To empower our members in their health care decision-making process, Wellmark is providing them with access to a national online tool which makes available a range of the total medical cost estimates for 100 of the most common elective procedures.

The tool uses Preferred Provider Organization (PPO) cost estimates when services are performed at hospitals, ambulatory surgery centers, and imaging centers across the nation.  The cost estimates are listed as a range, such as $1500 – $2100, and display bundled service and facility charges that are typically a standard part of a procedure or treatment.

The new tool can help members understand what the potential range of their out-of-pocket costs could be as they prepare for an upcoming procedure or if they need to select a care provider.

What You Should Know about the Data

• Cost estimates are based on claims data supplied by Blue Plans, including Wellmark, and are updated semiannually.
• Cost estimates are a guide and reflect the average claim allowed amount for the facility and any related physician or diagnostic/other related services included in the admission or outpatient date of service.
• Situations involving complications and outlier costs are not included in the data.

Additional Features of the Tool

The tool also provides:

• a facility’s distance from the provided zip code.
• a notation for facilities designated as Blue Distinction Centers of Specialty Care^®.
• procedure volumes for each facility.

We anticipate that in early December 2011, Wellmark members who have registered for access to our secure member website will see the link for the tool.