Through insurance
- Provider bills your plan's negotiated rate.
- A claim for the service is submitted to the plan.
- Before deductible, you often pay the negotiated rate yourself.
MRI lumbar spinenegotiated rate varies
Indiana law · plans entered into or renewed after June 30, 2025
Pay the provider directly. It may still count toward your deductible.
Nearly 64% of Hoosier employees are in high-deductible plans. For routine care, the direct cash price is often the lower bill, and under IC 27-1-48.5, a direct cash, card, HSA, or FSA payment can still count toward your deductible if it qualifies.
Four conditions must hold: you pay the provider directly; the service is covered and medically necessary; a claim for the service is not submitted to your health plan; and the amount is below the average discounted rate. Indiana law lets you use All Payer Claims Database information to determine that rate. Confirm the plan's process in writing.
The law applies once your plan year renews after June 30, 2025. Check your plan-year start date if unsure.
Public evidence in, clearer questions out.
KnownCost helps an Indiana patient identify the exact service, compare public cash-price evidence, open the official APCD comparison, and gather a packet for the plan. It does not determine eligibility or submit a claim.
64%of Indiana employees are on a high-deductible plan, among the highest in the U.S.IU Fairbanks / IBHC →
$1,700minimum 2026 HDHP deductible, self-only ($3,400 family), per the IRSIRS Rev. Proc. 2025-19 →
+27.2%final average approved rate increase for 2026 Indiana individual Marketplace plans.IDOI Rate Watch →
+22.6%Anthem's approved 2026 rate increase, average premium $576.41.IDOI Rate Watch →
+30%UnitedHealthcare's approved 2026 rate increase, average premium $699.99.IDOI Rate Watch →
The promise is simple. The paperwork is not.
Indiana says a health plan must credit a qualifying direct payment toward the deductible and annual out-of-pocket maximum. The plan still decides whether your service and documents meet the law's conditions.
The difference
You pay the provider, not your insurer.
For small, shoppable care, ask for the direct price before handing over your insurance card. Same procedure, two very different billing paths.
Cash / card / HSA
- You pay the provider's posted cash price.
- A claim for the service is not submitted to your health plan.
- It may still count if the payment qualifies.
MRI lumbar spineget the all-in price in writingconfirm read, facility, contrast, and follow-up fees
Why it matters
Either way, knowing the cash price pays.
You were paying out of pocket anyway. The lower direct price simply means you spend less for the same care.
A qualifying payment counts toward your deductible and out-of-pocket max, so your plan starts paying sooner.
Central Indiana price evidence
Only supported, dated public evidence belongs in the comparison.Use the procedure-first comparison to inspect the source and checked date, then confirm the current all-in price with a written Good Faith Estimate.
Think your payment qualifies? Four steps.
Full filing guide →All four conditions must hold. Cash, card, and HSA/FSA payments may qualify; confirm with your plan in writing.
1
Check the benchmark
Use your plan's average discounted rate or the Indiana APCD information the law lets you use to determine it. Keep the source, and ask your plan to confirm its process in writing.
2
Pay direct
Ask the provider to confirm in writing that a claim for the service will not be submitted to your health plan and your payment is accepted as payment in full, with no later balance bill.
3
Get the superbill
Keep CPT, ICD-10, NPI, TIN, date of service, amount paid, and proof of payment.
4
Ask for the credit
Send the packet to your plan and ask for the deductible and out-of-pocket accumulator update.