Price Comparison Tool

Health Plan participants are NOT required to use the Price Comparison Tool; however, you may find it helps you (1) learn what medical services will cost, (2) learn what providers of a service are available in your area, and (3) to compare pricing through more than one provider (to consider cost sharing estimates in order to minimize the amount of out-of-pocket health expenses – charges you are required to pay, otherwise referred to as “coinsurance.”

By making cost sharing estimates available to consumers prior to receiving care, you will be empowered to make more informed decisions regarding your healthcare and be better equipped to shop for healthcare goods and services across multiple providers in their network. Price comparison tools…

• Enable you to search for healthcare items or services, based on a billing code or description, in a specific user-defined geographical area.
• Provide good faith real-time estimates of your cost sharing (amount you may be billed for), based on contracted rates and current accumulated amounts.
• Provide you with real-time accumulated amounts, such as deductible, co-insurance, or other out-of-pocket expenditures.
• Allow you to compare contracted rates (amounts the Health Plan is expected to pay) and your estimated financial responsibility across multiple providers in the Plan’s network.
• Allow you to understand your estimated financial responsibility based on the plan’s allowances for out-of-network care.
• Detail any healthcare services that are subject to bundled pricing arrangements.
• List limiting factors or prerequisites to coverage, such as prior authorization.
• Provide cost sharing estimates in printed form, when requested.

Participants will need to register and sign into the Price Comparison Tool, which will require their Member ID Number (the nine-digit number that begins with “8” that participants can find on their Blue Cross Blue Shield ID card; or, the Benefits Office can provide this number if needed).

What is my CPT Code?

Importantly, once signed in, participants will find it is most useful to have what is referred to as the “CPT Code” for the medical service they are inquiring about. This code may not be readily available to the participant; however, the provider/physician who is ordering the medical service may be able to provide the accurate CPT Code or it may be available on correspondence related to the ordered service (such as in letters to the participant from the Health Plan’s prior authorization vendor, Valenz Health). Alternatively, participants can contact the Benefits Office for assistance in acquiring the CPT Code, and the Benefits Office will do its best to locate the most appropriate CPT Code for the service being considered.

The Price Comparison Tool does permit a general title search for a medical service; however, the available titles are highly technical and may not be easily matched with the participant’s understanding of what service they are considering. 

No. The Price Comparison Tool is only an optional source of information to help participants (1) learn what medical services will cost, (2) learn what providers of a service are available in their  area, and (3) to compare pricing through more than one provider. There is no requirement by the PDC 30 Health Plan to perform a price comparison, and coverage for services will not be affected by whether the participant used the Price Comparison Tool.