Beginning October 1st, members can request an estimate for an upcoming treatment or medical procedure, as part of Massachusetts' most recent health care reform, Chapter 224. Chapter 224 requires insurers to inform members of the allowed amount for a service within two business days of receiving the member's request. The estimate must include any facility fees and the member's estimated liability, such as fees, copayments, deductibles, and co-insurance.
To help members get the information they need, we will supply them with a checklist outlining the information we need to provide the written estimate. We encourage members to collaborate with their health care providers to get the required information.
How Members Get Their Estimates
Members may request an estimate online by logging in to Member Central or calling the phone number on the front of their ID card. The estimate will also explain the member's benefits, including their deductible and out-of-pocket costs.
To get an estimate, members must contact their health care provider and ask for specific information, such as the provider's NPI number, along with procedure and diagnosis codes (if available). Members can choose whether they would like the estimate mailed, emailed, or faxed to them.
Coming on October 1st
Members can visit www.bluecrossma.com/costestimates to learn more about requesting an estimate along with other cost and quality resources available to them.
To find out more, contact your account executive.