Common Questions
How is "fair market price" calculated?
Fair market price is derived from CMS Medicare reimbursement data and Healthcare Bluebook averages. It represents what uninsured or out-of-network patients can reasonably negotiate for a procedure. It's typically 1.2–2× the Medicare rate, far below what hospitals put on initial bills.
Why does my region matter?
Medical costs vary significantly by geography. Northeast and West Coast hospitals typically bill 30–40% more than Midwest or South facilities for identical procedures. Labor costs, hospital market concentration, and state insurance regulations all drive regional variation.
I have insurance — does this still apply to me?
Yes. Even with insurance, billing errors affect your out-of-pocket costs. Incorrect procedure codes change what your insurance pays, shifting more cost to you. EOBs (Explanation of Benefits) are notoriously difficult to read — billing errors often go undetected.
What's the difference between billed amount and what I owe?
The billed amount is the "sticker price" — almost no one pays it. Insurance companies have negotiated rates, and uninsured patients can often negotiate down. But billing errors in the original charge still affect your final cost. Start with the itemized bill before paying anything.
How does BillSniper help?
Upload your actual bill (PDF or photo). BillSniper's audit engine checks for duplicate line items, upcoded procedure codes, phantom charges for services not rendered, and charges that exceed Medicare rates by an unusual margin. You get a detailed report for $10 — and most audits find significantly more than that in recoverable charges.