Care planning with family

For the CPT code 90887, "Care planning with family," Boston Children's Hospital in Massachusetts offers a cash median rate of $469. While the facility does not provide a specific state or county average in the available data, the cash price is notable as it matches the gross charge listed for the service. It is important for patients to understand that cash-pay rates can sometimes be more economical than insurance negotiated rates, particularly for those with high-deductible plans where the insurer's allowed amount might exceed the cash price. In this case, the median negotiated rate across 21 payers is $352, which is lower than the cash rate, but individual plans vary significantly, with some offering high-end negotiated rates up to $469 and others as low as $230.

The pricing structure for this service reflects the complexity of commercial insurance contracts, where rates are determined by specific payer agreements rather than a single standard. Among the 21 payers identified, the highest negotiated rate is $469 (Cigna), while the lowest is $230 (Cdphp), demonstrating a wide variance in allowed amounts even for the same procedure. Patients should be aware that while the No Surprises Act protects against balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, it does not eliminate the need to verify the specific allowed amount for each plan. To potentially reduce costs further, patients are encouraged to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can offer an additional fee reduction for upfront payment, bypassing the administrative overhead and potential administrative load associated with the insurance billing cycle.