Our Individual, group and administrative services only (ASO) members can access estimates for certain medical procedures and services using the Cost estimator tool on our secure member website. The tool is integrated into our Find a doctor tool, helping members understand their treatment options so they can make more informed health care decisions in partnership with their providers.
The Cost estimator gives our members regional averages and provider-specific costs at the:
- Service level (a single procedure)
- Treatment level (diagnosis through episode completion)
- Encounter level (services from check-in through check-out for a visit or stay)
Members can search by more than 800 common treatments, procedures and services, including:
- Office visits
- Diagnostic labs
- Physical therapy
- Well-baby check-ups
- Immunizations and vaccines
- Pregnancy services (delivery)
- Imaging services, including MRIs, X-rays, etc.
The tool allows members to compare options based on the estimated average cost and treatment timeline. Members search for cost estimates within their selected geographic area. Cost results are based on average estimates from a 12-24-month period and are tied to the member's specific benefit plan. The Cost estimator includes provider quality information and reviews to help our members select a provider that is right for them.
The cost estimate incorporates the member's:
- Preventive care benefits
- Out-of-pocket maximums
- Accumulators (the amount of deductible met by processed claims)
- Cost share information (including coinsurance, visit limitations, upfront benefits and/or copayments)
Cost estimator results are limited to in-network providers. The results are average costs from Preferred network claims received with a 12-to 24-month timeframe. If a service is not a general benefit offered in all of our plans (e.g., chiropractic, massage therapy, acupuncture, mental health, or bariatric services), they are not included in the search tool. Therefore, your facility, practice or some of the services you offer may not be included in the results. Members can review their benefit information within their authenticated account or by contacting Customer Service.