The Hidden Price Risk in Healthcare Claims (Even at the Same Provider)

The total cost of care (TCOC) is staggeringly variable, even for the exact same treatment, at the same provider. This hidden volatility poses a major risk for stop-loss carriers, MGUs, and self-funded employers managing high-cost claims.

Let’s break it down.

Same Cancer Therapy. Same Hospital. $1.3M Price Gap.

At a major Midwest cancer center, HealthRate analyzed pricing data for Yescarta, a leading CAR-T therapy. Here’s what we found:

• Lowest contracted rate: $392,410‍
• Highest contracted rate: $1,728,291‍
• Difference: $1,335,881—for the same treatment, at the same provider.

This pricing spread exists within the same health system, across different network contracts. The lowest prices were often accessible through niche specialty networks—but most plan sponsors and intermediaries don’t have visibility into these rates.

HealthRate Flags Price Outliers Before the Claim Hits Your Books

HealthRate is an innovative insurtech platform designed to bring transparency and clarity to the most complex and costly healthcare claims. Specializing in pricing transparency, HealthRate equips employers, insurers, TPAs, and stop-loss providers with powerful tools to analyze and re-price healthcare cases in real-time.

Use HealthRate to:

• Benchmark rates in real-time
• Intervene before payment or care is authorized
• Optimize network utilization
• Reduce catastrophic claim payouts

In one case, using HealthRate insights provided a potential plan to refer a patient for the same therapy at the same provider for over $1 million less.

This Isn’t an Exception—It’s the Norm

Every major health system exhibits steep price variability across therapies, surgeries, and chronic care. Chargemaster variability, complex rate structures, siloed contracting, and lack of visibility mean plan sponsors are routinely overpaying—without knowing.

HealthRate surfaces these insights quickly and cleanly—in just minutes—so you can make high-impact decisions that preserve margin and protect your book.

Curious how HealthRate can reduce your largest claim categories? Let’s talk.