Maine HealthCost

More Information, Better Decisions

Welcome to the newest release of the MHDO’s Maine HealthCost website.

Recently, there has been a lot of talk—within the State of Maine and around the nation—about the importance of health care cost transparency. As health care consumers, we’re often unaware that prices for comparable medical services can vary widely among providers—even in a single county or state. We may also be unaware of differences in the quality or outcomes associated with these services. Many believe that health care consumers should have access to cost and quality information so they can make informed decisions about where to seek health care services. Making this information more widely available may also encourage providers and health plans to deliver less-expensive and higher-quality care.

MHDO collects data on health care claims for Maine residents. On this site, we present the average cost of specific medical procedures at over 50 different high volume health care facilities and hospitals around the state. Although your particular out-of-pocket cost for a procedure depends on a number of factors, you can use our Cost Compare function to get an overall idea of a procedure’s average cost by facility.

You can also:

  • Find out more about the important terms used throughout the site – Definitions
  • Learn how we calculate average costs – Methodology
  • Find contact information for the facilities and hospitals on this site – Facilities
  • View a list of the procedures (and their CPT codes) with available HealthCost information – Procedures
  • Explore other useful resources about health cost and transparency and links to cost calculators from several health plans – Resources
  • Learn about important updates to the site – Updates
  • Provide feedback regarding the information and functionality of this HealthCost website – Provide Feedback

HealthCost Questions and Answers

Question: What information is available in this release of the Maine HealthCost website?

Answer: Users can compare the average cost of approximately 200 procedures at over 50 high volume health care facilities and hospitals. Only facilities with both professional and facility costs are included (see the Definitions and Methodology pages for more information). The information used to calculate the average cost is from claims data collected by MHDO (as required by law) from all licensed health plans in the State and third-party administrators. We reviewed over 7 million claims from 42 health insurance providers. The data in this release cover the time period of July 1, 2012 to June 30, 2013. At present, we do not include Medicaid and Medicare claims data. The current site includes data from providers who are part of a health care facility. Approximately 80% of primary care physicians and 50% of specialists are employed by a health care facility or hospital.

Question: What information will be available in later releases of the Maine HealthCost website?

Answer: The MHDO received a $2.6 million grant from the federal government to assist us with enhancing the information and resources that we make available on this site. (Information about MHDO’s grant can be found on the Centers for Medicare & Medicaid Services website.) We are working with consumers and other stakeholders as we redesign the HealthCost website. Future releases will include additional medical procedures (such as inpatient procedures), additional providers, and some health care quality data.

Question: HealthCost reports average cost amount. What does this mean?

Answer: The average cost amount reported in HealthCost is the average payment to the provider for a procedure based on the claims data collected by the MHDO. The average cost amount does not represent what you may pay out-of-pocket for the procedure. Your individual out-of-pocket costs depend on the type of health insurance coverage you have. In the Resource section of this website, you’ll find links to several Health Plans that provide tools to their members; these tools include cost calculators that provide more accurate estimates of out-of-pocket costs.

Question: Why is the cost for the same procedure so different from one provider to another?

Answer: This is called cost variation. Research shows that there is no correlation between cost and the quality of the services provided, yet costs can vary widely across the state. A provider or facility will provide the exact same services, but will determine a pricing structure based on the amounts that insurance companies agree to pay, the complexity of their patients, administrative costs, etc.

Question: How does this information help me make better decisions?

Answer: Currently, HealthCost shows the average costs for common medical procedures by health care facility and hospital and how those costs differ around the state. To determine your specific out-of-pocket expense for a procedure, you’ll need to contact your insurance company. In our future release, we plan to enhance the site by providing additional information on health care quality. We are also interested in your feedback, so please take a few minutes to complete the survey and tell us what you think.

Question: Is this website useful to individuals without health insurance?

Answer: Yes! Effective January 1, 2014 a provision in the Affordable Care Act requires providers to charge uninsured individuals the average cost of the charges they have negotiated with their top insurance plans. The cost information presented on HealthCost is the average amount paid by insured individuals and their health insurance companies for a variety of procedures. Uninsured individuals can use these averages to estimate their own costs.

Question: Why do some facilities have low procedure counts?

Answer: The number displayed in the "Number Performed" column is not representative of the number of procedures a facility performs in a given year, but rather the number of procedure claims that were included in the analysis for HealthCost. For example, claims may be excluded from analysis if the costs are extremely high or low or the claim is missing necessary data. Please see the Methodology page for a detailed description of how claims data are processed.

This site was developed by the Maine Health Data Organization (MHDO) in partnership with HSRI. The data presented on these pages comes from claims data reported to the MHDO from health insurance companies in accordance with CMR 90-590 Chapter 243: Uniform Reporting System for Health Care Claims Data Sets. See Methodology for information on how costs are calculated and displayed.