Decision Support Tools
About Health Care Cost Estimator
The Health Care Cost Estimator is designed to provide you with the relative costs of services and treatments to help you better understand your health care choices. These costs include the average charges billed by providers for a given service or procedure. By selecting a condition or a service, you can learn about the relative costs and use this information to discuss health care alternatives with your health care provider.
The Health Care Cost Estimator should not replace the advice and/or direction of a health care provider. You should work with your doctor/health care provider to explore all of your treatment options and make an informed decision about your health care. The Health Care Cost Estimator is designed to support that discussion.
- Information to know before using the cost estimator
- Using the Health Care Cost Estimator
- Understanding health care terms
Information to know before using the cost estimator
The following information:
- Should not replace the advice and/or direction of a health care provider.
- You should work with your doctor/health care provider to explore all of your treatment options and make an informed decision about your health care.
- Is not intended to suggest any health care service or treatment approach is necessary/unnecessary or better/worse than any other service or treatment approach.
- Is not intended to report the member, provider or payer actual cost for any specific service or episode of care.
- The costs reported represent the billed charge, or retail price, for services, and do not reflect member benefits or negotiated provider discounts through your health insurance policy.
- Facility and professional billed charges vary from provider to provider.
The length of stay (hospital days) reported is an average. A patient's actual length of stay can vary based on the complexity of the case, as can the length of stay that will be covered by insurance. The information reported does not represent the length of stay that may be recommended by your physician or authorized by BCBSNC.
Episode of care vs. individual service: An episode of care is a series of billed charges from a hospital, doctor or health care provider that represents all of the care received during a physician visit, surgery or inpatient hospital stay. An episode of care is typically made up of charges for many individual services. Total billed charges related to an episode of care can vary based on the different individual services received during an episode of care.
- Example: If one patient is admitted to the hospital for pneumonia and has a chest X-ray while a second patient is also admitted to the hospital for pneumonia, but does not have a chest X-ray, the total billed charges for each member will be different for a similar episode of care.
Using the Health Care Cost Estimator
The Health Care Cost Estimator has four main sections:
- Inpatient hospital admissions:
Shows you average charges and length of stay information for when you are admitted to a hospital. - Outpatient procedures:
Shows you average charges for procedures performed in an outpatient hospital or ambulatory surgery center. - Doctor's visits and services:
Shows you average doctor charges for office visits and specific services that can be performed in a doctor's office. - Place of service cost comparison:
Shows you average charges for specific services that can be performed in different places of service.
Understanding health care terminology
Many terms throughout the tool are linked to glossary definitions. Just mouse over an underlined word and the definition will appear. To view the entire glossary, click on the word.