The Healthscore CT Cost Estimator pulls its information from the state’s All-Payer Claims Database (APCD). The costs reflect the payments made by the insurance companies for a particular “routine and non-emergency” procedures as well as the individuals’ out-of-pocket costs. Having this data in one place gives you a chance to compare the cost of medical treatment in health facilities throughout Connecticut.
The information on Healthscore CT is a good starting point for talking to your provider and insurer about the cost of your treatment. It can help you negotiate a lower price and calculate your out-of-pocket expenses.
Instructions and Overview
Why Use the Cost Estimator?
If you have health insurance in the State of Connecticut, you can use this Connecticut Cost Estimator to show the median costs for common healthcare procedures and services at various facilities across the state. These costs, also referred to here as the allowed amounts paid, are estimated amounts paid to the facilities and providers for their services. They are paid for by the insurance company and the insured persons based upon the details of their health insurance plan or policy. It is important to note that these costs do not represent the entire amount a person will pay, as that actual cost will be dependent on various factors – for example, health insurance plans have different out-of-pocket costs that can include co-pays, deductibles, and co-insurance for covered services. It is important to check with your insurer about the out-of-pocket costs for your specific situation.
If you don’t have health insurance, this Cost Estimator will not provide details on procedure costs at uninsured rates, but the data could be used as a reference to aid in negotiating with specific healthcare providers.
How to use the Cost Estimator tool:
- Select an Outpatient or Inpatient Service (Selected tab will be white)
In the example below, we selected outpatient services-inpatient services is the gray tab.
Using the arrow, Select a Service from the options in the Drop-Down Menu
*note: services included in the menu are identified as the top procedures performed
- Choose a Town to search for providers.
- Choose a Radius Around Your Town
*This step helps to narrow the search to facilities in a certain distance from your preferred town. In the example below using Hartford as a town preference, the largest radius around Hartford is selected to display all providers who perform the selected service. Narrow the search down determine the facilities within a certain distance from the selected town
- Sort Results By
This changes how you view the information, costs from low-high or high-low, distance and facility name. In the example below, the results are sorted by facility name so the choices can be viewed alphabetically.
Note: the dashboard will change as you make selections in the dropdown boxes.
Cost Estimator Methodology Overview
The data used for the Cost Estimator is derived from the state’s All-Payer Claims Database (APCD). Connecticut-regulated insurers and pharmacy benefit managers are required to submit their health insurance claims to the state’s APCD. The data used for the Cost Estimator excludes data from Medicaid, Medicare, and Medicare Advantage, at this time. We used the most recent and complete data, which includes the last 6 months of calendar year 2017 and the first 6 months of calendar year 2018 for the analysis period. We will continue to update the data and add new procedures as they are identified.
In our analysis, we identified some of the top procedures performed in Inpatient (IP) Hospital and Outpatient (OP) facilities. The IP services focused on acute care services that may not always be specifically associated with chronic diseases, but would require a person to spend a number of days in a hospital recovering from surgery. The number of days a person spends in an IP Hospital depends on the service(s) performed, and is also is referred to here as the length of stay (LOS). Conversely, OP services or procedures take place during the day and typically would not require an overnight stay.
In our analysis, we did a count of specific services performed by each facility using a standard procedure code, and removed all facilities that had less than 5 procedures within the analysis period. This was to remove the facilities that had a limited number of procedures and would otherwise skew the estimated costs. During our analysis, we also determined that the facilities that met the 5 or greater procedures range also displayed a wide range of costs, so instead of using a typical mean (or average) of all data points, we used the median. The mean includes all data points in the calculation, which means the results can easily be skewed or misleading based on the number of extremely low or highly paid amounts (called outliers) that are present. The median adjusts for these outliers, as the median is the number that falls exactly in the middle, such that half the numbers are higher and half are lower, as shown below.
Median – the number that falls exactly in the middle of all numbers in a group, such that half the numbers are higher and half are lower.
Length of Stay (or LOS) – the number of days a person stays in an inpatient hospital and is dependent on the type of procedure or services performed.
Allowed Amount Paid – the total amount paid to a facility for services performed, that includes the amount an insurer pays plus a person’s out-of-pocket costs, including copays, co-insurance, and total deductible paid.
CDAS – is the state’s Core Data Analytics Solution that is architected, designed, and implemented by UConn AIMS (Analytics and Information Management Solutions) in collaboration with the Office of Health Strategy (OHS).