Your Care and Costs

  • PharmacistOne of the first concerns after getting a life-changing diagnosis might be, “can I afford this?” We want to help alleviate this concern, so you can focus on your health.

    Cost of care

    Naturally, you want the top-quality care and cost is one factor many people worry about. We want you to be able to make informed decision about your options for treatment.

    Many people fear the cost of treatment will become unaffordable. Treatment options and drugs continue to evolve, but not all new treatment options provide better outcomes or longer life expectancy. On the contrary, some new treatments are more expensive and more expensive doesn't necessarily increase cure rates or provide a higher quality of life.

    To help ensure our customers get the most effective care and manage costs, we require preapproval for certain drugs and services that are costly and have limited data about effectiveness. Premera employs physicians, pharmacists and nurses who stay up to date on evidence-based treatments. They look at cost and outcome. 

    Be sure your providers are in-network. They will work with Premera to get approval on your behalf.

    Blue Distinction

    If your top priority is finding safe, effective treatment, we have something in common! Blue Distinction recognizes hospitals and other facilities that meet the Blue Cross Blue Shield Association standards for delivering exceptional care and results. These providers offer treatment for rare or complex conditions, and are known for providing high-quality and cost-effective care.

    Definitions

    Some definitions, just to make sure we're all on the same page.

    Deductible is the amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself.

    Coinsurance is the percentage of healthcare costs you're responsible for. First you'll pay your insurance, then you and Premera will split the cost of care until you've reached out-of-pocket maximum.

    Copay is similar to coinsurance, but it's a fixed amount you pay at the time of service rather than a percentage of the cost.

    Out-of-pocket maximum is the most amount of money you pay toward the cost of healthcare in one plan year with the exception of your monthly premium.

    That means, if all the costs you incur are covered and received with in-network providers, you meet deductible, then coinsurance, then Premera will pay 100 percent of your eligible expenses. The out-of-pocket max varies by plan. Sign into your online account for your specific numbers.

    Allowed amount is the amount our network providers have agreed to accept as full payment for covered healthcare services and supplies.

    More healthcare definitions

    Note: Benefits under your health plan may differ, so refer to your benefit booklet for information on what your specific plan covers. This is general information about benefits and coverage; actual benefits depend on your benefit plan and eligibility on the date of service.


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