Needs Improvement
Recently, we had used the BCBSBC cost estimator tool to get estimated cost. When we got the medical bills, the given estimated cost was 1/3 of actual cost. Lot of cost components part of treatment are not included in it. I think there needs to be more transparency for consumers to have accurate information.
After discussing and talking to a CSR why so much difference, it was told me that it's an average cost. Isn't it is misleading ?
Our Provider facility, did wrong diagnosis on our treament plan that is another reason for cost. Why we had to end up paying the huge bills ?
Espically being on HSA plan at end of year since it could make a huge difference 10% versus 100% of the bill ? Also, it does cost BCBSNC atleast 25% higher cost even I had to pay 10%.
What could be done on the above cost issus when consumer like us are just end up paying bills with no control over cost/bills ?
Hi Ginni – thanks for using the cost estimator tool and letting us know your thoughts. The costs in the tools are averages based on claims data. While the tool can give you an idea of your costs, it’s not a guarantee of that price. Your situation may be more or less expensive depending on the terms of your specific plan, exclusions/limitations and any conditions that apply to your coverage. Unfortunately the tool cannot take into consideration complications that may arise or, in your case, a change in diagnosis that very likely affected the treatment that was ultimately provided.
What this tool does do is help customers see that a given facility may generally be more or less expensive than another for a particular procedure. We hope that information helps our customers make more informed decisions about where to receive care.
So Ms. Menendez, what you are telling Ginni is that if she uses the cost estimator which insinuates that she will get treatment at a facility that has a cost several thousand dollars lower than others, and she chooses it even though it may be much more inconvenient to get to, and her doctor might not even be allowed to practice there, and then gets a bill that is thousands of dollars more than the estimator indicated, it's just "TOUGH"? Really?
And this site is about talking about the problems with medical and insurance bills/costs/issues? How about the issue of having a cost estimator that doesn't disclose that any estimate you get is BS? I think that if you put in the parameters of your search for a facility based on what you know, given any extraordinary problems during a surgery, then BC/BS should be bound by that estimate % - the % that it is lower than the others on the site should be discounted for all of the procedures that the person has done as a result of their stay and rehab. There should be a part of the estimator page that the person can "submit" that allows them to send the estimate to their patient page showing they've looked at choices and are choosing this one based on the fact that it's saving them and the insurance company money.
Ginni deserves a refund from BC/BS.
Hello Deborah, I’d like to reiterate that our cost estimator tool gives an estimated charge for a particular procedure based on claims data we have for hospitals in our networks. In the end, it is the physicians who work at these facilities who determine what care a patient ultimately needs. Claims are paid based on the services that were actually provided, and our customers pay a portion of those charges based on their plan design.
That said, we are working to offer more “flat fee” arrangements like the one we outline here on Let’s Talk Cost. In these arrangements, the patient receives a guaranteed price up front, and any complications that result are the responsibility of the physician and hospital who treat the patient. This is an unconventional model, but it’s one that we believe in because it provides a financial incentive to reduce complications and improve quality. That’s why we are leading the industry in making it available to our customers.
Hi Ginni and Deborah, as you have seen the answers you received are the same NCBC BS answere customers received from customer service ten, fifteen years ago. Nothing has progressed , just the electronics to tell the same story. WOW-- So comforting. Good luck . Don't hold your breath.
I want to comment on cost of medication. BCBS has one of the highest co-pays on medications in NC. My place of employment charges $2.00 for generics, Wal-mart charges $4.00. BCBS NC $12.00 minimum copay. It's cheaper for me to say I have no insurance and get my meds at Wal-mart. So why so I pay BCBS a fortune each month, I should be getting generics at a similar cost $2 to $4, no $12 plus, plus, plus. Um, speaking of containing costs, um.......
Hi Susan, you bring up a good point, and we’ve seen this question from others here on Let’s Talk Cost. In general, we process claims based on our negotiated contract with the pharmacy but also take into account the pharmacy’s usual and customary price. In the instances when our negotiated amount is higher than the price the pharmacy normally charges you are charged the lower amount. Our standard copay is around $10 for all generics, in your case Susan, $12. The $4 generic costs you hear advertised at Walmart does not include all generics, only a specific list of medications. This is fine print that I encourage our members to watch out for to ensure that they are indeed getting their medications at the price they expect to pay.
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