Market Actor for Reform
FAIR Health
Independent Nonprofit · Cost Data · Appeals Evidence
What They Built
FAIR Health is an independent nonprofit that built a transparent cost estimator for healthcare procedures. Their tool shows what a procedure actually costs in a given ZIP code — based on real claims data — so patients can compare that against what an insurer says it will pay.
Their data gets used as evidence in insurance appeals. When an insurer says a procedure is "not medically necessary" or prices reimbursement at an unreasonably low rate, FAIR Health data provides the external benchmark that can challenge it.
The structural argument: pricing opacity is a feature of the system, not a bug. FAIR Health produces transparency by building an independent database that neither hospitals nor insurers control.
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