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Don't Know How Much an X-Ray Costs You? Highmark Network Providers Will Begin Having Conversations With Highmark Members About Their Actual Cost of Care
Date:12/1/2008

Real-time capabilities support providers in discussing health care costs

PITTSBURGH, Dec. 1 /PRNewswire/ -- As health care costs continue to rise, many employers have shifted more of the cost of health care to their employees through higher premiums or cost-sharing on their benefit programs with deductibles and coinsurance. To help consumers better understand their actual cost of health care, Highmark providers, such as primary care physicians, specialists, health care facilities and hospitals, now have tools to assist them in discussions with Highmark members about their out-of-pocket costs. Highmark is the first insurer in the region to roll out real-time capabilities, which gives providers the ability to set payment expectations with members. With real-time capabilities, providers can send an electronic claim to Highmark and receive a response indicating the amount the Highmark member owes. Providers can use these tools prior to service or at the point of service, and then have the option to collect this payment or make payment arrangements with the member at the time services are received.

For example, if a Highmark member were scheduled to receive an x-ray, the provider could use Highmark's real-time capabilities to estimate the cost of the x-ray to the member taking in to account their specific health benefit design including deductibles and coinsurance. The member would then have a clear understanding of their financial responsibility for the service and would be prepared to make any necessary payments to the provider.

These real-time capabilities allow Highmark members with high deductibles, coinsurance or other types of cost-sharing to better understand the actual cost of health care services. Approximately 730,000 Highmark members in Pennsylvania are currently enrolled in health plans with cost-sharing that includes deductibles and/or coinsurance for in-network services.

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