How are Sidecar Health Benefit Amounts set?
A Benefit Amount is the fixed amount Sidecar Health plans pay for a covered, medically necessary service.
Sidecar Health calculates the cash price for all procedures, tests and drugs using multiple data points to determine how much procedures should cost.
The Benefit Amount for each covered, medically necessary service is approximately equal to the average amount a healthcare provider would accept as a cash payment for a given service in the local area.
We determine this amount by using multiple data points including, but not limited to: local market data, published government fee schedules, available provider information and anonymized Sidecar Health transactions.