Member

FairCost helps you and your benefit plan administrator save money on out-of-network medical claims. Out-of-network medical claims occur when you seek medical care outside of your medical network. If your benefit plan administrator has chosen to work with FairCost, they send your out-of-network medical claims to us to identify savings. We offer our clients two products for out-of-network medical claims, called FairCost QPA Assist and FairCost Optimizer.

FairCost QPA Assist helps eliminate “surprise bills” from out-of-network providers. A surprise bill occurs when you receive care from an out-of-network facility or health care provider that you didn’t choose, which results in a bill that may cost more than if care was provided by an in-network facility or health care provider. In 2021, the Federal government approved the Consolidated Appropriations Act (CAA). The CAA includes the No Surprises Act (NSA), which protects you from surprise billing. If your benefit plan administrator has selected FairCost QPA Assist, we supply them with a rate that is calculated in accordance with CAA for your out-of-network claims. We also support your plan benefit administrator with any questions or follow-up that may arise from the health care provider who submitted the claim.

FairCost Optimizer focuses on saving money on out-of-network claims that are not part of the No Surprises Act (NSA). If your benefit plan administrator has selected FairCost Optimizer, we apply a rate to your claim that we have determined is fair. If you have any questions on eligibility or whether your benefit plan includes access to FairCost Optimizer, please contact the benefit plan administrator using the phone number on your ID card.