Health Insurance carriers report this information under Virginia law 32.1-276.5:1, to increase healthcare transparency in Virginia. The healthcare services in this report are those provided by doctors, emergency rooms, hospitals, diagnostic and surgical centers.
The services reported were recommended to Virginia Health Information (VHI) by a workgroup of healthcare stakeholders. After VHI Board of Directors review, the list of services was approved by the State Health Commissioner. Commercial insurance allowed amounts are based on 2010 paid commercial claims and exclude government programs like Medicare and Medicaid. The Medicare information was obtained from CMS and related websites and are footnoted with their source.
After review for accuracy, and discussions with health insurance carriers, amounts reported for health insurance carriers are averaged for this report.
Virginia Health Information (VHI) is an independent non-profit organization. VHI works under contracts with state agencies and others to provide consumers with information on healthcare cost and quality.
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Limitations
Because insurance plans may have different benefits, our report does not show you exactly what you will pay. For that, you must check with your health insurance company or the healthcare provider.
- Consumers may not get as much of a discount as a larger health insurance carrier.
- Some geographic areas of Virginia may have lower prices. Statewide averages do not account for these differences.
- Some health insurance carriers may negotiate lower allowed amounts than others. State averages do not show the lowest allowed amount. In some cases, price variations between carriers were high.
- Health insurance carriers may categorize some expenses differently. For example, one carrier may report allowed amounts under the "surgeon" category that another carrier may report as "physician." Use this information as a starting point to better understand healthcare prices.
- Not all health insurance carriers reported amounts for each service or facility, physician type or other service. You may or may not be responsible for each of the possible categories of service.
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