Health Care Act

Blue Cross clarifies NC medical cost tool

Originally published Jan. 12, 2015.

When Blue Cross and Blue Shield of North Carolina unveiled a new online cost tool last week, the immediate concern raised by national experts and Charlotte health executives was that it wasn’t clear what the numbers mean.

Blue Cross spokeswoman Michelle Douglas said Monday the company has added an explanation: Cost estimates are averages based on historical BCBSNC claims data. Amounts listed typically include physician fees, facility fees and costs for things like anesthesia, drugs, medical supplies – as well as customer responsibility (deductible, co-pay and co-insurance). Your actual costs may be different based on variations in these factors as well as your health plan design, deductibles/co-insurance and out-of-pocket limits.

“The fact that hospitals say the numbers are Greek to them is indicative of why the tool was necessary,” Douglas said in an email. “Before, customers had no place to go and ask how much the total cost (physician fee, hospital fee, labs, anesthesia, etc.) of a health care procedure might be.”

Meanwhile, John Murawski with the News & Observer forwarded a message noting that UnitedHealthcare offers cost estimates to the public on its Health4Me mobile app (it's free on for Apple or Android devices, or see an online demonstration).

The UnitedHealthcare guest function lists estimates “based on local market average costs,” rather than breakdowns by provider, as the Blue Cross tool does. (UnitedHealthcare, Blue Cross and many other insurance companies offer more detailed members-only data, including what patients can expect to payout of pocket based on their plan.) I looked up knee replacement, which the Blue Cross tool listed as ranging from $20,154 to $40,148 in the Charlotte area. On Health4Me I got a Charlotte average of $60,185 ($59,125 for the procedure itself, with the rest for pre- and post-surgical office visits and physical therapy).

So we're all starting to get a peek behind the curtain of health care costs. But making sense of it is going to take a lot more work.