When you buy a new car, computer or refrigerator, you probably do some research first to better understand the price and quality options so you get the best value for your money.
Until recently, you couldn't do this sort of research for a medical procedure, such as knee surgery or an MRI. At Premera, we've improved the Find a Doctor tool to make it easier to get information about the cost and quality of many medical procedures from doctors, hospitals or other healthcare provider in our network.
Since you share in the costs you pay for healthcare procedures and services with Premera, this kind of information can help you spend your money wisely.
Let's say you need knee surgery to repair a torn anterior cruciate ligament (ACL). To show how the new features work, let's go “shopping” for an ACL repair:
What will it cost?
Log in to your account at premera.com, click on Find a Doctor and then on Search for Healthcare Provider. The costs are only accessible when you're logged into your account. This syncs the tool with your health plan to give you a personalized cost estimate based on current health plan's claims and the status of your deductible.
The costs you'll see in Find a Doctor are not exact prices, but estimates based on the discounted rates we've negotiated with the providers in our network. So you'll get a good idea of what you can expect to pay with a specific provider, which can help you choose a provider or budget for a future surgery, procedure or other service. Keep in mind though that these prices are for a “typical” procedure or treatment; the cost could be higher if your case is more complex or if complications occur.
Once you're logged in, you're ready to “Find a cost.”
First, enter the following information:
- Name of doctor, hospital or procedure
- Your city or ZIP code
This will list providers in your network and area who perform this procedure, along with estimated costs for each provider.
With “ACL (anterior cruciate ligament) Repair by Arthroscopy” as our example, you'll receive a range of prices, from lowest to highest, that you can expect to pay based on your plan's coverage and the amount remaining to meet your deductible.
The prices within this range are broken out for each provider, respectively.
By clicking on a specific provider's name, you'll get a breakdown of the cost, such as:
- Total cost of the procedure
- What you can expect to pay
- What Premera will pay
You'll also see how much of your expected cost will go towards your deductible and the amount that represents your share of the cost (or “coinsurance”) as called for by your plan's coverage.
What about the provider's qualifications?
Of course, when you buy anything, especially a medical service, you also want to know about the person or facility providing it. So we added reviews and ratings from patients, and professional awards and recognitions received by providers and facilities:
- Awards and recognitions, including “Blue Distinction.” This is awarded by the Blue Cross and Blue Shield companies to medical facilities that have demonstrated expertise in delivering high quality, safe medical care.
- Patient ratings and reviews of doctors and hospitals are based on a survey of a random sample of patients taken within 48 hours to six weeks after being discharged from a hospital.
- Quality scores are assigned by the Centers for Medicare and Medicaid Services (CMS) to hospitals based on how they meet performance standards set by CMS.
Getting a procedure from an out-of-network provider?
Should you choose a provider who's not in your plan's network, you may use our in-network prices as a starting point for negotiating with an out-of-network provider. However we recommend using an in-network provider to receive the highest level of coverage from your Premera health plan, including our discounted in-network prices.