Two facts most people are never told: in-network does not mean fair-priced, and higher price does not mean higher quality. Often it's the opposite.
Both facilities are in-network. Both perform the identical study. The only things that change are the price and the published quality score, and they move in opposite directions.
Large in-network hospital system
Independent, in-network center
Facility B costs about a quarter as much and scores higher. Same study, same network. Price was never a signal of quality. It was just the number the facility set.
Prices and scores are illustrative, chosen to show the pattern that published transparency and quality data repeatedly reveal. Real differences vary by service and market.
No one expects a member to research price-transparency files and quality scores from a waiting room. So PR Health does that work ahead of time and brings it to the moment of decision.
Through curated steerage and member navigation, a member sees a high-quality, fair-priced option and a real person to help them get there. They're always free to choose otherwise, guided, not restricted.
Providers are looked at on published outcomes for the specific service, before a member ever needs it.
Options are benchmarked so the plan isn't paying a list price someone else set.
Navigation handles scheduling and questions, so the better-value choice is also the easier one.
Steerage is a recommendation backed by data, members are guided, never locked in.
The plan structure that makes transparency and steerage possible, with stop-loss to cap the risk.
