Managing Your Health Care Costs

Transcription

1 Options for lower cost settings As a CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc. (CareFirst) member, how you use your benefits can reduce your health care costs. Use the information below to make smart choices to help you keep more of your money. Additional resources can be found by visiting and clicking on the For Members tab, then Managing Health Care Costs. After Hours Care It is important for you to understand your options before you need care so you can get the right care, at the right time, for the right cost. Please note: If you are eperiencing a medical emergency, please call 911 or go to the nearest emergency room immediately. Convenience and urgent care center costs are significantly less than emergency room visits. We ve compiled estimated cost comparisons for treatment of some of the most common ailments. Description Emergency Room Urgent Care Convenience Care Acute Bronchitis $795 $123 $69 85%-91% Acute Pharyngitis (Sore Throat) $593 $94 $74 84%-87% Acute Sinusitis $589 $105 $67 82%-89% Acute Upper Respiratory Infections $576 $113 $68 80%-88% Conjunctivitis $390 $101 $56 74%-86% Cough $681 $93 $66 86%-90% Influenza $804 $128 $83 84%-90% Otitis Media (Middle Ear Infection) $467 $94 $69 80%-85% Streptococcal Sore Throat $678 $112 $76 84%-89% Urinary Tract Infection $940 $108 $55 88%-94% This information represents a sample of conditions commonly treated in all three settings and includes all patients with these diagnoses, but does not take into account the severity of their illness. Costs are based on average CareFirst member s costs in 2013 and may not represent your patient s actual cost of care for the same services. Note: The doctors and other medical providers are independent providers making their own medical determinations and are not employed by CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc. MPCM014 (6/15) CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group ization and Medical Services, Inc. CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. are both independent licensees of the Blue Cross and Blue Shield Association. Registered trademark of the Blue Cross and Blue Shield Association. Registered trademark of CareFirst of Maryland, Inc.

2 When and Where to Go The information below also may be used as a guide to help you decide where and when to go for care. Unless you are having a medical emergency, always contact your doctor first for advice. Many doctors offer phone access 24 hours a day, 7 days a week. Even if you re only able to reach the provider on-call, they may be able to see you in the office or direct you to a convenience or urgent care facility. Illness/Injury Major Illness or Injury (Broken Bones, Burns, Bleeding) Chest Pain, Shortness of Breath, and Other Symptoms of Heart Attack or Stroke Significant, Uncontrolled Bleeding No Pulse Spinal Cord or Back Injury Labor Poisoning Convenience Care Urgent Care Emergency Room Minor Fracture Animal Bites X-Rays Stitches Back Pain Sprains and Strains Nausea, Vomiting, Diarrhea Mild Asthma Minor Headache Foreign Object in Eye or Nose Blood Work Allergies Bumps, Cuts and Scrapes Rash and Minor Burns Fevers Ear or Sinus Pain Eye Irritation, Swelling, Pain Vaccinations Minor Allergic Reaction Coughs and Sore Throat Cold or Flu Symptoms

3 How to Find an Urgent Care Near You For a complete listing of Urgent Care s, visit our Provider Directory, select your health plan and click continue. Net you will need to enter a zip code or city/state and select Urgent Care under Search by Type of Provider or Facility, and click continue. You also can download our free mobile app, which allows you to find a doctor or urgent care center anytime, anywhere. Visit our mobile app page for more details on how this app can help you. National Laboratories The choices you and your doctor make about where you have lab work and outpatient surgeries performed can help reduce your health care costs. The information below shows the cost differences between freestanding and hospital-based facilities. The following table represents a sample of the most frequently performed tests. National Laboratory Assay Thyroid Stimulating Hormone $45 $16 65% Comprehensive Metabolic Panel $38 $10 74% Glycosylated Hemoglobin Test $41 $9 78% Urine Culture/Colony Count $37 $8 78% member s costs in 2012 and may not represent your actual cost of care for the same services. LabCorp and Quest Diagnostics are the national laboratories for CareFirst and are a cost effective choice. You can easily schedule appointments online through LabCorp and Quest Diagnostics websites. LabCorp: (Note: LabCorp is the only network national lab that BlueChoice (HMO) members can use.) Quest Diagnostics: (Available for PPO members only.), Radiology and Freestanding Facilities Radiology s The costs of common radiology procedures vary widely between outpatient hospital and CareFirst-contracted freestanding radiology centers. The following table represents a sample of the most frequently performed tests. Radiology CAT Scan, Head/Brain without Dye $307 $200 35% MRI, Joint of Lower Etremity without Dye $1,061 $389 63%

4 Radiology X-Ray, Chest (2 views) $113 $35 69% Urine Culture/Colony Count $37 $8 78% member s costs in 2012 and may not represent your actual cost of care for the same services. Ambulatory Surgery s An Ambulatory Surgery (ASC) are health care facilities that specialize in providing surgery and diagnostic services in an outpatient setting. The following table represents a sample of the most frequently performed tests. Ambulatory Surgery Cataract Removal 3,560 $1,682 53% Colonoscopy $1,557 $846 46% Decompression, Carpal Tunnel $2,753 $1,212 56% Repair of Inguinal Hernia $3,654 $1,936 47% member s costs in 2012 and may not represent your actual cost of care for the same services. Surgery represents the total cost of all services ecept anesthesia. CareFirst offers a wide range of accredited Ambulatory Surgery s that are appropriate in various situations. > To find an in-network facility or other network provider, use our Find a Provider search. Cost of Prescription Drugs Understanding when to use generic drugs may save you 20%-80% on your prescription costs. In the table below, we ve provided a sample of brand-name versus generic drug costs. If your medication doesn t have a generic equivalent, ask your doctor if there s a generic alternative that will work for you. Brand Name Brand Name Average Monthly Cost* of Brand Average Monthly Cost* of Generic Monthly if using Generic AMBIEN (10mg) ZOLPIDEM TARTRATE $329 $2 $327 COUMADIN (2mg) WARFARIN SODIUM $50 $3 $47 LIPITOR (20mg) ATORVASTATIN CALCIUM $239 $5 $234 SINGULAIR (10mg) MONTELUKAST SODIUM $177 $7 $170 *Costs based on August 2014 prices at CVS pharmacies and rounded to the nearest dollar.

5 To help you get the most savings, we will notify you by mail about opportunities to save with generic drugs. If you fill a prescription for a non-preferred brand drug you will be notified of lower-cost generic alternative options. Visit and click on Ways to Save in the Drug Coverage section for tips on how to save on your prescription drug costs.