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Cost Estimator Frequently Asked Questions

The Cost Estimator is your secret weapon against rising healthcare costs. Use the Cost Estimator to estimate and compare your medical costs. You can also get a better idea of what costs to expect and learn more about treatments for common medical conditions.

Please note: The information on this site is intended to help you estimate costs and is not meant to be a price guarantee for the estimates you receive.

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Using the Cost Estimator

Answer: The Cost Estimator provides you with estimated costs for specific treatments and procedures. You can discuss this information with your doctor or use it to help choose a provider.

Answer: Type the name of the treatment, condition or procedure in the search box or browse by medical condition. The guided search lets you choose related results based on your search criteria. Simply select one of the suggestions to view the cost information.

Answer: No. The information provided by the Cost Estimator will never be used to alter the cost of your treatment or your coverage. Your health privacy is a priority for us, and we comply fully with the Health Information Portability and Accountability Act (HIPAA). You can freely explore health conditions and healthcare choices without affecting your insurance rates or coverage.

Answer: Currently, the Cost Estimator cannot calculate estimated costs for dental-related care. Please contact your dental provider for more information.

Answer: Yes. You can estimate costs for treatments and services by changing your search location. Please note that the results rely on the supporting information available, which may include historical claims information and other information sources to support calculation of an accurate estimate.

Answer: Many factors in addition to cost can impact the types of treatment you select for your diagnosis or condition. Please discuss treatment options with your doctor or other healthcare provider to determine what type of care is best for you. It may help to bring your cost estimate and a list of questions about your treatment options when you go.

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Understanding Estimates

Answer: You can save both money and time on your healthcare costs when you talk with your doctor and compare options before deciding where to go for treatment. The Cost Estimator can also help you find estimated costs and ways to save on different components of a treatment, such as: MRIs, tests, therapy services, X-rays and other services.

Answer: Several factors are used to calculate your out-of-pocket estimate. These include:

  • The rate your plan has agreed to pay your selected provider or facility.
  • Your plan’s specific benefits (copay, coinsurance, up-front benefits, etc.)
  • Credits you have earned (accumulated) that count toward your deductibles and out-of-pocket

Answer: The Cost Estimator can provide you with:

  • Cost and location options for:
    • medical treatments (including evaluation, surgery and follow-up)
    • outpatient procedures and immunizations
    • services related to treatments, like CT scans or physical therapy
  • Savings alerts that let you know when you might be able to save money on a treatment or service
  • User-friendly explanations and definitions of medical conditions and treatment names

Answer: We selected health conditions, treatments and services based on several factors. These include what members search for most often, what conditions and treatments are most common, where members spend most of their healthcare dollars, and when members will have an opportunity to save money and time.

Answer: The total cost estimate is the cost for treatments and services before your plan benefits are applied. The estimated amount covered by your plan is also displayed, as well as your total out-of-pocket cost for treatments and services.

Answer: No. The Cost Estimator is for informational purposes only. It is intended to help you understand what to expect during a treatment and to spark conversations with your doctor.

The information here or on any linked sites is not a substitute for the medical advice of your doctor or other healthcare provider. It may be helpful to use this information combined with other research in discussions with healthcare professionals to make decisions that offer the best possible results and lowest costs. We endorse guidelines developed by health experts at federal agencies such as the Centers for Disease Control and the U.S. Department of Health and Human Services. Your doctor may use these guidelines to plan your general wellness care and other types of treatment.

Answer: Yes! This tool is designed to encourage conversation between patients and providers. Please talk to your doctor or other healthcare provider about what type of care is best for you. You may want to print your cost estimate and bring a list of questions about treatment options and their costs with you. If you have medical or health-related questions, contact your healthcare provider. Let your provider know your plans before you take any medicine, change any medicine or stop any treatment. If you think you may have a medical emergency, immediately call 911.

Answer: Your estimate includes costs for a specific group of procedures and services you are likely to receive at a facility over the course of your treatment. If you receive any additional care during the treatment, procedure or service, there will be additional medical expenses. Depending on your plan, you may be responsible for paying some or all those additional costs.

Answer: Our estimates include all the usual charges related to medical costs. These estimates are for informational purposes only. The estimated cost for professional services could include costs such as anesthesia, medical supplies, operating room use or pathology evaluation. You may receive separate bills for these charges.

Answer: In order to provide cost estimates, we looked at the costs for services, tests, visits and prescription drugs most commonly used in treatments and then developed averages and frequencies for each. We also used our understanding of the healthcare system and population health to develop the total payments for treatments and services.

Please note: The actual cost for treatment will depend on what your doctor or other healthcare provider recommends or prescribes for your healthcare needs. If you have Medicare, you may be charged less for treatment.

Answer: You can save both money and time on your healthcare costs when you talk with your doctor and compare options before deciding where to go for treatment. The Cost Estimator can also help you find estimated costs and ways to save on different components of a treatment, such as: MRIs, tests, therapy services, X-rays and other services.

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Troubleshooting

Answer: Please contact the customer service number on the back of your ID card for additional assistance. We may not have information about the treatment you're searching for yet.

Answer: If you can’t get an out-of-pocket estimate, it may be because of one of the following:

  • You don’t have coverage under the plan for the treatments and services you selected.
  • An issue with your benefits information prevents us from calculating your estimate.
  • A technical issue prevents us from calculating your estimate.
  • In some cases, cost estimates cannot be provided if you have a supplemental Medicare insurance plan.
  • The treatment or service is not in our Cost Estimator.

Answer: For questions about using the tool, contact the customer service number on the back of your member ID card.

Answer: There are several variables that can impact your total cost for treatment and services. The information on this site is meant to help you estimate costs. There is no price guarantee for the estimates you find using this tool.

Answer: We may not have enough recent historical information from other member claims to accurately estimate the cost for a particular service for a specific provider.

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Providers and Facilities

Answer: The costs are based on in-network PPO or HMO rates. Using facilities or providers who are not in your plan’s network will likely be more expensive.

Answer: Yes, selecting an alternate facility such as an out-patient surgery center instead of a hospital can often reduce your treatment costs.

Answer: The Cost Estimator is not a substitute for medical advice. Please discuss your treatment options with your doctor or other healthcare provider. Depending on your medical history, one facility may be more appropriate for you than another. If you experience complications during or after a procedure performed in a surgery or birthing center, your doctor may require you to receive additional care in a hospital setting.

The Cost Estimator provides treatment cost options for the following places of service:

Inpatient Hospitals are licensed or formally approved hospitals. They offer round-the-clock healthcare services to patients who require overnight hospital stays. Inpatient hospital accreditation programs include the Joint Commission, the National Integrated Accreditation for Healthcare Organizations (NIAHOSM) program and the Community Health Accreditation Program (CHAP).

Outpatient Hospitals are run by licensed or formally approved hospitals. Like surgery centers, they offer a wide variety of services to patients who do not require overnight hospital stays. Outpatient hospital accreditation programs include the Joint Commission, the National Integrated Accreditation for Healthcare Organizations (NIAHOSM) program and the Community Health Accreditation Program (CHAP).

Surgery Centers may be run by doctors and/or large healthcare companies. They offer a wide variety of medical procedures to patients who do not require overnight medical care. Accreditation programs include the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), Accreditation Association for Ambulatory Health Care (Accreditation Association or AAAHC) and the Joint Commission.

Answer: No, the options presented in the Cost Estimator are for informational purposes only and are designed to spark more informed conversations between you and your doctor. Your doctor or other healthcare provider will create a personalized healthcare plan for you.

Answer: A provider may choose to limit their practice even if they commonly perform some services and procedures. Please contact the provider to find out whether they offer the service or procedure you want.

Answer: You may call the customer service number on the back of your member ID card to find out whether you need a referral. You can also talk to customer service about whether you need to be pre-approved for treatment, or whether there are any limits or exclusions for your treatment. While you may not need a referral, you should speak to your doctor about any questions you have about his/her recommendation.

Answer: When a doctor or provider is affiliated with a facility it means they can practice at that location. They may be employed by a facility or simply have an agreement that allows them to perform some or all procedures at that location (i.e., admitting privileges).

Please note: A provider may be affiliated with a facility, but not necessarily have admitting privileges at that facility. If you need in-patient care, ask your provider to explain his or her admitting privileges to you.

Answer: Your estimate includes costs for a specific group of procedures and services you are likely to receive at a facility over the course of your treatment. If you receive any additional care during the treatment, procedure or service, there will be additional medical expenses. Depending on your plan, you may be responsible for paying some or all those additional costs.

Answer: Our estimates include all the usual charges related to medical costs. These estimates are for informational purposes only. The estimated cost for professional services could include costs such as anesthesia, medical supplies, operating room use or pathology evaluation. You may receive separate bills for these charges.

Answer: In order to provide cost estimates, we looked at the costs for services, tests, visits and prescription drugs most commonly used in treatments and then developed averages and frequencies for each. We also used our understanding of the healthcare system and population health to develop the total payments for treatments and services.

Please note: The actual cost for treatment will depend on what your doctor or other healthcare provider recommends or prescribes for your healthcare needs. If you have Medicare, you may be charged less for treatment.

Answer: You can save both money and time on your healthcare costs when you talk with your doctor and compare options before deciding where to go for treatment. The Cost Estimator can also help you find estimated costs and ways to save on different components of a treatment, such as: MRIs, tests, therapy services, X-rays and other services.

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