What a number on Rede is

Four labels describe an amount on Rede. What each label means is fixed. How much of it a particular amount carries depends on what the evidence behind that amount holds, and the difference between those two things is itself part of the disclosure.

• Its kind — what sort of number it is: a rate negotiated with a plan, a price a place published, a charge that was billed, or arithmetic Rede did itself. Every amount carries its kind.
• Its source — where it was read from, named: whose file it is, or that the number came out of Rede's own arithmetic. Every amount carries its source. The identifier of the individual record inside the file is shown where the evidence carries one, and is not on the screen otherwise.
• Its basis — what the amount measures: a charge, a cash price, an allowed amount, a plan's payment, or a person's share — together with the setting it was billed under and whether it matched your exact plan or only your plan's issuer. Each of those appears when the evidence carries it. The plan is the one a person chooses; Rede has not confirmed enrolment, network status or deductible progress with any insurer, and says so beside the plan choice and under any estimate a plan was applied to.
• Its date — the file's own last-updated date, where the published file states one. Where it does not, Rede shows the day it fetched the file and says that is what the date is: a fetch date tells you when Rede looked, not when the price took effect. Where there is neither, the amount carries no date.

There is no fifth label, and there is no stand-in for a missing one. A piece the evidence does not carry is shown as absent — no substituted date, no invented file name, no guessed plan match. The first two are the ones never absent: Rede does not put an amount on the screen without saying what kind of number it is and where it came from.

The five kinds

Rede sorts every amount onto one ladder, from a rate somebody actually agreed to, down to arithmetic Rede did in the absence of one. The rung, the name and the sentence beside each kind are read from the same module the search results are rendered from, so this page and the product cannot describe a number differently.

• Rung 1Negotiated rate

  A negotiated rate at this place, taken from a published price file.

• Rung 2Published price

  A price this place published in its own file.

• Rung 2Cash price

  This place's published cash price — what it charges people paying without insurance.

• Rung 4Billed charge

  What this provider billed Medicare, from CMS claims. Real money, not your price.

• Rung 5Modeled estimate

  Rede's own arithmetic: no applicable published amount was available for this service and plan.

One rung on the ladder carries no kind at all: a spread of adjudicated claims is a distribution, not a single number, so no amount on Rede ever wears it as a label.

A kind is never mixed with another kind in one estimate. Rede does not average a cash price with a negotiated rate, and it does not take a billed charge and present the result as what a plan allows. Where the only amounts available are of different kinds, there is no estimate.

When Rede shows nothing

Missing evidence is an outcome, not a failure. Where Rede has no compatible evidence for a place, a procedure and a plan together, it shows a blank with its reason — never a guess, and never zero. A blank means Rede does not know: missing is not zero. A zero is a claim of its own, and one shown on Rede has to carry its own basis — a zero share for you can sit beside a non-zero amount allowed under your plan, where the plan covers the service in full.

Every abstention has a name. These are the reasons a search can give, in the words it gives them in:

• measured_sources_below_standard

  Rede withheld this estimate because every available compatible pricing source performed below its minimum measured reliability standard in comparable reported outcomes.

• published_formula_no_exact_dollar

  The hospital published a negotiated contract formula, but no exact dollar. Rede will not convert variable claim terms into a quote.

• model_disabled

  The modeled commercial allowed-amount lane is temporarily disabled; facility-specific prices remain available.

• incompatible_plan_math_basis

  A cash price or billed charge is available, but insurance cost-sharing applies to an allowed or negotiated amount. Rede will not relabel that source amount or calculate “you pay” from it.

• incompatible_value_basis

  CMS ASC data here is a program-payment model, not an allowed amount. Rede will not multiply it by an allowed-amount ratio.

  Only a Medicare program payment is available for this code; a commercial allowed-amount estimate would mix incompatible bases.

• missing_commercial_ratio

  A compatible Medicare allowed amount exists, but no sourced commercial allowed-amount ratio applies to this setting.

Each sentence above is the message the search itself returns for that reason, not a paraphrase written for this page. One of them covers two situations and so carries two sentences. They are the messages a search can give; which one you meet, if any, depends on the evidence behind the place, the procedure and the plan you asked about.

Where the numbers come from

Rede reads files that are already public: the machine-readable price files hospitals publish, federal fee schedules and payment limits, plan and coverage data, and state Medicaid schedules. An amount taken from one of those files carries the name of the file to the screen. Whether it also carries a date depends on the file: the file's own last-updated date where the file publishes one, otherwise the day Rede fetched the file, labelled as a fetch rather than as an effective date, and otherwise no date at all.

What this page will not tell you is how many such files Rede reads, how much of the country they reach, or how recently any of them was refreshed. Those are three different questions, and each one is easy to answer dishonestly. Registration of a source is not ingestion, and ingestion is not coverage: a source can be known to Rede without having been read, and read without producing a price for the place, the procedure and the plan in front of you. Where a number appears, its kind and its source appear beside it, and its date appears when the evidence carries one.

How to read a comparison

A comparison is like for like when two amounts are the same kind, the same setting and the same basis. Change any one of the three and the numbers stop answering the same question: a hospital outpatient amount and an office amount are different settings, a cash price and a negotiated rate are different kinds, and what a plan allows and what a person owes are different bases. Read a comparison in that order — check the three first, then read the gap.

Amounts that do not share a basis are sometimes still worth setting side by side. Comparing plans at one place is the plain case: one plan may have a negotiated rate published for it while another has only a modeled amount, and forcing both onto a single basis would invent something. So each column keeps its own basis, and where the bases differ that difference is disclosed beside the numbers rather than smoothed away. The amounts are never blended into one figure, and a column with no price data says so instead of showing zero.

When two amounts are like for like and still differ: a difference is a difference, never an overcharge. A price difference on its own does not establish its cause. Rede can tell you what each number is and where it came from; what the gap means for you is yours to decide, with the place you are considering and with your plan.

The same rules everywhere

These are not settings on one screen. They hold on every surface Rede offers — a search, a facility page, a bill check, a saved estimate — and in anything Rede builds for an employer or a provider, and in anything Rede publishes for machines to read rather than people. The labels an amount carries here travel with it into an export, a report or a response to another program; a piece the evidence does not carry is left absent there too, rather than filled in to make a row look complete; and where amounts rest on different bases, the difference is disclosed there as well. A rule that applied only where a person happened to be looking would not be a rule.

What Rede will not do

• No guessed amounts. An amount Rede cannot source is not shown at all, and nothing is put in its place.
• No average presented as a price. A spread of what other people paid is labelled as a spread. It is never promoted into a headline number, because an average describes a set of other people’s amounts, not the amount a person will be billed.
• No savings figure. Rede does not know what you would otherwise have paid, so it will not put a number on the difference.
• No accuracy percentage. Rede has no accepted measurement of its estimates against real bills and claims yet, so any accuracy figure it published today would be unfalsifiable. There is none.
• No count without its unit and the date it was measured. Sources, files, facilities, procedures and prices are different things counted in different ways. A count that names neither what it counts nor when it was taken is not a fact.