Frequently Asked Questions
What information is available on CompareMaine?
Users can compare the average cost of 268 procedures at 320 healthcare facilities and hospitals. The information used to calculate the average cost comes from the Maine Health Data Organization’s (MHDO) All-Payer Claims Database (APCD) as required by Maine State law. The cost data represents the time period April 1, 2019 – March 31, 2020 and includes over 17 million claims for services provided in Maine, from 33 health insurance plans, including claims from self-insured ERISA plans that voluntarily submit data to MHDO.
Given that these analyses are based on claims data, they do not reflect payments for procedures and services provided to uninsured people. At this time, these analyses also do not include people with Medicare or Medicaid (MaineCare). After these claims were excluded, a total of 7,429,489 claims from 31 payers remained in analysis.
Why can I only search for 5 payers on CompareMaine when more are included in the data?
To calculate credible cost estimates, MHDO requires a certain volume of claims for each procedure. The 5 specific payers that are identified on CompareMaine represent approximately 80% of the claims data that is used to generate the estimates on CompareMaine; and in most cases have the required volume. The smaller payers do not have the required volume and therefore are not identified independently.
Is the cost on CompareMaine the price I will pay?
No. The costs on CompareMaine represent median payments. They are meant to serve as a reference point for comparison. Please contact your insurance company to find out your actual payment. If you do not have insurance, please contact the facility that you are interested in. When contacted directly, facilities often report their charges which may be higher than the actual payments they receive from insurance companies and patients.
How do I know if I'm looking up the correct procedure?
We provide information on common procedures using CPT codes, along with user-friendly procedure descriptions. A CPT code is a five-digit code used by healthcare providers and medical facilities to identify medical procedures. CPT Codes distinguish procedures from one another, such as a CT of abdomen with dye (CPT Code 74160) and a CT of abdomen without dye (CPT Code 74150). To get an accurate average cost, you can ask your provider for the CPT code for your procedure. The information provided on CompareMaine is intended to support conversations that you have with your medical provider. There may be additional services or procedures that you receive along with a given procedures that can change the cost.
What information will be available in later releases of the CompareMaine website?
Future releases will include additional medical procedures and facilities.
CompareMaine reports average cost amount. What does this mean?
The average cost reported on CompareMaine is the average payment to the provider for a procedure based on the claims data collected by the MHDO. We calculate the average using the median, the middle number of a range of numbers ordered from lowest to highest. The average cost amount represents the amount paid by the insurance company and the patient's out-of-pocket costs. Your individual out-of-pocket costs depend on the type of health insurance coverage you have. In Resources, you will find links to several Health Insurance Cost Calculators; these include cost calculators that provide more accurate estimates of out-of-pocket costs for members.
Why is the cost for the same procedure so different from one provider to another?
This is called cost variation. Research shows that there is no correlation between cost and the quality of the procedures and services provided, yet costs can vary widely across the state. A provider or facility will provide the exact same procedures and 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.
How does this information help me make better decisions?
CompareMaine shows the average costs for common medical procedures by healthcare facility and hospital and how those costs differ around the state. This information gives consumers a starting point to begin conversations with their providers and/or health plans. You'll need to contact your insurance company to determine your specific out-of-pocket expense for a procedure.
Is this website useful to individuals without health insurance?
Yes! A provision in the Affordable Care Act addresses what hospitals may charge individuals eligible for financial assistance for emergency and medically necessary care: “Section 501(r)(5) requires a hospital organization to limit amounts charged for emergency or other medically necessary care that is provided to individuals eligible for assistance under the organization’s financial assistance policy to not more than the amounts generally billed to individuals who have insurance covering such care.” The cost information presented on CompareMaine is the average amount paid by insured individuals and their health insurance companies for a variety of procedures.
Do imaging costs include both the facility and professional fees?
Yes. We understand that some facilities provide both the facility and professional components of an imaging procedure while other facilities only provide one component. To facilitate comparison for consumers we include both components in the cost estimate. For example, if a facility only provides the facility component we find the matching claim for the professional component in the data to derive the total payment.
Do blood laboratory services include costs for the blood draw?
Yes. The median cost estimate for labs includes the costs to take (for example, blood draw codes) and transport the sample, when applicable.
I'm having trouble understanding the information on the site. Who should I contact?
Please do not hesitate to contact MHDO with any questions.
How can I provide feedback on the site?
We appreciate your feedback, so please take a few minutes to complete the survey and tell us what you think.