For health plans, TPAs and employers
An outside price for U.S. hospital procedures
Accredited hospitals outside the United States post their own prices for the whole procedure and hospital stay. Sylk Health collates those prices and licenses them to the institutions that pay for U.S. hospital care, as a reference point that was not set inside the U.S. market.
Who it is for
Health plans and insurers
Facility-level international pricing for network design and tiering, and a reference point for value-based contracting.
Third-party administrators (TPAs)
Price data that fits claims and plan-document workflows, and a reference for an annual price review with each plan sponsor.
Self-funded employers and advisers
A documented outside comparator for the plan's file, and a reference for direct negotiation, with no change to benefit design.
Researchers and public bodies
Dated prices, attributed to the hospital that posted them, for research and procurement analysis.
Prices measured against themselves
U.S. hospital prices are set in private negotiations between hospitals and the plans that pay them. Most of the benchmarks used to judge a price are drawn from the market they are meant to test. One example is the median of a plan's own contracted rates.
A multiple of Medicare avoids that problem, because no hospital negotiates the base. Medicare's rates cannot show, though, whether a given multiple is too high or too low.
What an outside price adds
An outside price is what an accredited hospital outside the United States lists for the same procedure. It gives a buyer a reference point that the U.S. market did not set.
For a buyer's comparison, Sylk Health supplies the outside figure, and the inside figure is the buyer's own claims. The comparison is used in planning and negotiation, and it does not require any member to travel.
What the data contains
What a hospital charges for a procedure and the stay, posted by the hospital itself and held to one published definition. How prices are defined
Prices posted by the hospital
Each hospital lists a minimum and a maximum in U.S. dollars for every procedure it offers. Each price is attributed to the hospital and dated.
One price for the whole procedure
The listed range covers anesthesia, operating room and facility charges, and room and board for the expected stay. It also covers practitioner fees, standard implants and consumables, routine tests and medication, and complications treated before discharge.
Figures by country
For each procedure, a country figure runs from the lowest to the highest price posted by listed hospitals there. It shows how many hospitals contributed, and a flag is raised where fewer than two did.
Accreditation the hospital warrants
Listed hospitals warrant accreditation by Joint Commission International or another approved hospital accreditation body. Sylk Health publishes the status each hospital warrants.
Terms that bind the price
The listing terms require the range to cover everything within its scope and bar any separate charge after booking. Sylk Health may check the amounts charged against the range.
How buyers can use it
Seven uses, from the budget to the contract. These are scenarios rather than case studies.
01
Customizing the data
An outside price is useful only beside what the plan itself paid, for the same procedure and a stated scope. The buyer runs that comparison on its own claims.
02
Planning and budgeting
An outside price adds a reference for the level of a procedure's price, set outside the plan's own market. The budget stays the actuary's.
03
Negotiation planning
An outside price shows how far a plan's rate sits from a published alternative. It helps a plan decide in advance what it will do if a hospital refuses a lower rate.
04
Contracting with a TPA
A plan and its administrator can agree to review each year what the plan paid against a reference set outside its market. The review grades no one.
05
Direct contracting
An employer or union fund negotiating a bundle can set an outside price beside the hospital's offer. The rate binds only if the hospital agrees to it.
06
ERISA compliance
An annual review of targeted hospital rates against an outside reference is one way to document a prudent process. It is evidence of prudence, not a safe harbor.
07
Direct patient use
The same prices can help patients and their advocates ask better questions before a planned operation. Sylk Health arranges no care, travel or accommodation.
How licensing works
Pricing is quoted against each buyer's procedures and regions. A license requires no change to benefit design, nothing has to be filed, and no plan year has to turn.
A buyer's own systems query the data through a licensing interface, scoped to what the buyer has licensed. A separate feed reports what has changed since a given date. Sylk Health can also map its procedure definitions to a buyer's own categories and deliver the data in the buyer's format.
Prices are attributed to the hospital that posted them and carry the date they were last updated.
At a glance
- Source
- Prices posted by hospitals
- Unit
- The whole procedure and stay
- Currency
- U.S. dollars
- U.S. comparison
- The buyer's own claims
- Patient data
- None
Questions
Discuss a license
enterprise@sylkhealth.com
Disclosure: Sylk Health supplies procedure-price data and earns a commission from providers on bookings completed through its platform. It would benefit from broader use of externally benchmarked prices for medical procedures, and from any gap between those prices and prices in the United States.
Sylk Health operates a marketplace platform only. It is not a healthcare provider, clinical intermediary, broker, referral service or travel service. It does not select, match, steer or recommend providers, does not rank providers by clinical quality, and does not arrange travel, accommodation, interpretation or visas. All providers listed are independent and contract directly with patients. Each provider warrants its own accreditation against the bodies listed in the Provider Listing Agreement. Sylk Health checks public registers before listing and does not assess clinical quality. Naming an accrediting body implies no endorsement by it. Every listed price is a USD range posted by the provider, who keeps it current and states what it includes and excludes. Where a United States figure is shown it is Sylk Health's own estimate from Medicare rates and published cash prices, not a provider price or a quote. Actual costs depend on the individual case. Listing order reflects commercial, geographic or algorithmic criteria applied equally to every provider. No listing is displayed in preference to another in return for commission. No sponsored placement is sold today; if one is introduced it will be labelled. Sylk Health is operated by Hydra Holding L.L.C-FZ, Meydan Free Zone, Dubai, United Arab Emirates, trade licence 2529593.01. Sylk Health processes no payment between a patient and a provider. Content on this page is for information only and is not medical, legal, actuarial or fiduciary advice. Sylk Health has no affiliation with any third-party organisation referenced on this page unless stated.