Finding your needle in the haystack of insurance prices

After the introduction of the Transparency in Coverage Act in 2020, insurers are required to publish their “negotiated rates” (i.e. pricing for medical procedures) in a machine-readable format. Machine-readable does not mean “open in Excel”–we are talking about trillions of healthcare prices spanning petabytes of data updated monthly. With some big-data engineering, we were able to ingest ~100 million prices from UHC out of a total of 1 trillion prices and build a small web spreadsheet to explore the dataset.

Finding your needle

You can get to the web spreadsheet here, and you’ll notice a few things:

  1. Filters along the top of the sheet to slice and dice the 100M prices
  2. A data table where each row has: an NPI, a CPT code, a Negotiated Rate, and a Payer. There are other description fields for the provider’s name and geography, specialty, etc, but the aforementioned fields uniquely define each row.

*Note that State, County, Billing Code, Taxonomy, and Row Count are all required filters

The data is currently configured to show data for : John Maddox (a pediatrician), who practices in Middlesex County, Massachusetts, for the 99202, 99203, 99204, and 99205 (e.g. new patient visit) CPT codes. Remember, the data only includes UHC for now!

Unless you’re John Maddox, update the filters to set your state, county, relevant CPT codes, NPI number, etc., and let us know if UHC is publishing truthful data (or more likely, that we have an error in our spreadsheet).

At this point, if your rates with UnitedHealth look right, you might be curious about what other folks in your area are getting paid by UHC. If so, read on…

Sifting through the UHC haystack

You may have noticed the grass-colored bars at the bottom—these show a distribution of prices by CPT code in the above view. Since only one NPI is selected, there’s only one bar for each CPT.

To see a fuller distribution, clear the NPI filter you should see the bars below update:

Now you can see how your negotiated rates stack up against other providers performing the same CPT codes in the same county. If you want to see specific providers that have higher rates, simply click on one of the bars, it will automatically set the Billing Code filters to show you just those higher-paid providers. Click “X” and the table will reset to the 99202-99205 codes.

*Note, that for performance reasons our public database limits us to 100 rows of data at a time, and only returns data for NPI-1 providers (individuals not clinics or hospitals). Feel free to contact us at happy to share access to a private server

Click around and let us know what you find!



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