Decision Support Tools
Tips for consumers
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.
The health care system can be confusing at times. Here are some tips to help you take control of your health care needs:
- Before visiting a doctor, check to see if they are part of your BCBSNC health plan's network:
- Search BCBSNC's online provider directory
- Search BCBSNC's paper provider directory
- Call Customer Service
- Ask your provider if he/she participates with BCBSNC
- Make sure you understand the type of coverage you have, including what services are not covered and costs such as:
- Co-pays
- Coinsurance
- Deductible
- Out-of-network responsibilities
- Referrals or authorizations required
- Maintain a record of your medical visits, hospital stays, drug prescriptions and procedures.
- Save hospital or doctor's encounter sheet, statement of charges or "superbill" typically provided on request at hospital discharge or when leaving a doctor's office visit
- Retain your explanation of benefits (EOB) typically distributed by your health plan
- Keep provider's itemized bill
- Research your health condition before or soon after your doctor visit
- Visit bcbsnc.com
- Call a nurse advice line (Health Line Blue)
- Review doctor, hospital or other health care provider's Web site or educational resource center
- Try your local public library
- Compare online health care information
- Consult national health care associations (American Heart Association, American Lung Association, etc)
- Ask your provider for alternative treatment options. Many treatments have alternatives that may produce similar outcomes in appropriate patients.
- Can my minor surgery be performed in the doctor's office?
- Do I have to go to the hospital to have a mammogram?
- Can I have my surgery performed at the hospital outpatient surgery center rather than being admitted to the hospital?
Who's who in the health care system
The chart below is designed to outline the relationship between the key participants in the health care delivery system:
| Participant | Description/Role |
| Member/Patient | Person seeking medical care from hospitals, doctors, health care providers and health care suppliers. |
| Provider | A hospital, non-hospital facility, doctor, pharmacy or other health care provider, accredited, licensed or certified where required, in the state of practice, performing within the scope of license or certification. |
| Benefit Contract Holder (Employer/Individual) | Employers or individuals who purchase health care coverage from a health insurance carrier. The employer or individual pays a premium to the health insurance carrier for coverage. |
| Health Insurance Carrier (payer) | Any organization that pays for health care services - including insurance companies, third party administrators (TPAs) and various government programs such as Medicare and Medicaid. Typically, payers negotiate discounted rates for health care services and pays participating providers for services based on negotiated rates and member benefits. |
Key points
- Employers or individuals pay premiums to health insurance carriers for health care coverage, and health insurers pay their members' health care expenses in accordance with the members' benefits.
- Health insurance carriers typically negotiate discounts with providers on behalf of their members.
- In-network providers agree to accept discounted rates for covered services provided to insured members
The following chart is designed to provide an overview of the types of health care providers, such as doctors, hospitals, and pharmacies that a member could utilize. This listing is not intended to be a complete listing of all provider types, but is designed to assist you in better understanding the components of the health care delivery system.
If you have received services from several different providers and provider types, you can expect to receive a separate bill from each provider.
| Provider Category | Types of Providers | Examples |
| Professional | Doctors | Primary care medical doctors:
|
| Non-doctor providers |
|
|
| Other professional providers |
|
|
| Facility | Facility where care is received | Hospitals (inpatient and outpatient)
Ambulatory surgery centers Birthing Centers Treatment Centers
|