A new way to know what you’ll owe before a doctor’s visit

Published February 21, 2019

Want to know what a knee or hip replacement costs, including how much your insurance covers or whether you’ve met your deductible? What about the cost of an MRI? Often, you have to wait for an Explanation of Benefits, or EOB, (a form from your insurance company that helps you understand what claims they paid and what you might still owe). And then, you wait for the doctor’s bill.

Providing more information before scheduling a procedure or a doctor visit is top of mind for Blue Cross Blue Shield companies across the country. Increasingly, there are new ways to empower consumers to make the most informed decisions about getting the best care at the best price.

“Can you imagine filling your grocery cart and being told, ‘We’ll tell you what it costs in 30 days?’” says Christina Ochsner, director of innovation delivery at Blue Cross and Blue Shield of Nebraska (BCBS Nebraska). 

Ochsner and the team at BCBS Nebraska set about solving this and other problems members face in finding affordable care. She says being able to shop for healthcare as easily as shopping for other necessities is critical, especially as the cost of healthcare rises. “There are people avoiding care because they’re not sure what it’s going to cost,” Ochsner says. The team wanted to make sure BCBS Nebraska members are able to find that information and get the care they need.

A cost transparency app that knows you and your doctor

The BCBS Nebraska team developed a downloadable app called HATCX | cost (pronounced “hatch”) that shows members how to shop around before choosing a healthcare provider or making an appointment. The app combines cost and quality data—including patient reviews—to help users make decisions that fit their preferences. Ochsner wants members to know that a lower-cost provider or facility may not necessarily be lower quality, and vice versa.

The BCBS Nebraska team tapped into multiple sources of data to calculate the estimated cost for individual users, patient ratings for doctors and provider locations. Users can also view claims and will soon be able to pay anything they owe doctors directly from the app—a step beyond what many cost transparency apps can do.

Sharing information to save time and money 

Knowing the cost of a doctor visit or procedure up front is helpful. But BCBS Nebraska teams knew the service would need to provide even more information for members to get excited about using it. “What if we could say to members, ‘We see that you did a provider search, and we see a claim for a doctor visit. Did you end up going where you planned to go?’” says BCBS Nebraska’s Lisa Pabian, who also works as a director of innovation delivery. “If not, we could alert users about what they might have saved by going to a lower-cost provider with equal or better quality ratings.”

A growing impact on spending

It’s clear that BCBS Nebraska members want information at their fingertips to make the best decisions about where to receive care. One sign: Since 2017, the free app has received more than 12,000 downloads, with the average user spending 17 percent less on healthcare than non-users. 

Blue Cross and Blue Shield of Nebraska is independent licensee of the Blue Cross Blue Shield Association, an association of independent, locally operated Blue Cross and Blue Shield companies.

HATCX is an independent entity providing mobile solutions to Blue Cross and Blue Shield of Nebraska members and is solely responsible for these solutions.