Transparency in Coverage for members

Helping you find the right health care price

Everyone wants to make informed decisions about their health and find quality options that fit their budget. When you use your HealthPartners insurance, we can help you understand provider costs, estimate your out-of-pocket expenses and more. So the next time you see your doctor, you can focus more on your health and think less about what you’ll pay.

Our tools are available if you have any medical insurance plan with us (except Medicare or Medical Assistance).

3 things to keep in mind when comparing health care costs

Health care is different than other products and services. That’s because there isn’t always a set cost for everyone, and it can be hard to predict exactly what kind of care you’ll need before you get it. Even if you have insurance, these and several other factors impact what you’ll finally pay out of pocket.

We recommend keeping the below three things in mind when considering your health care options:

1. Whether your provider is in your plan’s network

One of the easiest ways to save money on your care is by going to an in-network provider. That’s because we’ve pre-negotiated reduced prices with these hospitals, clinics and pharmacies to help our members save money.

The easiest way to find an in-network provider or determine if your current doctor is covered is to search your network through your online account.

During an emergency, you might not have time to pick an in-network provider. But don’t worry – emergency care (no matter where you get it in the United States) is always covered at in-network levels. For follow-up care after an emergency, be sure to use in-network providers for the best coverage.

2. Where (and from whom) you get care and prescriptions

Even if they’re all in network, different providers may charge different rates for the same service or the same medicine. Those rates can also be influenced by where you get care or fill a prescription – for example, you may pay less when you visit the doctor’s office versus the emergency room, or when you have outpatient surgery at a specialty center versus inpatient surgery at a hospital.

If you have time, shopping around before your appointment, procedure, test or pharmacy visit is the best way to estimate costs and decide where to go. Most HealthPartners members can get an estimate online to make price comparison easier.

3. Your provider’s cost and quality ratings

Cost isn’t the only reason to shop around for health care – it’s just as important to consider provider quality to prevent complications that may require more treatment in the future. You also want to be sure you’re getting the right value for your money.

When available, you’ll see cost and quality ratings on a four-star scale when you search your network. These ratings are based on extensive analysis of data, patient outcomes and much more. Combined with a cost estimate for your personal situation, cost and quality ratings can help you get the best sense of what you’ll pay and the level of care you can expect.

Machine-readable files (for health care industry professionals)

The Transparency in Coverage rule from the U.S. Departments of Health and Human Services, Labor, and Treasury requires health insurance issuers offering non-grandfathered health insurance coverage in the individual and group markets and group health plans to publicly disclose price information for covered items and services.

Please note:

  • For price information on specific procedures or services, eligible members should use our cost estimators. The provider rates in the files below are not specific to a member’s benefit plan out-of-pocket cost.
  • The files below are very large and in formats that are impractical for direct consumer use. The goal of the Transparency in Coverage rule is to give researchers and third-party developers the comprehensive data they need to create solutions that help people understand the costs associated with health care, make better price comparisons and choose the care that’s right for them.

In-network provider-negotiated payment rates between plans and providers

These files include applicable in-network rates for certain HealthPartners networks, including rates from contracted network partners. Posted rates include negotiated rates, claims-derived amounts for providers who are reimbursed on a discount from billed charges and underlying fee schedule rates where reimbursement is based on another methodology.

Network Markets National Wrap? Network file
Open Access All Yes* Download now (ZIP)
HP Select Minnesota small group, large group, individual Yes (small group, large group)*
No (individual)
Download now (ZIP)
TieredChoice Minnesota small group, large group Yes* Download now (ZIP)
Robin Select NE Wisconsin small group, large group, individual No Download now (ZIP)
Robin Focused NE Wisconsin small group, large group Yes* Download now (ZIP)
Robin Oak NE Wisconsin individual No Download now (ZIP)
Achieve Minnesota large group Yes* Download now (ZIP)
Achieve SE Minnesota small group Yes* Download now (ZIP)
Peak Minnesota individual No Download now (ZIP)
Cornerstone Minnesota small group, large group, individual Yes (small group, large group)*
No (individual)
Download now (ZIP)

*Download national wrap files

A single employer may offer multiple networks. Employer names are repeated where applicable.

Network

Employers

National wrap?

Network file

Coborn’s Coborn’s Yes* Download now (ZIP)
Essentia Butler Machinery
Capstone Classical Academy
Carr's Tree Service
Choice Bank
Christianson Companies
Cloverdale Foods
East River's Edge
Epic Management
Eventide
Fargo Public School District
FMI
JDS Moline d/b/a Service Master by Moline
Johnson Laffen Galloway Ltd d/b/a JLG Architects
Northern Plains Laboratory
Peterson Farms Seed
RD Staffing
SKL d/b/a Home Heating, Plumbing & Air Conditioning
Small Wonders Preschool & Child Care Center
Swan Machine
Tellwell
Verndale ISD 818
Western State Agency
Depends on plan* Download now (ZIP)
Essentia – ND Butler Machinery
Cloverdale Foods
Yes* Download now (ZIP)
Mahaska County Hospital Mahaska County Hospital Yes* Download now (ZIP)
MercyOne Tier 1 Academy Roofing & Sheet Metal
Accel Holdings
Ames Therapy & Consulting
Bergland And Cram Architects
BubbaDSM d/b/a Bubba Southern Comforts
Center For Siouxland
CF Financial d/b/a Corporate Farmer
City of Tripoli
Connectify HR
DICA Marketing
Dr Greg J McCarthy d/b/a Siouxland Podiatry Associates
Fiberutilities Group
First Reformed Church of Maurice
FM Controls
Forge Financial And Management
Grey Dog Media
GSTC Logistics
Hickory Hill Farms
Hiway Truck Equipment
HS Occupational Wellness
Iowa City Reunion
Iowa Municipal Insurance
Kline Electric
Laird, Heiny, McManigal, Winga, Duffy & Stambaugh
M & W Hydraulics
Martin Brothers Distributing
Martinson Construction
Midwest Growth Partners
Mr Gutter
Nichols Rise & Company
Northeast Iowa Area Agency On Aging
Petroblend
Prairie Lakes Church
Precision Millwright Specialists
Primary Health Care
R Perry Construction
Rock River Eye Care
Siouxland Women's Health Care
Tama County
The West Liberty Telephone
TKCO d/b/a Express Employment Professionals of Cedar Rapids
Ver Hoef Automotive
Vetter's
White Transfer & Storage
Young Parents Network
Zeutenhorst Financial
Depends on plan* Download now (ZIP)
Monument Health Caregiver Monument Health Depends on plan* Download now (ZIP)
Northern School District Trust Bayfield School District
CESA 12
Crandon School District
Hurley Schools
Prentice School District
School District of Ashland
Solon Springs School District
South Shore School District
Washburn School DistrictWinter School District
Yes* Download now (ZIP)
Olivia – New Business Southern Minnesota Sugar Beet Cooperative Yes* Download now (ZIP)
Spencer – Mahaska Academy Roofing & Sheet Metal
BubbaDSM d/b/a Bubba Southern Comforts
M & W Hydraulics
Midwest Growth Advisors II
Northeast Iowa Area Agency On Aging
Rock River Eye Care
Vetter's
White Transfer & Storage
Depends on plan* Download now (ZIP)
Spencer Hospital (IA) Spencer Hospital (IA) Yes* Download now (ZIP)
State of Minnesota State of Minnesota (SEGIP/PEIP) No Download now (ZIP)
State of WI ETF State of Wisconsin No Download now (ZIP)
Trinity Butler Machinery
Cloverdale Foods
Dakota Fence Company dba DFC
Yes* Download now (ZIP)
UIHC Tier 1 Accel Holdings
Ames Therapy & Consulting
Bergland And Cram Architects
BGM School District
Bob Brown Chevrolet
Center For Siouxland
City of Marshalltown
Compass Memorial Healthcare
First Reformed Church of Maurice
FM Controls
Forge Financial And Management Consulting
Greater Regional Health Medical Center
GSTC Logistics
Hawarden Regional Healthcare
Henning Companies
Hickory Hill Farms
Hiway Truck Equipment
HS Occupational Wellness
Innovative Injection Technologies (i2Tech)
Iowa Municipal Insurance
Laird, Heiny, McManigal, Winga, Duffy & Stambaugh
M & W Hydraulics
Marshall County
Martinson Construction
Midwest Growth Advisors II
Mr Gutter
Nichols Rise & Company
Northeast Iowa Area Agency On Aging
OPN Architects
Petroblend
Prairie Lakes Church
Primary Health Care
Rock River Eye Care
Schuster
Sioux City Truck Sales
Siouxland Women's Health Care
Summit Agricultural Group
Tama County
TDT CPAs and Advisors
The West Liberty Telephone
Total Component Solutions
University of Iowa Center for Advancement
Ver Hoef Automotive
Vetter's
Wartburg College
Waterloo Community School District
Wayne County Hospital
Worldwide Integrated Supply Chain Solutions
Young Parents Network
Zeutenhorst Financial
Depends on plan* Download now (ZIP)
UIHC Tier 2 2nd Adventure Group
Academy Roofing & Sheet Metal
BubbaDSM d/b/a Bubba Southern Comforts
CDI
CF Financial d/b/a Corporate Farmer
City of Tripoli
Connectify HR
Dental Prosthetic Services
DGR Engineering
DICA Marketing
Dr Greg J McCarthy d/b/a Siouxland Podiatry Associates
Earlham Community School District
Express Employment Professionals of Cedar Rapids
Fiberutilities Group
Grey Dog Media
Iowa City Reunion
Kingsgate Insurance
Kline Electric
Martin Brothers Distributing
Precision Millwright Specialists
Prestage Farms
R Perry Construction
Spencer Hospital
Story Construction
VGM Group
White Transfer & Storage
Depends on plan* Download now (ZIP)
VGM Group VGM Group Yes* Download now (ZIP)
Waterloo Community School District Waterloo Community School District No Download now (ZIP)

* Download national wrap files

Allowed amounts for services provided by out-of-network (non-contracted) providers

This file includes historical payments to, and billed charges from, non-contracted providers. Rates are displayed only for providers with 20 or more claims to HealthPartners during the previous three-month reporting period.