Transparency in Coverage

Per the Department of Health and Human Services (HHS) Transparency in Coverage final rule, below are machine readable files of pricing data.

Please note: Files are zipped and in a JSON format. They may contain millions of lines of data and be very large in file size. Please consider your system’s capacity and memory when downloading these files. These files are not member-friendly and should not be used in place of the Member Evidence of Coverage (EOC). Members should contact CCHP Member Services with any questions about costs.

Members should refer to their Evidence of Coverage (EOC) for information about co-payments. Alternatively, members may call Member Services at 1-877-661-6230 (option 2) (TTY 711), Monday – Friday, 8am – 5pm, for information about co-payments or negotiated rates.

Important Information about Cost Estimates

Estimates members may receive from CCHP are designed to provide information about the cost of an item or service before members receive care. However, this estimate has certain limitations that members should consider before making any decision to obtain the item or service.

If you are treated by an out-of-network provider, after paying the cost-sharing amount determined by your health plan, you may still receive a bill for the difference between the amount the out-of-network provider charges for the item or service and the amount paid by your health plan. This is called balance billing, and this amount is not included in your cost estimate.

The actual charge for the item or service may be different than the cost estimate, depending on the actual care you receive. For example, if your physician provides additional services during your visit, your charges could be more than the cost estimate. This is one reason why it is important to discuss with your provider both before and during your visit which items and services you will receive and to request a new cost estimate if new information becomes available.

This cost estimate is not a benefit determination or guarantee of coverage for the item or service for which you requested information. For example, your plan may need to determine whether the item or service is medically necessary in your case before making a payment. You should follow your health plan’s process for filing a claim for benefits and contact your health plan to help determine if there are any additional requirements that apply to you as part of that process.