BCBS Estimated Treatment Cost Tool

Estimated Treatment Cost Tool

With this tool, Preferred Care PPO members may view PPO cost displayed on the national Blue Cross Blue Shield Association (BCBSA) Hospital & Doctor Finder website. The Tool features the costs and volumes associated with 1,638 elective/planned procedures. Total cost of care estimates display bundled service and facility charges that are typically a standard part of a procedure or treatment.

Cost Estimates

Cost estimates are developed from our historical claims with updates, as needed, to reflect current arrangements and combined data that enables members to understand the total cost for a service without complications. These estimates are created in four ways:

• For inpatient procedures primary DRG codes(s) related to each treatment category should reflect the professional, diagnostic and other related costs for the category per line and the total displayed.

• For outpatient procedures primary CPT code(s) identify each treatment category and all costs for that member that day are summed to create the estimate.

• For diagnostic services both the technical and professional component are combined.

• For professional office visits, primary CPT code(s) identify each treatment category. For chiropractic and physical therapy, all costs for the visit are summed to create the estimate. For other categories, weighted average costs per CPT codes(s) created the estimate.

Viewing Cost Estimates

A report of cost estimates is available to providers on iLinkBLUE. Log into your existing login ID and click the new menu item named “Estimated Treatment Costs.” You must have access to iLinkBLUE in order to view your cost data, as this information will not be mailed. The report contains the cost ranges calculated for the facility or practicing location, as well as, an overview of the methodology used to develop these cost ranges. Providers who log into iLinkBLUE to view PPO cost data should be aware that no data will be displayed for providers with:

Applicable for facility procedures Applicable for office procedures
• less than three episodes • less than three episodes
• episodes less than $100
• episodes that do not contain facility charges

Figures displayed are a total PPO cost and includes all facility and professional charges. Individual physician costs will not be displayed as they are lumped together with the facility costs. The member will see the approximate cost range for the selected treatment category with all fees associated for the service. In addition, the member will be able to view the name, address and phone number of the provider. The member will be able to see the cost broken out by the facility and physician to help in managing their healthcare.


Reconsideration Process

Providers have 30 days from the date of notice that the data is available to review the cost data and determine if they want to request a reconsideration. To access the interactive Estimated Treatment Cost Reconsideration Form, provider’s will log onto iLinkBLUE and click on Estimated Treatment Cost >Reconsideration Form. Follow the instructions on the screen to complete the form. Prior tosubmitting the form, you will have the option to print a copy for your records. All required fields must be completed and forms must be submitted electronically. Faxed or mailed forms will not be accepted. The Electronic Reconsideration Form will only be available to providers during the  deconsideration period prior to each cost data submission. During times outside this window, the link to the form will be inactive.