Blue Cross and Blue Shield of North Carolina Sheds Light on Medical Costs

Blue Cross and Blue Shield of North Carolina (BCBSNC) is taking some of the mystery out of health insurance and care costs.

BCBSNC, North Carolina's largest health insurer, is publishing online the average prices it pays statewide for physician office visits, diagnostic procedures and screenings, prescription drugs, and disease treatments. The Health Cost Estimator, now available to members at bcbsnc.com, includes one of the most comprehensive listings of total average costs related to diseases and conditions of any health insurance plan. Along with its effort to promote health cost clarity for its members, BCBSNC supports initiatives to increase the quality, safety and effectiveness of health care.

"Our Health Cost Estimator will give our customers a much clearer idea of where their health care dollar goes because the prices we pay translate to the premiums that customers pay." said BCBSNC President and CEO Bob Greczyn. "Consumers are paying an increasing share of health care costs, but until now they've had little way of knowing what medical services actually cost."

The Health Cost Estimator includes:

Physician office visits, with separate categories of average costs for a variety of services for men, women and children. For example, the average cost BCBSNC pays statewide for an annual physical examination for a 35-year-old man is $279, including recommended lab work and immunizations. A child's doctor visit for a cold typically costs the company $75.

Diagnostic screenings and surgical procedures, with average costs broken out by place of service. For example, an MRI provided in an outpatient hospital setting costs BCBSNC $1,975 on average, while the same scan in a freestanding facility costs $933. Anterior cruciate ligament (ACL) surgery costs the company an average of $10,337 if done in an outpatient hospital setting, and $6,859 if done in an ambulatory surgical center. The average cost for an outpatient colonoscopy is $2,040 at a hospital, $1,203 at an ambulatory surgical center and $889 in a physician's office.

Total average costs for treatment of diseases and conditions. For example, the average total that BCBSNC would expect to pay for a member who requires heart bypass surgery is $57,280, including office visits, hospital costs, drugs, tests and other services. A typical course of breast cancer treatment, including surgery, costs $26,749.

The Health Cost Estimator includes prices BCBSNC pays for the most commonly used prescription medications. Members can learn, for example, that a brand name cholesterol-lowering drug can cost as much as $150 or more for a month's supply, while a generic drug can cost as low as $20 per month.

Members can customize the tool, adding services they expect to receive during a medical visit, such as lab tests and x-rays, or removing those services they do not expect to receive.

"With this information, members will be better able to make informed choices about quality, cost-effective health care options," Greczyn said. "That could help moderate health care costs."

Having reliable information on the cost of care is particularly important for consumers with the latest health plan designs that couple a high-deductible plan with a Health Savings Account. HSA plans are becoming increasingly popular because they typically have lower premiums than traditional health insurance plans. Participants are responsible for paying a greater proportion of their medical costs upfront, which they can manage through tax-free, interest-bearing health savings accounts.

Actual costs of medical services provided to members depend on a number of factors, including the severity of their case, the actual treatment they receive, BCBSNC's contracted prices with the particular physicians and facilities members visit and other circumstances.

BCBSNC has also enhanced the health information on its Web site to provide members with quick access to information about health care provider quality, linking customers to details about doctors and facilities that have been named BCBSNC Centers of Excellence for obesity surgery and heart surgery. It also provides information about physicians who participate in other quality recognition programs.

The Health Cost Estimator is available to customers who sign up for online member services, a secure, password-protected site that allows them to check claims and benefits, request member cards, sign up for care management programs and participate in the Blue Points physical activity and wellness incentive program.