Price transparency tells members a number. A lock make it hold
Four ways members get a price before care, and what each one commits to
Transparency in Coverage explainer
Plan cost estimators: required for 500 shoppable services since January 1, 2023; a number that binds no one.
Copay-only plan designs: a set price, if the employer adopts a different plan.
Bundled-price programs: a fixed price, at a curated carve-out network for selected procedures.
Hi Neo lock: the member’s own out-of-pocket cost under the plan they already have, held through adjudication while the lock is valid
Why a lock matters
A cost estimate tells a member what their care might cost. A lock is what makes that number hold. On planned, in-network care, a member can choose an in-network hospital and surgeon, schedule ahead, and still get a bill that doesn’t match what they were quoted, because nothing ties the estimate to the claim. Each gap like that can start a chain of contacts: the call before care, the call back to double-check, the call about the surprise bill, and sometimes an appeal. A lock closes the gap. It fixes the member’s out-of-pocket cost under the benefit design the plan already has, then holds it through adjudication, so the price the plan shows is the price the member pays. Members judge their health plan on the bill, not the estimate. A lock gives the plan a way to keep its word on cost, and it sets the plan apart in a way the plan controls.
Where does Hi Neo come in?
Hi Neo sits between the moment a member’s cost is quoted and the moment the claim is paid. Hi Neo uses their real-time deductible and accumulator status to lock their out-of-pocket cost. Before each claim adjudicates, Hi Neo applies the locked amount through the claims platform’s own extension points, so the plan’s adjudication engine and benefit logic aren’t reprogrammed. If a claim doesn’t match what was locked, it goes to review before payment. The plan keeps its benefit design, its network and its claims system through this patent-pending approach.
