Cost Tool Disclaimer
Things You Should Know When Using My Cost Calculator
Whether you're a patient or caregiver, we've made it easier for members to make decisions about health care costs with My Cost Calculator. Use this tool to research estimated cost ranges for various health care services. You can also use the tool to research the differences in the estimated costs of a particular service based on the facility where the services are provided, such as a doctor's office, hospital, imaging center or ambulatory surgery center. We get these estimates from 12 months of Preferred Provider Organization (PPO) health benefit claims data. Your out-of-pocket costs will differ from the estimated costs, based on your specific benefit and coverage information, as well as the specific services you receive.
The information provided by this tool is not a guarantee of coverage, a guarantee of payment or an authorization for a particular service. The estimates provided by this tool are not an exact calculation of your actual costs and do not reflect all of the terms, conditions, limitations and exclusions that may apply to your coverage. Your actual costs will vary depending upon the specifics of your benefit plan and the particular services and supplies you receive.
My Cost Calculator is intended to be a reference tool and is not a substitute for medical decision-making. Your health is an important priority, so do not avoid getting health care based on the cost estimates on this website. Use this information when you talk to your provider or physician, only you and your doctor can decide which medical decision is best for you. Be sure to consult with your own physician about your particular medical condition and discuss treatment and facility options. The information in the tool is not a recommendation or endorsement of any particular health care facility or its services and doesn't guarantee services will be available or will be of any particular quality or cost.
Typical Costs
Costs for the same health care service can vary a great deal by location and health care provider; My Cost Calculator can help you compare what it may cost to have your desired service performed at various facilities and with various health care providers.
The information available within this tool is developed using 12 months of PPO health benefit claims data, and provides members with an estimate of the range of costs for a specific health care service at a specific facility or with a specific provider before your benefits are applied. For example, the typical cost for a knee replacement may range from around $11,000 to $13,000 at one facility, and may range from around $36,000 to $40,000 at another facility. The tool also provides an estimated average cost for the specific health care services at a specific facility or with a specific provider before your benefits are applied, as well as an estimate of your out-of-pocket costs.
The estimated costs reported by the tool represent only the typical costs for services supplied by facilities and professional health care providers that are related to the primary health care service you selected. There may be costs for other services provided in addition to the primary medical treatment that are not reflected in the cost estimate, such as medications, lab tests, x-rays, etc., as well as additional costs for related services received at other facilities. In some cases these additional costs can be high, and you could be responsible for those costs depending on your benefit plan.
The costs displayed are estimates and your actual costs will vary based on:
- The specific services you receive;
- The amount you must pay before your health plan pays anything (deductible);
- Your share of costs (co-payments or co-insurance);
- Your health plan’s rules (such as authorization and pre-certification requirements); and
- Your health plan’s coverage exclusions or limitations.
What's Not Included in the Typical Costs Estimate
Estimates do not take into account certain types of claims and services, such as:
- Medicare claims
- Claims paid after a primary health plan has paid (secondary coverage)
- Costs for services provided in addition to the primary health care service selected, such as medications, lab tests, x-rays, etc.
- Emergency cases
- Claims that include numerous complications
In addition, typical cost estimates for hospitals, facilities, and providers that do not have enough claims information for your selected health care service are excluded from the results.
About Facilities and Providers
The information about the facilities and providers presented in this tool is for reference only and may have changed since this tool was last updated. Be sure to confirm with the facility and provider their address, phone number, specialty, and network participation (in-network) status before making an appointment.
If you find that a particular facility or provider is not listed for a certain type of health care service, it may be that the facility or provider does not participate in the BCBSRI network, that we do not have enough claims information to be able to provide a useful estimate of the cost of the selected health care service at such facility or provider and/or the that the facility or provider does not provide the service.
About Health Care Services
The cost estimates provided by this site represent the cost of care for health care services rendered by facilities and healthcare providers. The cost estimates include facility and professional costs, if applicable. Facility costs can be incurred at various sites, including provider offices, free-standing facilities and acute care hospitals. Professional costs are for services provided by a doctor or other healthcare professional. Cost estimates for provider office visits represent the average costs for multiple types of office visits across a state-wide or broader geographic area than the specific ZIP code used in your search.
Remember, the costs displayed are estimates and your actual cost will vary. Health care services listed in the tool were selected because they are not emergency services and can be performed by a variety of health providers, allowing you to 'shop' for your health care in advance.
About Out-of-Pocket Costs
My Cost Calculator uses your current overall medical spending to estimate your out-of-pocket cost.
Claims that have not yet been processed by BCBSRI are not included in your overall medical spending amount. Once these claims are processed, your balance towards deductible and out-of-pocket maximum may change. Your actual out-of-pocket cost may change from those estimated in the tool based on the timing of claims processing.
If your benefits include service type specific deductibles or visit limits (e.g. for chiropractic or acupuncture), these have not been accounted for in the estimation of your out-of-pocket costs. Your actual out-of-pocket cost may be different from the estimated out-of-pocket cost based on the service-specific deductible or visit limit.
Additionally, your actual out-of-pocket cost may be influenced by many other factors such as the mix of services, past performed services, and other factors, and may be different from the estimated out-of-pocket costs provided in the tool.