Understanding Costs

A guide to understanding costs for common medical procedures

Nov 6, 2018 | 3 min

Health plans play an important role in managing the cost of care in the American healthcare system. We know we’re often seen as the bad guys. But our goal is to help our customers get the most appropriate care at fair prices.

We negotiate prices on your behalf. We also have medical experts on staff. They work with doctors and hospitals to make sure you:

  • get the care you need
  • avoid treatment that is ineffective or unnecessary,
  • and have a smooth and easy experience.

You play a role too. That’s why it’s important to understand some of the factors that affect the costs of your care. We want you to be able to find and compare costs for common medical procedures, so you can make informed choices.

Why costs vary

Costs vary by location and facility. For example, outpatient surgery and imaging centers often charge less for the same procedures than hospitals. Prices in rural areas are usually higher than in urban areas, where you’ll also have more choices among providers.

What you pay also depends on what type of health plan you have. Do you have a high-deductible plan with a health savings account (HSA)? You’ll pay more up front for your care, until you hit your deductible. Then you’ll share costs with your health plan until you hit your out-of-pocket maximum.

What’s important to know is that the cost for the same procedure can vary widely, even in the same area. And unlike in retail shopping, higher prices don’t necessarily mean better quality or a better experience.

What price and quality have in common

Traditionally, health plans paid doctors and hospitals a fee for each service they provided. This fee-for-service model tended to inflate prices. It also led to unnecessary tests and procedures because there was a financial incentive to perform more services.

Now most of the contracts Premera negotiates with providers pay them based on outcomes. These value-based contracts include incentives to coordinate your care. This means you get:

  • lower prices
  • fewer complications
  • and a better experience.

How can you find out where to get this kind of care? Premera recognizes high-quality providers in several ways. Look for awards and distinctions when you search using the Find Care tool on premera.com. Blue Distinction, for example, is awarded by the Blue Cross and Blue Shield companies to medical facilities that have demonstrated expertise in delivering high-quality, safe medical care.

Why it matters

Healthcare costs add up to higher monthly premiums. So even if it doesn’t cost you more out of pocket, a more expensive surgery could lead to higher bills in the long run.

Premera is working with the people who provide your care to negotiate fair prices. But as long as a range of prices exist, your choices help determine overall costs. Understanding the prices for common procedures can help you make choices that are more informed. The best time to do this is when it’s not an emergency and you have time to plan for services you need.

How to find costs for common procedures


Compare Procedure Costs

Log in to your Premera account to use our cost estimator tool .Sign into your account

For Premera customers, the clearest way to estimate what you will pay based on your plan is to use our cost estimator tool. You can also compare costs for different providers. Go to the Premera provider directory and sign into your account to get started.

Simply type the name of the procedure or service you need into the search bar. The tool will default to your current location. You can change the location to match the area where you’re planning to get care or search for a wider area to see more options.

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