Managing your health care costs
Here's some good news about your health care costs: You can take simple steps to help control what you pay. Discover how to estimate your costs, understand your bills, make cost-effective care choices, and what you can do if care isn't covered.
The easiest ways to save on health care
Stay in-network
Providers and facilities in the Blue Cross MA network agree to provide discounted services. That means when you stay in-network, your
out-of-pocket expenses will be lower.
Prioritize preventive care
Preventive care, like routine health checkups, cancer screenings, and immunizations, are crucial for catching issues early — and reducing the need for costly care down the line.
Ask about generic medications
Your provider may be able to prescribe a generic version of your medication, which typically cost a fraction of brand-name medications.
Compare options to find more affordable care
You can get estimates for the cost of your care up front — think of it like shopping around for the best price.
- Health care costs can differ
Did you know you can estimate what the cost of your care will be from different providers? The cost for health care can differ by region, facility, and more. For example, the cost of an X-ray may be different at a hospital versus an urgent care center. And in-network care costs much less than out-of-network care. - How estimating your cost can help
Estimating your cost helps you compare options, avoid surprise bills, and plan for what you'll pay out of pocket. It also shows you what's included, like labs or imaging, so you know your full cost before you schedule care. When you have the full financial picture, you can choose the most cost-effective option. - Where to find cost estimates
Sign in to MyBlue to shop for care with our cost estimator tool.
How referrals and prior authorizations can affect your costs
Referrals and prior authorizations are sometimes required by health plans for care to be covered.
Understanding what they are and how they work can help you avoid surprise bills.
Referido | Prior authorization | |
|---|---|---|
| Qué es | A recommendation from your primary care provider (PCP) to see a specialist or get certain health care services. | A review completed by your health plan to review a treatment, test, or medicine before it can be approved for coverage. |
| Why it's there | To ensure care coordination and that services are clinically appropriate, and to help maintain overall affordability. | To ensure services and medications are clinically appropriate, safe for you, and covered under your plan, and to help maintain overall affordability. |
| When it's needed | Typically required by some plans, like HMOs. | For certain prescriptions and health care services, like imaging, surgery, and specialty medications. |
| How to get it | You can ask your PCP to submit a referral, and you'll be notified of your health plan's decision to approve or deny care. At Blue Cross MA, we have a team of clinicians who review these requests. | Your provider requests prior authorization, and you'll be notified of your health plan's decision to approve or deny care. At Blue Cross MA, we have a team of clinicians who review these requests. |
| If it's denied | Your health plan likely won't pay for the service. You can pay out of pocket to receive care, or use funds from a health financial account. | Your health plan won't pay for the service. You can pay out of pocket to receive care, or use funds from a health financial account. You also have the option to appeal. |
Sign in to MyBlue, your online member account, to see what your plan requires.
Get to know your EOB/summary of health plan payments
After you receive care, we'll send you an Explanation of Benefits (EOB) (sometimes called Summary of Health Plan Payments). An EOB is not a bill - it's a statement from your health plan summarizing the health care services you received and how the costs break down.
How to read your EOB
First, review your EOB for accuracy. Make sure you received the health care services listed and your patient details are correct. Then, review the payment details. Here's what you'll see:
- Amount your provider charged: Your provider’s actual charge for the services you received
- Health plan discount: The amount you save by staying in-network
- Allowed amount: The most your health plan will pay for covered services received
- Amount covered: The actual amount your health plan pays. This doesn’t include non-covered services, deductible, copays, and co-insurance
- What you owe: The amount you’ll pay out of pocket. The provider or facility will send you a bill
How it affects your costs
You should review your EOB to ensure you'll be billed the correct amount. Look for:
- Incorrect in-network rates
- Services you didn’t receive
- Items not applied to your deductible
If you have questions or think something isn’t accurate, contact your health plan or provider. You may need to file an appeal or grievance.
Sign in to MyBlue, your online member account, to see your EOBs.
Appealing a denial for coverage
Health plans sometimes deny coverage for a health care service or medication. This happens for many reasons, including missing information, lack of prior authorization, and issues around medical necessity. When that happens, you have the right to request an appeal to protect both your health and your health care costs.
An appeal is a formal request asking your health plan to review and reconsider a decision about your coverage or costs. At Blue Cross MA, medical experts are always part of this review.
If you don't appeal, you could pay the full cost of the service you were denied coverage for. By filing an appeal, you may be able to:
- Get coverage approved and reduce or avoid out-of-pocket costs
- Access services or medications that support your health
- Make sure your benefits are properly applied
You can appeal denied claims, coverage limits, prior authorization denials, or changes to approved treatment plans.
Submit a written request here.
You’ll receive a written decision regarding your appeal or grievance within 30 days.
Learn more about appeals and grievances here.
Descubra todo lo que su plan tiene para ofrecer
Es hora de aprovechar su plan de salud al máximo. MyBlue is your online member account where you can see your plan benefits, track costs, refill medications and more.
Obtenga más información sobre MyBlue.
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