies, researchers and others. FAIR Health also uses its database to power a free consumer website, available in English and Spanish and as an English/Spanish mobile app that enables consumers to estimate and plan their healthcare expenditures and offers a rich educational platform on health insurance. For more information on FAIR Health, visit fairhealth.org .__ Back to Top
HOW WAS FAIR HEALTH CREATED? In January 2009, then-New York Attorney General Andrew Cuomo announced the settlement of an investigation into the method used by certain health insurers to determine reimbursements for patients who received care from out-of-network providers. The settlement agreement reached with 12 health insurers focused on bringing fairness and transparency to the out-of-network reimbursement system by creating a non-industry, independent repository of claims data that would be overseen by a not-for-profit organization. FAIR Health was formed to establish that database and oversee the ongoing contribution of claims data to it.__ Back to Top
WHAT DOES THE FAIR HEALTH DATABASE INCLUDE? FAIR Health oversees the nation's largest collection of healthcare claims data, which includes a repository of over 29 billion billed medical and dental procedures that reflect the claims experience of over 150 million privately insured individuals, and separate data representing the experience of more than 55 million individuals enrolled in Medicare. Certified by CMS as a Qualified Entity, FAIR Health receives all of Medicare Parts A, B and D claims data for use in nationwide transparency efforts. To keep our cost information current, we ask our contributors to send us new records regularly throughout the year, and we update the cost data on this website twice each year.__ Back to Top
WHAT IS THE YOUCANPLANFORTHIS.ORG WEBSITE? Funded by the New York State Health Foundation, this website enables New York State residents to identify and compare providers in their geographic locations. In September 2017, FAIR Health launched this consumer website which offers: * De-identified, aggregated allowed and billed-charge data bygeozip;
* Provider-specific charges, practice attributes and quality information (e.g., participation in e-health records, education) based on 100 procedures commonly performed in the state; and * Cost bundles for 25 episodes of care (e.g., knee arthroscopy,C-section).
* In February 2018, this website also will feature quality and cost information for certain commonly performed hospital procedures for hospitals in Westchester, Syracuse, Albany and Buffalo, New York.__ Back to Top
HOW DID FAIR HEALTH SELECT THE PROCEDURES FOR WHICH TO OFFER PROVIDER-SPECIFIC INFORMATION? FAIR Health selected procedures that were the most common in the FAIR Health database; that are most commonly performed in an out-of-network setting; and that consumers search for the most.__ Back to Top
HOW WERE HEALTHCARE PROVIDERS SELECTED TO BE LISTED ON THIS WEBSITE? This website includes those providers (physicians, physical therapists, chiropractors, acupuncturists and others) in New York State who performed one of the 100 common procedures, at least the median number of times compared to other providers in a geozip. We list those providers and practices in random order on this website. Based the claims in our database we identify each of those providers' range of prices charged and most common price charged for the 100 common procedures, over the course of one year.__ Back to Top
WHY AM I NOT INCLUDED ON THE WEBSITE AS A LISTED PROVIDER? Provider-specific charges are not included for all providers and practices. You may not be listed on this website for a number ofreasons, including:
* You did not submit claims to any of the contributors to our database (our data come from health plan claims); * You performed the procedure fewer times than the median providerin your geozip;
* You asked not to be listed on this site; * Your practice does not accept insurance; or * Your specialty is not one of the common specialties included on our website at this time.__ Back to Top
HOW DID FAIR HEALTH DECIDE WHICH TYPES OF INFORMATION TO SHARE ABOUT PROVIDERS? WHERE DOES THIS INFORMATION COME FROM? We learned from consumers through focus groups and surveys what type of information they would like to know when choosing a healthcare provider. We then looked at the FAIR Health database which includes provider-level information and pricing, the CMS National Plan and Provider Enumeration System (NPPES) file, and the CMS Provider File, and selected information about individual providers that consumers said would be useful to include on this website.__ Back to Top
DOES FAIR HEALTH ENDORSE ANY OF THE HEALTHCARE PROVIDERS OR PRACTITIONERS WHO ARE LISTED ON THIS WEBSITE? FAIR Health is an independent, not-for-profit organization and does not endorse any of the healthcare providers or practitioners who are listed on this website.__ Back to Top
DOES FAIR HEALTH OFFER PRODUCTS FOR HEALTHCARE PROVIDERS? Yes, FAIR Health offers the FH® Fee Estimator for physicians and other healthcare providers. To learn more, email info@fairhealth.org or call 855-301-FAIR (855-301-3247).__ Back to Top
Copyright 2019, FAIR Health, Inc. FAIR Health has not evaluated and does not endorse any healthcare providers or practitioners listed on this website. Learn more . What is FAIR Health? Consumer Website Tools Available through This WebsiteSearch Limits
Licensing/Linking to this WebsiteStay in Touch
Hospital Information and Quality WHAT IS FAIR HEALTH? FAIR Health's mission is to help you understand your healthcare costs and health coverage. We are an independent, national, nonprofit organization known for providing fair and neutral information to all those we serve, including consumers like you. We are able to provide reliable information about healthcare costs because each year health insurers around the country send us over 2 billion healthcare claims, which are added to FAIR Health's database of more than 29 billion claims. We use information from those claims to estimate what providers charge, and what insurers pay, for providing healthcare to patients all across the country. We make this information available to consumers, researchers, businesses and many other users. Learn more by visiting our company website atfairhealth.org .
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WHY WAS FAIR HEALTH CREATED? FAIR Health was created in 2009, after the New York State Office of the Attorney General investigated potential conflicts of interest in the methods that health insurers were using to set reimbursement for patients who received care from out-of-network providers (doctors or other health providers that do not contract with the patient's health insurer). The case was settled with health insurers that do business in New York State. The settlement agreements focused on bringing fairness and transparency to the out-of-network reimbursement system. FAIR Health was created as part of this settlement and charged with establishing and overseeing an independent database with cost data for billions of billed medical and dental services and procedures. We use that database to power this free website.__ Back to Top
WHERE DOES FAIR HEALTH GET ITS COST DATA? We collect healthcare claims data from health plans and plan administrators for all 50 states, Washington, DC, Puerto Rico and the US Virgin Islands. This data tells us how much doctors are charging, and how much insurers are paying, for people's care. We organize the claims data we receive by geozip—a geographic area, usually based on the first three numbers of a zip code. From these data, we provide three kinds of cost information: * CHARGE ESTIMATES. Different providers are generally free to charge different prices for the same service. We organize these charges into percentiles, from lowest to highest. For example, if a provider's price is in the 80th percentile for a certain service, that means 80 percent of the fees billed by other providers for the same service were that amount or lower. * IN-NETWORK RATES. The in-network rate is FAIR Health's estimate of what an insurer may pay your in-network provider for a particular service. To estimate this, FAIR Health determines the ratio between what providers charge and how much insurers pay for certain categories of medical services. We apply those ratios to the charges in our database for services within those categories. The results are organized into percentiles for each geozip. For example, the 80th percentile in-network rate for a certain service means that we estimate 80 percent of payors paid that amount or less for theservice.
* PROVIDER-SPECIFIC CHARGES. In New York State, FAIR Health reports what some specific providers in your area typically charge for 100 commonly performed procedures. We looked at physicians, physical therapists, chiropractors, acupuncturists and other providers in New York State. We identified those services that appeared most frequently in our database; were most commonly provided out of network; and/or were most searched for by consumers. We excluded some preventive screening procedures because health plans typically cover them for free. Additional services will be added in the future.__ Back to Top
HOW DOES FAIR HEALTH MAKE SURE THAT ITS DATA ARE RELIABLE? FAIR Health's in-house experts in statistics, economics and technology carefully follow a rigorous, multi-step process to check that the data are valid and reliable. Only valid data are added to the FAIR Health database. Learn more about our process here.
The medical and dental charge estimates on this website are based on the FAIR Health database and reflect 12 months of claims. The charge estimates are kept current with updates twice a year.__ Back to Top
DOES FAIR HEALTH SET “USUAL, CUSTOMARY AND REASONABLE” (UCR) RATESFOR INSURERS?
No. FAIR Health offers benchmark charge data that some insurers may use to help inform their rates for out-of-network reimbursement. FAIR Health does not set UCR rates or out-of-network reimbursement rates for insurers. Although some insurers may choose to use our data (usually combined with other information) to determine UCR, these decisions are made solely by insurers based on their internalpolicies.
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WHO SERVES ON THE FAIR HEALTH BOARD OF DIRECTORS? The FAIR Health Board of Directors comprises recognized leaders in the fields of medicine, healthcare policy, law, consumer advocacy, technology, education, medical research and business. They serve without compensation and adhere to rigorous conflict-of-interestpolicies.
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CONSUMER WEBSITE TOOLS AVAILABLE THROUGH THIS WEBSITE WHAT WILL I FIND ON THIS WEBSITE? THIS WEBSITE is here to help both INSURED and UNINSURED people make decisions about healthcare. The COST LOOKUP TOOL shows you what medical and dental care cost in your area. At this time, we have costestimates for:
* Thousands of medical and dental services (professional fees); * Medical supplies (e.g., diabetes supplies, walkers, canes, vision supplies, hearing aids); * Anesthesia services; * Ambulance rides; and * Services done in a facility (e.g., hospital or ambulatory surgerycenter).
The EDUCATIONAL RESOURCES help you choose a health plan, pick a doctor, understand your healthcare bills, negotiate prices with your provider, appeal your plan's payment, plan your costs in advance and more. THIS WEBSITE allows you to search for: * HOW MUCH YOU MIGHT PAY FOR A MEDICAL OR DENTAL SERVICE if you'reUNINSURED.
* OUT-OF-NETWORK COSTS that you may pay if you go to doctors who are not in your health plan's network. * FOR IN-NETWORK COSTS, you can estimate how much you may have to pay for doctors in your health plan's network if you haven't met yourdeductible.
* COSTS AND OTHER INFORMATION ABOUT EPISODES OF CARE. Educational videos explain the many different services, supplies, tests and medications involved in treating complex conditions like diabetes or procedures like knee replacement. Our cost estimator can show you the overall cost you can expect to pay for everything you need during these 25 “episodes of care,” both for in-network and out-of-network care. * THE BASICS OF HEALTH COVERAGE, from the differences among plan types to how a deductible works and more. Health insurance is very complicated, but our educational articles, videos and glossary terms can help you better understand how health insurance works. * WHERE TO GET HELP. We provide links to health-related organizations that can help you. Some of the features and content of this website may look familiar to you if you've previously visited FAIR Health's award-winning national consumer website or used our mobile apps. You can get our cost information on your phone by downloading our FH® Cost Lookup mobile app in English and Spanish from the App Store and Google Play. We also provide nationwide cost lookup tools in English (fairhealthconsumer.org ) and Spanish (consumidor.fairhealth.org).
We've also created new features and educational content especially for New Yorkers. This website offers a new healthcare planning tool developed by FAIR Health for New York State residents, with support from the not-for-profit New York State Health Foundation. It features information on local physicians and other healthcare providers who can provide some of the healthcare services or procedures found on this website. You also can compare providers by price and certain practice features, such as the number of years they've been in practice, their location, the hospitals they work at and their training. In the future, the site will also feature quality and cost information for certain commonly performed hospital procedures for hospitals in Westchester, Syracuse, Albany and Buffalo, New York. WHO CAN USE THIS WEBSITE? Insured and uninsured people can use this website. It may be of particular use to people managing a deductible, wanting to learn more about health insurance or looking for access to one of the 25 episode of care cost bundles. Before you receive care, you can use the site to plan your costs. After you receive care, you can use it to negotiate payment or support appeals. DO THE MEDICAL COST ESTIMATES APPLY TO PEOPLE WHO ARE COVERED BY MEDICARE, MEDICAID OR OTHER GOVERNMENT PROGRAMS? No. The cost estimates generally apply only to those who are covered by private insurance or who are uninsured. These cost estimates do not apply to those who are covered by government programs such as Medicare, Medicaid or Tricare. However, these cost estimates may be useful to you if you have coverage under a government program, but you are getting care that is not covered by that program. For example, Medicare does not cover most dental services. If you have Medicare and you need to see a dentist, you can find out how much you may pay. The information on the site can also help you evaluate a Medicare Advantage plan that requires you to pay more for services outside of the plan's network. Note: Some private insurers (i.e., non-government) use Medicare rates to set out-of-network reimbursement, which means that the insurer will pay some percentage or multiple of what Medicare would have paid for the services. This is not the same as being covered by Medicare. If your insurer refers to Medicare rates in this way, you can use this website to estimate your medical out-of-pocket cost: on the cost results page, selecting the appropriate option under the “Estimated Reimbursement” dropdown section under “Adjust Charge.” I SEARCHED FOR A COST ESTIMATE AND GOT "N/A." WHAT DOES IT MEAN? If you see N/A (Not Available) after searching for a cost estimate, this means that we cannot provide at this time a cost estimate for the procedure code in the geographic area you searched.__ Back to Top
SEARCH LIMITS
WHY DOES THE WEBSITE LIMIT THE NUMBER OF SEARCHES I CAN CONDUCT? * This website is for consumer use. It is expected that in most cases, consumers will be able to meet their needs before reaching the search limits: When looking up MEDICAL COSTS, search up to 20 medical codes per week. Entering a zip code and a medical procedure code (or choosing a procedure from the menu) counts as one medical search. * When looking up DENTAL COSTS, search up to 20 dental codes per week. Entering a zip code and dental procedure code (or choosing from the menu) counts as one dental search. Search limits are reset at the end of the weekly search period to enable consumers to estimate costs for additional codes. FAIR Health uses a computer's IP address to track searches. If you use a computer whose IP address is shared throughout an office, library or other organization, you may reach the limit before you have personally conducted the maximum amount of searches. If you are a consumer and feel you have been inappropriately blocked, please e-mail us at consumer@fairhealth.org. For information on licensing FAIR Health data for healthcare professionals and commercial businesses, contact info@fairhealth.org.__ Back to Top
LICENSING/LINKING TO THIS WEBSITE I WOULD LIKE TO LINK TO YOUR WEBSITE FROM MY ORGANIZATION'S WEBSITE. HOW CAN I LEARN MORE? FAIR Health welcomes organizations to link to our website and download materials for consumer use. FAIR Health is a not-for-profit organization that relies in part on license fees to support its work. When consumers use our site, we incur fees from third parties. For that reason, links to fairhealthconsumer.org for COMMERCIAL PURPOSES require a license agreement and nominal fees. Commercial purposes include, but are not limited to, links established by providers or third-party payors in connection with participation on state or federal health benefit exchanges. FAIR Health also licenses educational material, videos and cost lookup tools for use on organization websites and for other uses. Please contact info@fairhealth.org to learn more.__ Back to Top
STAY IN TOUCH
HOW CAN I GET FAIR HEALTH UPDATES? Sign up for FAIR Health's newsletters. Follow FAIR Health on Facebook and Twitter . New features are also announced on the website homepage. HOW CAN I GIVE FEEDBACK ON THIS WEBSITE? You can e-mail consumer@fairhealth.org, call 855-LOOKUP-1 (855-566-5871) or complete a survey.
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HOSPITAL INFORMATION HOW DID YOU SELECT THE HOSPITALS LISTED ON THE WEBSITE? We selected hospitals that are located in Albany, Buffalo, Syracuse or Westchester and that have 50 beds or more. HOW DID YOU SELECT THE HOSPITAL-BASED OUTPATIENT PROCEDURES FOR WHICHYOU OFFER PRICING?
We selected the outpatient procedures based on how often they appeared in our database, how often they are provided out of network and what consumers search for the most. Pricing for inpatient services is not provided at this time. FROM WHERE DID YOU GET THE PRICES FOR THE HOSPITAL OUTPATIENTPROCEDURES?
FAIR Health drew the price information for the selected outpatient hospital procedures from its comprehensive, proprietary claimsdatabase.
HOW DID YOU SELECT THE QUALITY METRICS FOR EACH OF THE HOSPITALS? FAIR Health met with stakeholders representing consumers, hospitals and plans before selecting the quality measures featured on this website. We selected measures from the New York State Department of Health's NYS Health Profiles website and the Centers for Medicare & Medicaid Services' Hospital Comparewebsite.
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HELP US IMPROVE OUR SITE TO BETTER MEET YOUR NEEDS! Take a Brief Survey NowTERMS OF USE
FOR CONSUMER USE: I agree to FAIR Health´s Terms of Use LAST UPDATED: SEPTEMBER 15, 2017 PLEASE CAREFULLY READ THIS TERMS OF USE AGREEMENT (THE "AGREEMENT"), WHICH GOVERNS YOUR ACCESS TO THIS WEBSITE. YOUR USE OF THE WEBSITE CONSTITUTES YOUR AGREEMENT TO COMPLY WITH THESE TERMS. This Agreement is between you ("you," "your") and FAIR Health, Inc. ("FAIR Health," "we," "us") and governs your use of FAIR Health's online websites (together with any successor site(s), the "Site"). By logging onto the Site, you signify your agreement to all of the terms and conditions for using the Site. This Agreement shall have the same binding effect as if the same Agreement was in paper form and signedby you.
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ACCEPTANCE OF TERMS. The Site is made available by FAIR Health to you subject to the terms of this Agreement. We reserve the right to update or make changes to this Agreement from time to time in our sole discretion, which changes we may provide to you by any reasonable means, including without limitation, by posting the revised version of this Agreement on the Site. You can determine when this Agreement was last revised by referring to the "LAST UPDATED" legend at the top of this Agreement. When using the Site you agree that you are subject to this Agreement and to any additional posted guidelines, rules, terms and conditions applicable to such use, which are hereby incorporated by reference into this Agreement. We reserve the right, at any time and from time to time, temporarily or permanently, in whole or in part, to modify or discontinue the Site, with or without notice. You agree that neither FAIR Health nor any of our licensors shall be liable to you or to any third party for any modification, suspension or discontinuance of the Site, in whole or in part or of any service, content, feature or product offered through the Site. YOUR CONTINUED USE OF THE SITE AFTER SUCH CHANGES WILL INDICATE YOUR ACCEPTANCE OFSUCH CHANGES.
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LICENSED CONTENT. You agree that (i) Current Procedural Terminology Codes ("CPT®") displayed on the Site are owned and copyrighted by the American Medical Association ("AMA") and licensed to FAIR Health, (ii) Current Dental Terminology codes ("CDT®") displayed on the Site are owned and copyrighted by the American Dental Association ("ADA") and licensed to FAIR Health, and (iii) ASA content including CROSSWALK®, Reverse CROSSWALK® and/or Relative Value Guide® ("ASA Content") displayed on the Site is owned and copyrighted by the American Society of Anesthesiologists ("ASA") and licensed to FAIR Health. The CPT, CDT and ASA Content are referred to collectively as "Licensed Content."*
INFORMATION SUBMITTED THROUGH THE SITE. Your submission of information through the Site is governed by FAIR Health's Privacy Policy.*
LIMITS ON USE. FAIR HEALTH'S CONSUMER WEBSITE AND YOUCANPLANFORTHIS.ORG ARE PROVIDED SOLELY FOR PERSONAL, CONSUMER USE, AND NOT FOR ANY COMMERCIAL, PROFESSIONAL, RESEARCH, LITIGATION OR OTHER PURPOSES. You are not permitted to modify or download content from the Site (other than page caching), or any portion of it, except with the express written consent of FAIR Health. This license does not authorize or allow any resale or commercial use of this Site or its contents; any collection and use of any product listings, descriptions, or prices; any derivative use of this Site or its contents; any downloading or copying of information for the benefit of another party; or any use of data mining, robots, or similar data gathering and extraction tools. No portion of this Site may be reproduced, duplicated, copied, sold, resold, visited, or otherwise exploited for any commercial purpose without the express written consent of FAIR Health. Any unauthorized use terminates the permission or license granted by FAIR Health to use this Site. Your use of the Site is conditioned on your compliance with the limits on use set forth in this section and your failure to comply with such rules may result in termination of your access to the Site pursuant to Section 15 ("Termination"), below. While using the Site you will comply with all applicable laws, rules and regulations and you will respect the rights and dignity of others. TO THE EXTENT THAT THE SITE PROVIDES INFORMATION ABOUT A PARTICULAR PHYSICIAN, DENTIST, OR OTHER HEALTHCARE PROVIDER, YOU WILL USE THAT INFORMATION FOR THE SOLE PURPOSE OF EVALUATING WHETHER YOU OR YOUR FAMILY WILL RECEIVE HEALTHCARE FROM THAT PROVIDER. YOU WILL NOT CONTACT PROVIDERS LISTED ON THIS SITE FOR ANY REASON OTHER THAN FOR THE PURPOSE OF SEEKING HEALTHCARE SERVICES FOR YOU OR YOUR FAMILY. YOU ACKNOWLEDGE THAT FAIR HEALTH LIMITS THE NUMBER OF SEARCHES THAT INDIVIDUALS MAY MAKE OVER A SPECIFIC TIME PERIOD. YOU AGREE NOT TO TAKE ANY STEPS TO CIRCUMVENT THESE LIMITATIONS. IF YOU EXCEED THESE LIMITATIONS, FAIR HEALTH WILL DISCONTINUE YOUR USE OF THE WEBSITE. IN NO EVENT SHALL YOU USE THE WEBSITE OR ANY INFORMATION OBTAINED THEREFROM FOR OR ON BEHALF OF ANY THIRD PARTY OR FOR COMMERCIAL PURPOSES. THIS PROHIBITION INCLUDES BUT IS NOT LIMITED TO USE OF THE WEBSITE FOR COMMERCIAL PURPOSES TO PROVIDE CONSULTING, TIME-SHARING OR OUTSOURCING SERVICES OR TO ACT AS A SERVICE BUREAU OPERATION. YOU ARE EXPRESSLY PROHIBITED FROM DISTRIBUTING ANY OF THE SERVICES OR PORTIONS THEREOF, TO ANY PERSON, FIRM OR ENTITY. YOU AGREE THAT YOU WILL NOT: * Use the Site for any fraudulent or unlawful purpose. * Interfere with or disrupt the operation of the Site or the servers or networks used to make the Site available; or violate any requirements, procedures, policies or regulations of such networks, including without limitation, by posting, transmitting or otherwise making available through or in connection with the Site, any virus, worm, Trojan horse, Easter egg, time bomb, spyware or other computer code, file or program that is harmful or invasive or may or is intended to damage or hijack the operation of or to monitor the use of, any hardware, software or equipment. * Restrict or inhibit any other person from using the Site (including without limitation by hacking or defacing any portion ofthe Site).
* Reproduce, duplicate, copy, sell, resell or otherwise exploit for any commercial purposes, any portion of, use of or access to the Site. * Modify, adapt, translate, reverse engineer, decompile or disassemble any portion of the Site. * Remove any copyright, trademark or other proprietary rights notice from the Site or materials originating from the Site. * Frame or mirror any part of the Site without FAIR Health's express prior written consent. * Create a database by systematically downloading and storing Sitecontent.
* Use any robot, spider, site search/retrieval application or other manual or automatic device to retrieve, index, "harvest," "scrape," "data mine" or in any way gather Site content or reproduce or circumvent the navigational structure or presentation of the Site without FAIR Health's express prior written consent. You also acknowledge and agree that you (and not FAIR Health) are responsible for: (i) obtaining and maintaining all telecommunications, broadband and computer hardware, equipment and services needed to access and use the Site and (ii) paying all charges related thereto.*
FAIR HEALTH DOES NOT SET USUAL AND CUSTOMARY FEES (UCR) OR REIMBURSEMENT LEVELS FOR OUT-OF-NETWORK HEALTHCARE SERVICES. FAIR Health is a 501(c) (3) tax-exempt organization with a mission to enhance the transparency and objectivity of information about provider charges and insurance reimbursement rates for out-of-network care. One of the ways FAIR Health pursues its mission is by licensing data products to researchers and to the healthcare industry. FAIR Health provides charge data for specific healthcare services, based on claims data provided to FAIR Health by payors from all areas of the United States, and organized by medical, dental and postal codes. FAIR Health does not determine, develop or otherwise set these charges or the reimbursement rates for healthcare services. FAIR Health's licensees use the licensed data as a tool to help determine their own fees or rates of reimbursement, or for other purposes. FAIR Health does not guarantee that service providers will receive the amount that is set as the benchmark charge amounts included in FAIR Health's data products. FAIR Health does not provide advice, legal or otherwise, regarding healthcare insurance or fees related to providing healthcareservices.
The Site may include charge information about providers in New York State, based on information in our database of privately billed health insurance claims. We selected a number of common procedures, and identified providers who have performed those procedures at least the median number of times compared to other providers in a geozip. Based on the claims in our database, we identified each of those providers' range of prices charged, and the most common price charged, by that provider for each procedure over the course of one year. If there were two equally common prices for a provider, we used the more recent charge. DATA MAY NOT BE COMPLETE OR CURRENT, AND MAY HAVE CHANGED. FAIR HEALTH DOES NOT REPRESENT, WARRANT OR GUARANTEE THAT ANY PROVIDER CHARGE INFORMATION IS ACCURATE OR CURRENT, OR IS DETERMINATIVE OF WHAT ANY PROVIDER MAY BILL YOU. THE CHARGE DATA ARE PROVIDED "AS IS" AND FOR INFORMATIONAL PURPOSES ONLY. PROVIDERS ARE FREE TO SET THEIR OWN PRICES FOR SERVICES. YOU SHOULD ASK ANY PROVIDER ABOUT THE PRICES THEY CHARGE BEFORE VISITING OR RECEIVING SERVICES FROM THEM.*
ACCURACY OF INFORMATION. We attempt to provide information that is complete, accurate and current. Despite our efforts, the information on this Site may be inaccurate, incomplete or out of date, and we make no representation or guarantee that the information on the Site is complete, accurate or current.*
ELECTRONIC COMMUNICATIONS. When you visit the Site or send e-mails to us, you are communicating with us electronically and thereby you consent to receive communications from us electronically. We will communicate with you by e-mail or by posting notices on this Site. You agree that all agreements, notices, disclosures and other communications that we provide to you electronically satisfy any legal requirement that such communications be in writing.*
PROPRIETARY RIGHTS OF FAIR HEALTH. All information, content, software and materials included on this Site, such as text, graphics, logos, button icons, images, audio clips, digital downloads, data compilations, and software, including any compilations of such items, are the property of FAIR Health or its content suppliers and are protected by copyright, trademark, patent and/or other proprietaryrights and laws.
Subject to your compliance with this Agreement, and solely for so long as you are permitted by FAIR Health to access and use the Site, you may make one (1) copy of any content on the Site to which we provide you access hereunder on any single computer solely for your personal, non-commercial home use, provided that you keep intact all copyright and other proprietary notices. Except as expressly authorized in advance by FAIR Health in writing, you agree not to reproduce, modify, rent, lease, loan, sell, distribute or create derivative works based (whether in whole or in part) on, all or any part of the Site or any materials made available through the Site. Trade names, trademarks and service marks of FAIR Health include without limitation, "FAIR Health," "FAIR Health," "FAIR Health Fee Estimator" and any associated logos. All trademarks and service marks on the Site not owned by FAIR Health are the property of their respective owners. The trade names, trademarks and service marks owned by FAIR Health, whether registered or unregistered, may not be used in connection with any product or service that is not ours, in any manner that is likely to cause confusion, or in any manner that disparages or discredits FAIR Health. Nothing contained on the Site should be construed as granting, by implication, estoppel or otherwise, any license or right to use any of FAIR Health's trade names, trademarks or service marks without our express prior written consent.*
PROPRIETARY RIGHTS OF FAIR HEALTH'S LICENSORS. Except for the limited rights expressly granted to you by this Agreement, all other rights in the Licensed Content are owned and retained, respectively, by the ADA, AMA and ASA. You acknowledge that the ADA, AMA and ASA, respectively, own all right, title and interest (including all copyrights and other intellectual property rights), and all rights of commercialization, of rental or sale, to make any derivative work and to distribute, their respective Licensed Content. You acquire no proprietary interest in the Licensed Content or any portion thereof. You will not use the Licensed Content except as authorized by this Agreement. For example, and without limitation, you will not download or otherwise copy, extract, excerpt, paste, email or print Licensed Content other than as expressly permitted by this Agreement; resell, license, or transfer copies of Licensed Content to others, access the Site as a substitute for using the Licensed Content, create any modified or derivative work of Licensed Content, or make any commercial use of the Licensed Content. Commercial use includes, without limitation, use within a medical or dental practitioner's office, hospital or insurance company. In order to use Licensed Content for any purpose other than as authorized in this Agreement, you must obtain a license through the applicable licensor. If you violate the terms of this Agreement, or if the ADA, AMA or ASA no longer make Licensed Content available, we may terminate this Agreement and your rights to use the Licensed Content. THE LICENSED CONTENT IS PROVIDED "AS IS" AND NEITHER FAIR HEALTH, THE ADA, AMA OR ASA MAKES ANY REPRESENTATION AS TO ITS COMPLETENESS OR ACCURACY. ADA, AMA AND ASA ARE THIRD-PARTY BENEFICIARIES OF THIS AGREEMENT WHOSE RIGHTS ARE LIMITED SOLELY TO ANY VIOLATION OF THIS AGREEMENT ARISING OUT OF YOUR USE OF ANY OF THEIR RESPECTIVE LICENSED CONTENT. YOU AGREE THAT ADA, AMA AND ASA WILL BE AWARDED COURT COSTS AND REASONABLE ATTORNEY FEES IF THEY PREVAIL IN ANY ACTION OR PROCEEDING AGAINST YOU DUE TO A BREACH OF THIS AGREEMENT.*
HYPERLINK USE AND DISCLAIMER. We do not necessarily review or approve of the content displayed on websites that have linked to the Site, or to which the Site links. No link to or from this Site shall be construed to imply sponsorship or endorsement by FAIR Health of any other website or its contents.*
DISCLAIMER OF WARRANTIES. THIS SITE AND ALL INFORMATION, CONTENT, MATERIALS, DATA PRODUCTS (INCLUDING SOFTWARE) AND SERVICES INCLUDED ON OR OTHERWISE MADE AVAILABLE TO YOU THROUGH THIS SITE, INCLUDING THE LICENSED CONTENT, ARE PROVIDED BY FAIR HEALTH TO YOU ON AN "AS IS" AND "AS AVAILABLE" BASIS, WITHOUT ANY WARRANTIES OF ANY KIND, WHETHER EXPRESS, IMPLIED OR STATUTORY. YOU AGREE THAT YOU MUST EVALUATE, AND THAT YOU BEAR ALL RISKS ASSOCIATED WITH, THE USE OF THE SITE, INCLUDING WITHOUT LIMITATION, ANY RELIANCE ON THE ACCURACY, COMPLETENESS, TIMELINESS OR USEFULNESS OF ANY MATERIALS AVAILABLE OR LICENSED THROUGH THE SITE, INCLUDING THE DATA PRODUCTS AND LICENSED CONTENT. FAIR HEALTH DISCLAIMS ALL WARRANTIES WITH RESPECT TO THE SITE INCLUDING BUT NOT LIMITED TO THE WARRANTIES OF NONINFRINGEMENT ANDTITLE.
FAIR HEALTH DOES NOT WARRANT THAT THIS SITE; THE INFORMATION, CONTENT, MATERIALS, PRODUCTS (INCLUDING SOFTWARE) OR SERVICES INCLUDED ON OR OTHERWISE MADE AVAILABLE TO YOU THROUGH THIS SITE; THE SERVERS; OR ELECTRONIC COMMUNICATIONS SENT FROM FAIR HEALTH ARE FREE OF VIRUSES OR OTHER HARMFUL COMPONENTS. FAIR HEALTH WILL NOT BE LIABLE FOR ANY DAMAGES OF ANY KIND ARISING FROM THE USE OF THIS SITE OR FROM ANY INFORMATION, CONTENT, MATERIALS, PRODUCTS (INCLUDING SOFTWARE) OR SERVICES INCLUDED ON OR OTHERWISE MADE AVAILABLE TO YOU THROUGH THIS SITE, INCLUDING, BUT NOT LIMITED TO DIRECT, INDIRECT, INCIDENTAL, PUNITIVE AND CONSEQUENTIAL DAMAGES, UNLESS OTHERWISE SPECIFIED BY FAIRHEALTH IN WRITING.
CERTAIN STATE LAWS DO NOT ALLOW LIMITATIONS ON IMPLIED WARRANTIES OR THE EXCLUSION OR LIMITATION OF CERTAIN DAMAGES. IF THESE LAWS APPLY TO YOU, SOME OR ALL OF THE ABOVE DISCLAIMERS, EXCLUSIONS OR LIMITATIONS MAY NOT APPLY TO YOU, AND YOU MIGHT HAVE ADDITIONAL RIGHTS.*
LIMITATION OF LIABILITY. TO THE MAXIMUM EXTENT PERMISSIBLE BY APPLICABLE LAW, FAIR HEALTH WILL NOT BE LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, CONSEQUENTIAL, SPECIAL, EXEMPLARY OR PUNITIVE DAMAGES OF ANY KIND, UNDER ANY CONTRACT, NEGLIGENCE, STRICT LIABILITY OR OTHER LEGAL THEORY, INCLUDING WITHOUT LIMITATION, DAMAGES FOR LOSS OF PROFITS, USE OR DATA OR FOR LOSS OF OTHER INTANGIBLES, LOSS OF SECURITY OF INFORMATION YOU HAVE PROVIDED IN CONNECTION WITH YOUR USE OF THE SITE OR UNAUTHORIZED INTERCEPTION OF ANY SUCH INFORMATION BY THIRD PARTIES, EVEN IF ADVISED IN ADVANCE OF SUCH DAMAGES OR LOSSES. IN PARTICULAR, AND WITHOUT LIMITATION, FAIR HEALTH WILL NOT BE LIABLE FOR DAMAGES OF ANY KIND RESULTING FROM YOUR USE OF OR INABILITY TO USE THE SITE OR FROM ANY CONTENT POSTED ON THE SITE BY FAIR HEALTH OR ANY THIRD PARTY. YOUR SOLE AND EXCLUSIVE REMEDY FOR DISSATISFACTION WITH THE SITE IS TO STOP USING THE SITE. THE MAXIMUM LIABILITY OF FAIR HEALTH FOR ALL DAMAGES, LOSSES AND CAUSES OF ACTION, WHETHER IN CONTRACT, TORT (INCLUDING WITHOUT LIMITATION NEGLIGENCE) OR OTHERWISE, SHALL BE THE TOTAL AMOUNT, IF ANY, PAID BY YOU TO FAIR HEALTH TO ACCESS AND USE THE SITE, AND IN ANY CASE SHALL NOT EXCEED $100.00. IN NO EVENT WILL THE ADA, AMA OR ASA BE LIABLE TO YOU FOR ANY DAMAGES, INCLUDING ANY LOST PROFITS, LOST SAVINGS OR OTHER INCIDENTAL OR CONSEQUENTIAL DAMAGES ARISING OUT OF THE USE OR INABILITY TO USE LICENSED CONTENT, EVEN IF ADA, AMA AND/OR ASA HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES, OR FOR ANY CLAIM BY ANY OTHER PARTY. FAIR HEALTH, AMA AND ASA DO NOT DIRECTLY OR INDIRECTLY PRACTICE MEDICINE OR DISPENSE MEDICAL SERVICES. ADA, AMA AND ASA ARE NOT THE SOURCE OF NON-LICENSED CONTENT OR INFORMATION CONTAINED ON THE SITE, AND NO ENDORSEMENT OF THE SITE BY ADA, AMA OR ASA IS INTENDED OR IMPLIED. AMA AND ASA DISCLAIM RESPONSIBILITY FOR ANY CONSEQUENCES OR LIABILITY ATTRIBUTABLE TO OR RELATED TO ANY USE, NON-USE, OR INTERPRETATION OF INFORMATION CONTAINED OR NOT CONTAINED IN CPT OR ASA CONTENT, IN CONNECTION WITH ANY CLAIM OR CAUSE WHATSOEVER, WHETHER IN CONTRACT, TORT OR OTHERWISE. THE SOLE RESPONSIBILITY OF ASA AND AMA IS TO MAKE AVAILABLE TO FAIR HEALTH REPLACEMENT COPIES OF ASA CONTENT AND CPT TO BE POSTED TO THE SITE. ASA AND AMA DISCLAIM ANY LIABILITY FOR ANY CONSEQUENCES DUE TO USE, MISUSE, OR INTERPRETATION OF INFORMATION CONTAINED OR NOT CONTAINED ON THE SITE.*
INDEMNITY. You agree to defend, indemnify and hold harmless FAIR Health, ADA, AMA and ASA from and against all claims, losses, costs and expenses (including attorneys' fees) arising out of (a) your use of or activities in connection with, the Site or Licensed Content; or (b) any violation of this Agreement by you.*
GOVERNMENT RIGHTS. This Site includes information, including Licensed Content, which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable, which were developed exclusively at private expense by FAIR Health, ADA, AMA or ASA, respectively. Government rights (if any) to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (December 2007) and/or subject to the restricted rights provisions of FAR 52.227-14 (December 2007) and FAR 52.227-19 (December 2007) as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.*
TERMINATION. This Agreement is effective until terminated. FAIR Health, in its sole discretion, may terminate your access to or use of the Site, at any time and for any reason, including if FAIR Health believes that you have violated or acted inconsistently with the letter or spirit of this Agreement. Upon any such termination, your right to use the Site will immediately cease. You agree that any termination of your access to or use of the Site may be effected without prior notice. You agree that FAIR Health shall not be liable to you or any third party for any termination of your access to the Site. Upon termination, you must destroy any copies made of any portion of the Site, including but not limited to Licensed Content.*
GOVERNING LAW AND JURISDICTION. This Agreement is governed by and shall be construed in accordance with the laws of the State of New York, U.S.A., without regard to its principles of conflicts of law that would lead to the application of any other law. FAIR Health does not represent or warrant that the Site or any part thereof is appropriate or available for use in any jurisdiction other than the United States. Any dispute arising under or relating to this Agreement shall be subject to the exclusive jurisdiction of a state or federal court located in the County of New York in the State of New York, and you agree to submit to the personal and exclusive jurisdiction and venue of such courts.*
APPLICABLE LAWS. In choosing to access the Site, you do so on your own initiative and at your own risk, and you are responsible for complying with all applicable federal, state, local and foreign laws, rules and regulations. If you license any data products, you also are subject to United States export controls and are responsible for any violations of such controls, including any United States embargoes or other federal rules and regulations restricting exports. We may limit the Site's availability, in whole or in part, to any person, geographic area or jurisdiction we choose, at any time and in our solediscretion.
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MISCELLANEOUS. If any provision of this Agreement is found to be unlawful, void or for any reason unenforceable, that provision will be deemed severable from this Agreement and will not affect the validity and enforceability of any remaining provision. You may not assign, transfer or sublicense any or all of your rights or obligations under this Agreement without our express prior written consent. This, together with all policies referred to herein, is the entire Agreement between you and FAIR Health relating to the subject matter herein and supersedes any and all prior or contemporaneous written or oral agreements or understandings between you and FAIR Health relating to such subject matter. Notices to you may be made via posting to the Site, by e-mail or by regular mail, in FAIR Health's discretion. The Site may provide notices of changes to this Agreement or other matters by displaying such notices or by providing links to such notices. Without limitation, you agree that a printed version of this Agreement and of any notice given in electronic form shall be admissible in judicial or administrative proceedings based upon or relating to this Agreement to the same extent and subject to the same conditions as other business documents and records originally generated and maintained in printed form. FAIR Health will not be responsible for failures to fulfill any obligations due to causes beyond its control. This Agreement is written in and is to be interpreted for all purposes in accordance with the English language as used in the United States. Any version of this Agreement in any other language is for convenience only and not binding on any party.*
CONTACT US. If you have any questions regarding the meaning or application of this Agreement, please direct such questions to info@fairhealth.org or FAIR Health, Inc., 530 Fifth Avenue, 18th Floor, New York, NY 10036. Please note that communications are notsecure.
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