As health care evolves and costs continue to rise, you are being asked to share more of the expense. But do you know the difference in cost between a visit to the doctor’s office and a trip to an urgent care center? How about the average cost for a hospital stay? Do you know what portion of those costs (if any) that you'll be responsible for paying?
We negotiate and contract with plan providers to get you discounted rates for your covered health care services. Depending on your plan type, you may be responsible for paying a portion of the cost of your health care service. This is called "cost-sharing." Your cost-sharing may be in the form of copayments, coinsurance and/or deductibles.
- A copayment is the dollar amount that you need to pay for a covered service, usually when you get the service. For example, if your plan has a $20 copayment for doctor office visits, you'll pay $20 when you visit the doctor.
- Coinsurance is the percent that you need to pay for a covered service. For example, if you have a 20% coinsurance for a covered benefit, you pay 20% of the cost and the plan pays the rest..
- A deductible is the dollar amount that you pay before the plan starts to pay for certain services. For example, if you have a $1,000 deductible, you must pay up to $1,000 for certain services before your plan will start paying for them.
You can log into MyFallon to find out what your specific copayments, coinsurance and deductibles are. You can also find this information in your Summary of Benefits, Member Handbook or your other plan materials.
Costs for some common health care services**
The tables below show cost ranges for some common health care services. This section illustrates examples of the average costs for the indicated services. However, individual experiences and costs may vary. Depending on your plan design and where you are in your deductible (if you have one), you may be responsible for paying all, some or none of these costs. You can log into MyFallon to find out what your specific copayments, coinsurance and deductibles are. You can also check your Summary of Benefits, Member Handbook or your other plan materials.
Office visits, hospital visits and other facility visits
|Doctor office visit||$53–$344|
normal delivery, including doctor’s fees
c-section delivery, including doctor’s fees
|Emergency room visit, minor injury||$75–$903|
|Urgent care center visit||$78–$425|
Tests, imaging and labs
|Service||Cost range in a non-hospital setting||Cost range in a hospital setting|
Costs vary based on test requested.
Costs for other health care services
If you have questions about costs for medical services that aren't listed on this page, you can:
- Log into our Fallon SmartShopper tool
- Call our Customer Service Department at:
Monday, Tuesday, Thursday, and Friday from 8 a.m. to 6 p.m. and Wednesday from 10 a.m. to 6 p.m.
- Or complete a Request for Good Faith Estimate of Medical Services form (pdf) to get an estimate for proposed medical services.
Things to consider when completing the Request for Good Faith Estimate of Medical Services form
The accuracy of the estimate depends on how accurate the information is on the form. To avoid delays in getting your estimate, please provide as much information as possible about the exact service you'll be receiving. Also, please include information about any procedures, services or tests that are associated with the service. Some examples are: anesthesia, facility, pathology, tests or screenings and radiology. Make sure to choose how you'll like us to send the cost estimate to you. You can have it emailed*** or sent through regular mail. Email will be delivered in 2 business days. Mail will be sent out in 2 business days to your address we have in our records. Mail delivery is dependent on the postal service.
* *This section illustrates examples of the average costs for the indicated services. However, individual experiences and costs may vary. Please remember:
- This information should not replace your health care provider’s advice and direction. You should work with your doctor and health care provider to explore all of your treatment options to make an informed decision about your health care.
- These examples are based on average costs charged by Fallon Health network providers.
- Unusually high-cost or low-cost cases are not included.
- Actual out-of-pocket costs will depend on services received, benefits, negotiated rates for a hospital or professional provider and the billed charges for a hospital or professional provider.
- This information does not suggest that any health care service or treatment approach is necessary or unnecessary, nor better or worse than any other service or treatment approach.
- These figures do not list a specific, actual cost for any specific service or episode of care. Facility and professional billed charges vary from provider to provider.
*** Information transmitted by and to you by email is unencrypted and as such is not secure. As a result, it may be possible for others to intercept the information sent and received.