Cost Expectations Prior to Care

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The costs are based on in-network PPO or HMO rates. Using facilities or providers who are not in your plan’s network will likely be more expensive.
Yes, selecting an alternate facility such as an outpatient surgery center instead of a hospital can often reduce your treatment costs.

The Cost Estimator is not a substitute for medical advice. Please discuss your treatment options with your doctor or other healthcare provider. Depending on your medical history, one facility may be more appropriate for you than another. If you experience complications during or after a procedure performed in a surgery or birthing center, your doctor may require you to receive additional care in a hospital setting.

The Cost Estimator provides treatment cost options for the following places of service:

Inpatient Hospitals are licensed or formally approved hospitals. They offer round-the-clock healthcare services to patients who require overnight hospital stays. Inpatient hospital accreditation programs include the Joint Commission, the National Integrated Accreditation for Healthcare Organizations (NIAHOSM) program and the Community Health Accreditation Program (CHAP).

Outpatient Hospitals are run by licensed or formally approved hospitals. Like surgery centers, they offer a wide variety of services to patients who do not require overnight hospital stays. Outpatient hospital accreditation programs include the Joint Commission, the National Integrated Accreditation for Healthcare Organizations (NIAHOSM) program and the Community Health Accreditation Program (CHAP).

Surgery Centers may be run by doctors and/or large healthcare companies. They offer a wide variety of medical procedures to patients who do not require overnight medical care. Accreditation programs include the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), Accreditation Association for Ambulatory Health Care (Accreditation Association or AAAHC) and the Joint Commission.

Your out-of-pocket costs, which may include copays, coinsurance and deductible, are directly related to the cost of the service itself, as well as where (office location or type of facility) the service is being provided.

Generally speaking, emergency rooms and hospitals are the most expensive places to receive care, so your out-of-pocket costs will be the highest in these locations.

Remember, you have many choices when you need care and the more you know before you go, the better chance you have to get the best care at the best price.

No, the options presented in the Cost Estimator are for informational purposes only and are designed to spark more informed conversations between you and your doctor. Your doctor or other healthcare provider will create a personalized healthcare plan for you.
A provider may choose to limit their practice even if they commonly perform some services and procedures. Please contact the provider to find out whether they offer the service or procedure you want.

When a doctor or provider is affiliated with a facility it means they can practice at that location. They may be employed by a facility or simply have an agreement that allows them to perform some or all procedures at that location (i.e., admitting privileges).

Please note: A provider may be affiliated with a facility, but not necessarily have admitting privileges at that facility. If you need inpatient care, ask your provider to explain his or her admitting privileges to you.

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The Cost Estimator provides you with estimated costs for specific treatments and procedures. You can discuss this information with your doctor or use it to help choose a provider.

For this, you’ll need to use the Treatment Cost Estimator tool.

  • First, log in to My Account.
  • On your My Account homepage, select Tools.
  • From the drop-down menu, click on Treatment Cost Estimator.
  • On the following page, click Proceed.

Once you’ve opened the tool, you can search in two ways:

  • Type the name of the procedure into the search field where it says, “Type to filter.”
  • Click on the letters beneath the search field to browse procedures alphabetically.

You can save both money and time on your healthcare costs when you talk with your doctor and compare options before deciding where to go for treatment.

The Cost Estimator can also help you find estimated costs and ways to save on different components of a treatment, such as: MRIs, tests, therapy services, X-rays and other services.

No. The information provided by the Cost Estimator will never be used to alter the cost of your treatment or your coverage. Your health privacy is a priority for us, and we comply fully with the Health Information Portability and Accountability Act (HIPAA). You can freely explore health conditions and healthcare choices without affecting your insurance rates or coverage.
Currently, the Cost Estimator cannot calculate estimated costs for dental-related care. Please contact your dental provider for more information.
Yes. You can estimate costs for treatments and services by changing your search location. Please note that the results rely on the supporting information available, which may include historical claims information and other information sources to support calculation of an accurate estimate.
Many factors in addition to cost can impact the types of treatment you select for your diagnosis or condition. Please discuss treatment options with your doctor or other healthcare provider to determine what type of care is best for you. It may help to bring your cost estimate and a list of questions about your treatment options when you go.
The Cost Estimator is not a substitute for medical advice. Please discuss your treatment options with your doctor or other healthcare provider. Depending on your medical history, one facility may be more appropriate for you than another. If you experience complications during or after a procedure performed in a surgery or birthing center, your doctor may require you to receive additional care in a hospital setting.

The Cost Estimator provides treatment cost options for the following places of service:

Inpatient Hospitals are licensed or formally approved hospitals. They offer round-the-clock healthcare services to patients who require overnight hospital stays. Inpatient hospital accreditation programs include the Joint Commission, the National Integrated Accreditation for Healthcare Organizations (NIAHOSM) program and the Community Health Accreditation Program (CHAP).

Outpatient Hospitals are run by licensed or formally approved hospitals. Like surgery centers, they offer a wide variety of services to patients who do not require overnight hospital stays. Outpatient hospital accreditation programs include the Joint Commission, the National Integrated Accreditation for Healthcare Organizations (NIAHOSM) program and the Community Health Accreditation Program (CHAP).

Surgery Centers may be run by doctors and/or large healthcare companies. They offer a wide variety of medical procedures to patients who do not require overnight medical care. Accreditation programs include the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), Accreditation Association for Ambulatory Health Care (Accreditation Association or AAAHC) and the Joint Commission.

Our Cost Estimator is your online resource designed to help you estimate your personal cost for procedures, doctor’s office visits, lab tests and surgery beforehand. Talk with your doctor about which treatment options are right for you. With Cost Estimator you can:
  • Receive personalized estimates based on your healthcare plan and factor in your remaining deductible, benefit maximums, copayments and coinsurance.
  • Avoid surprises and save money by comparing costs from different doctors and facilities.
  • Plan ahead to keep health costs under control and make the best care decisions for you.

Access My Account and either log in or create an account to take a look.

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You can save both money and time on your healthcare costs when you talk with your doctor and compare options before deciding where to go for treatment. The Cost Estimator can also help you find estimated costs and ways to save on different components of a treatment, such as: MRIs, tests, therapy services, X-rays and other services.
Several factors are used to calculate your out-of-pocket estimate. These include:
  • The rate your plan has agreed to pay your selected provider or facility
  • Your plan’s specific benefits (copay, coinsurance, up-front benefits, etc.)
  • Credits you have earned (accumulated) that count toward your deductibles and out-of-pocket
The Cost Estimator can provide you with:
  • Cost and location options for:
    • Medical treatments (including evaluation, surgery and follow-up)
    • Outpatient procedures and immunizations
    • Services related to treatments, like CT scans or physical therapy
  • Savings alerts that let you know when you might be able to save money on a treatment or service
  • User-friendly explanations and definitions of medical conditions and treatment names
We selected health conditions, treatments and services based on several factors. These include what members search for most often, what conditions and treatments are most common, where members spend most of their healthcare dollars, and when members will have an opportunity to save money and time.
The total cost estimate is the cost for treatments and services before your plan benefits are applied. The estimated amount covered by your plan is also displayed, as well as your total out-of-pocket cost for treatments and services.

No. The Cost Estimator is for informational purposes only. It is intended to help you understand what to expect during a treatment and to spark conversations with your doctor.

The information here or on any linked sites is not a substitute for the medical advice of your doctor or other healthcare provider. It may be helpful to use this information combined with other research in discussions with healthcare professionals to make decisions that offer the best possible results and lowest costs.

We endorse guidelines developed by health experts at federal agencies such as the Centers for Disease Control and the U.S. Department of Health and Human Services. Your doctor may use these guidelines to plan your general wellness care and other types of treatment.

Yes! This tool is designed to encourage conversation between patients and providers. Please talk to your doctor or other healthcare provider about what type of care is best for you. You may want to print your cost estimate and bring a list of questions about treatment options and their costs with you. If you have medical or health-related questions, contact your healthcare provider. Let your provider know your plans before you take any medicine, change any medicine or stop any treatment. If you think you may have a medical emergency, immediately call 911.
Your estimate includes costs for a specific group of procedures and services you are likely to receive at a facility over the course of your treatment. If you receive any additional care during the treatment, procedure or service, there will be additional medical expenses. Depending on your plan, you may be responsible for paying some or all those additional costs.
Our estimates include all the usual charges related to medical costs. These estimates are for informational purposes only. The estimated cost for professional services could include costs such as anesthesia, medical supplies, operating room use or pathology evaluation. You may receive separate bills for these charges.

CareFirst uses historical claims information from across the country to estimate average costs per procedure. This information is collected by the Blue Cross Blue Shield Associate (BCBSA) and housed in its National Consumer Cost Transparency (NCCT) database.

When you use our Cost Estimator tool, it pulls NCCT data specific to your location to generate the most accurate estimate possible. However, please remember that your estimate is not your bill. Your actual costs may vary.

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Please contact the Member Services number on the back of your ID card for additional assistance. We may not have information about the treatment you're searching for yet.
If you can’t get an out-of-pocket estimate, it may be because of one of the following:
  • You don’t have coverage under the plan for the treatments and services you selected.
  • An issue with your benefits information prevents us from calculating your estimate.
  • A technical issue prevents us from calculating your estimate.
  • In some cases, cost estimates cannot be provided if you have a supplemental Medicare insurance plan.
  • The treatment or service is not in our Cost Estimator.
For questions about using the tool, contact the Member Services number on the back of your member ID card.
There are several variables that can impact your total cost for treatment and services. The information on this site is meant to help you estimate costs. There is no price guarantee for the estimates you find using this tool.
We may not have enough recent historical information from other member claims to accurately estimate the cost for a particular service for a specific provider.

Questions that Require Phone Support

The following questions are best answered by one of our Member Services experts.

Questions that Require Phone Support

Some questions are too specific or personal to be answered online. That’s when you need to talk to one of our experts.

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Member Services

  • How do I get immediate help with a change in my membership?
  • When will I get my new member ID cards?
  • How do I get proof of coverage or a letter of credible coverage?

Technical Help

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Call Member Services using the phone number on the back of your ID card.

Call Technical Help

Phone: 877-526-8390
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Member Services

  • Can you help me understand how my insurance plan works?
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  • How do I find out if I need prior authorization for a procedure?
  • What’s the status of my prior authorization request?
  • How do I know how many visits I have remaining for a specific service (e.g., physical therapy)?
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Member Services

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  • Can you explain the denial code on my benefits claim?
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  • Why is my claim being adjusted?
  • Why was my claim with my in-network doctor processed as out-of-network ?
  • Can you help me figure out how much I owe and to whom?
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  • Can you help me with a routine visit that requires applied a cost share/patient liability?
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Member Services

  • I can’t find a medical specialist for a specific issue. Can you help me?
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  • Do I need prior authorization for a procedure I’m considering?
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Member Services

  • How can my healthcare plan help me save money?
  • Am I eligible for any non-medical discounts through CareFirst?

Support & Service

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Questions Requiring Support

Need help with your plan?

Have a question about your benefits? Not finding your answer online? Something else? We’re here for you.

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If you have additional questions, call Member Services using the phone number on the back of your ID card.

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Technical Help

Phone: 877-526-8390
Hours: Monday–Friday, 8 a.m.–6 p.m. ET

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Do you have a coverage question that's hard to explain? Or do you just prefer meeting face-to-face? Either way, you're welcome to visit us.

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Baltimore, MD 21224
Hours: Monday–Friday, 10 a.m.–6 p.m. ET
To schedule an appointment, click here.

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