TruePrice™ Care

Every negotiated rate is published.The files are unreadable.

Since 2026 every insurance company publishes every negotiated rate. Every hospital publishes its cash prices. I read all of it.

Upload your claims file

I hold every price. Your employee is shown the best four.

17.5 million rows. One insurance company spelled 163 ways. Every hospital in its own format.

I have no contract with any facility. No facility pays to appear. Every price is ranked on cost, quality grade and distance. Your employee sees the best four, and the rest are one tap away.

17,563,803published prices
67hospital price files read
307international hospitals
—providers, counting
—procedure codes, counting

Counted in my own database on 5 October 2026. Texas first; the other 49 states follow.

What your employee can look up:

Any doctor in their network Any hospital or surgery center Imaging centers and labs Every bundled cash price Medical tourism, accredited hospitals What their own plan pays

In network, they get the rate their plan agreed. Out of network, they get a price if the facility publishes one. If nothing is published, Ruth says so, and says the search is still running. Ruth never shows an average.

The same knee replacement, priced across Texas.

Every figure below is a real published rate for one operation. Watch Ruth sort them.

69published rates for one knee replacement, $8,006 to $68,667

69 published rates for CPT 27447 in Texas, counted in my own database. The four shown are Austin prices on 2 October 2026.

With TruePrice, your employees get:

Every option, not a short list17.5 million published rates, read facility by facility. No contract with any of them, so none of them paid to be on the list.

The price before the appointmentRuth reads the order the doctor wrote and prices it at every facility open to that member. One message, English or Spanish, any hour.

$0 at the vetted facilityWaive the deductible on the better price. Your employee pays nothing. The plan pays $9,692 instead of $28,733 for the same knee.

A grade on every facilityBuilt from infection rates, readmissions inside 30 days, how many of that operation the facility does a year, and the state inspection record.

How a price reaches your employee.

Four stages, every time, for every procedure a doctor orders.

Read
  • Every insurance company file
  • Every hospital price file
  • 163 spellings resolved to one company
Clean
  • Percentages and per-diems dropped
  • Stale rows dropped
  • A doctor’s fee never counted as a facility price
Rank
  • Price, quality grade, distance
  • Their own city first
  • Then driving distance, state, country
Send
  • Four options to the member
  • Booked on the one they pick
  • The bill checked against the price

What Ruth does for a member.

Six things Ruth does without being asked. Open one to read the steps.

Prices the order before the visit
  1. Ruth reads the order the doctor wrote, from the member’s own records.
  2. Ruth prices that order at every facility open to that member.
  3. Ruth sends the options in one message, English or Spanish, at any hour.
  4. The member picks. Ruth books the one the member picked.

“I priced this for you. Your doctor sent you to the hospital. Under your plan that is $2,847. an imaging center nearby is $890. Cash at an independent imaging center is $280. Your share goes from $1,900 to $890.”

Books the ride and the ride home
  1. Ruth books the car to the surgery center for the morning of the operation.
  2. Ruth tells the member the driver’s arrival time the night before.
  3. Ruth books the car home, because a member who has had anesthesia cannot drive.

A bundled surgery center is often in the next suburb. Distance is the reason a member books the hospital after seeing both prices.

Prices the refill and has it delivered
  1. Ruth reads the last dispense record and works out the date the member runs out.
  2. Ruth prices the refill at every pharmacy near the member.
  3. Ruth orders the cheaper box and has it delivered before that date.
Lisinopril, cheaper pharmacy
$4
Lisinopril, pharmacy three miles away
$48

A member who is out of tablets buys the $48 box, because the $48 box is on the way home.

Checks a new drug against the others
  1. A new medication appears in the member’s record.
  2. Ruth checks that medication against every other medication the member takes.
  3. Ruth reports the result: “Checked against your other 3 medications: no interactions.”

A first sleep-medication fill in six months gets a check-in offering the plan’s virtual visit. That check-in reaches the member alone and never appears in your reporting.

Reads the bill and disputes the difference
  1. The member photographs the bill.
  2. Ruth compares every line against the price the facility published and the rate the plan agreed.
  3. Ruth names any line that does not match.
  4. Ruth files the dispute and follows it to an answer.
Answers at 11 pm, in English or Spanish
  1. What a doctor’s note means, in plain words.
  2. What a procedure costs on that member’s own plan.
  3. Where to go tonight: a virtual visit, urgent care, or the emergency room for chest pain.

Every choice Ruth offers is a button the member taps. Typing is for a question Ruth has not asked.

Twenty-five reports on your own claims file.

Pick one to see what it answers.

Sample

What it does

Bundled cash pricing

Bundled cash pricing

One price for the operation, paid before the date, with the surgeon inside it.

A bundled price covers the whole operation. an orthopedics facility in Austin does a knee replacement for $21,500. That buys the operating room, the surgeon, the anesthesia, the implant and the follow-up visits. Your plan pays $28,733 at the hospital for the same operation, in pieces, over a year.

Why the cash price is lower than the negotiated rate

  1. A cash facility never chases the money. One payment, agreed before the date. No claim to code, submit, appeal or collect. That is the main reason the price is lower.
  2. A billed claim pays for the people who bill it. US hospitals spent $43 billion on billing and collections in 2025. Collecting a dollar costs 2 to 4 cents.
  3. Insurers denied 11.6% of hospital claims in 2025. Providers spent $18 billion overturning denials, and a denied claim restarts the wait for payment.
  4. Overhead is the second reason. A surgery center runs operating rooms. A hospital also runs an emergency room and beds upstairs, staffed around the clock.

How a hospital bills the same operation

  1. The hospital bills for the operating room.
  2. The surgeon bills separately.
  3. The anesthesiologist bills separately again.
  4. Three bills reach your employee over four months.
Independent surgery and imaging centers

Independent surgery and imaging centers

The same scan, a quarter of the price, days instead of weeks.

An imaging center or surgery center owned outside a hospital system does scheduled outpatient work only. No emergency room, no beds upstairs, no facility fee on the bill. A knee MRI is $285 at an independent imaging center against $2,847 at the hospital.

Knee MRI, the hospital, your plan’s rate
$2,847
Knee MRI, an independent imaging center, cash
$285
Chest x-ray, cash
$45

Outcomes against a hospital

Readmission after a hip replacement, 30 days
1.0% surgery center, 1.8% hospital outpatient, 3.4% hospital
At 90 days
1.7% against 5.5% at the hospital
Ankle replacement, reoperations
3.6% outpatient against 5.5% inpatient
Discharged the same day
99.6%, with 0.45% needing a hospital bed

Michigan Arthroplasty Registry Collaborative Quality Initiative, 2025; outpatient ankle replacement meta-analysis, 2024.

Two things cut against that, and you should hear them here rather than from a broker. For joint replacement, those same registries find infection rates about equal at a surgery center and a hospital outpatient department. And a surgery center picks healthier patients for same-day surgery, which explains part of the readmission gap. The case rests on readmissions, reoperations, same-day discharge and the price.

Medical tourism

Medical tourism

The same operation, for a fifth of the price.

A knee replacement is $28,733 at the hospital in Austin. an accredited hospital abroad does the same operation for $3,621, all in, and has done 2,000 robotic joint replacements.

The surgeon is usually American or English trained. One accredited hospital abroad has 210 doctors holding American board certification. Another accredited hospital abroad was founded by a surgeon who operated in New York for twenty years and does 10,000 cardiac procedures a year.

They go for the price. Then they find out they can get a date in two weeks instead of four months.

The hospital books the hotel, sends a car to the airport and gives the member a coordinator who speaks English. A companion travels with them. Recovery is two weeks in Spain or India or Turkey instead of two weeks in their living room. Flights, hotel, surgery and follow-up together still cost the plan less than the hospital down the road charges for the operation alone.

What I show and what I do not

  1. Only hospitals holding JCI accreditation, the overseas arm of the body that accredits American hospitals. 400 hospitals across 80 countries hold it.
  2. JCI accredits the hospital, not the surgeon, so every card names the surgeon’s training and board certification.
  3. Nobody is sent. The option sits beside the other three and the member chooses.
1.4 millionAmericans went abroad for care last year, against 750,000 in 2007
44%of large employers offer this benefit or plan to
$20,000–$30,000reported saving on one hip or knee
400JCI-accredited hospitals, across 80 countries

My international prices are estimates from published package prices until the hospital confirms them, and every card says so.

The PPO markup

The PPO markup

Your plan’s negotiated rate is often higher than the same hospital’s cash price.

How to measure the markup on your own plan

  1. Take one procedure your members had last year.
  2. Read the rate your plan agreed with that hospital, out of the hospital’s published file.
  3. Read the cash price the same hospital publishes for the same procedure, in the same file.
  4. Subtract. The difference is what the discount was worth.

How a negotiated rate is set

  1. A hospital or a doctor agrees a discount with an insurance company and takes the lower rate in exchange for volume. That is the trade, and that is the facility’s own case for it.
  2. The rate is agreed facility by facility, so two facilities in one network hold two different rates for the same scan.
  3. A hospital system that owns most of the beds in a city sets the rate it wants.
  4. Your employee is never shown either number before the appointment.
The deductible waiver

The deductible waiver

Your employee pays $0 at the better facility, and the deductible never moves.

An employee on a high-deductible plan pays the first $3,000 either way. The building makes no difference to them. Waiving the deductible on the better price is what changes the decision.

How the waiver runs

  1. You switch the waiver on for the vetted lower-price options. One setting in your dashboard.
  2. Ruth marks which options carry the waiver when the prices go out.
  3. Your employee books a vetted option and pays nothing.
  4. Your employee books the hospital instead, and the deductible applies as before.
Employee at an independent surgery center nearby
$0
Plan pays
$9,692
Plan pays at the hospital
$28,733
Claims forecast

Claims forecast

Next year’s claims, scored from your own file and tested against real ones.

What the forecast is built from

  1. The conditions already in your claims file.
  2. Refills your members have stopped collecting.
  3. Follow-up scans a doctor ordered and nobody booked.
  4. Emergency visits a clinic could have handled.
Tested against
Two real de-identified national panels
12-month projection landed within
2.9% and 8.9% of actual spend
Against “last year repeats”
Beat that forecast on both panels

Every figure carries two lines. What your plan spends without TruePrice, and what your plan spends with Ruth steering members. The second line is 20% lower in the first year. That 20% is my assumption, and every report says so where the figure appears.

What the test does not cover: both panels are national survey populations, not an employer’s claims file. The forecast is proven against real people and not yet against a real plan. Yours would be the first.

CAA fiduciary duty

CAA fiduciary duty

You are required to know what your TPA charges you.

You are a fiduciary of your own health plan. The Consolidated Appropriations Act killed the gag clauses that hid negotiated rates from plan sponsors, and made the sponsor responsible for knowing whether those rates are reasonable. A sponsor who never looked has no answer for a member, and none for a regulator.

How to meet the duty

  1. Send the request letter. Your insurance company owes you 36 months of claims, and the letter is written for you.
  2. Upload the file you get back.
  3. Read what you were charged beside what the same care costs elsewhere.
  4. Keep the dated report. That report is the record that you looked.
Plan design modeling

Plan design modeling

Run a plan change against last year’s real claims before signing it.

  1. Pick the change: the deductible waived on bundled cash procedures, the copay waived for urgent care over the emergency room.
  2. Run the change against your own claims file.
  3. Read what the plan would have spent under the new design, line by line, before you sign.

Start with your own claims file.

Your insurance company owes you 36 months of claims under the CAA. The request letter is written and ready to send. Upload what comes back and every report runs on your own numbers.

Upload your claims file Download the request letter

Upload your claims file

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