Understand Services & Costs
With Hospital Choice Cost Sharing, you can control what you pay for certain types of care by choosing Lower Cost Share hospitals, freestanding labs, and imaging centers.
Our Learn, Plan, Save Approach helps you find lower-cost, high-quality hospitals, free standing labs and imaging centers.
Categories of Service
Hospital Choice Cost Sharing only applies to six categories of service.
| Categories of Service* | Examples |
|---|---|
| Outpatient diagnostic lab tests |
Blood tests, strep test |
| Outpatient diagnostic X-rays and other imaging tests | Ultrasounds, non-routine mammograms |
| Outpatient diagnostic high-tech radiology | CT scans, MRIs, PET scans, nuclear cardiac imaging |
| Inpatient care | Maternity care, joint replacement |
| Outpatient day surgery | Arthroscopic knee surgery, hernia repair |
| Outpatient physical, occupational & speech therapy | N/A |
Categories of Service*
| Outpatient diagnostic lab tests |
| Outpatient diagnostic X-rays and other imaging tests |
| Outpatient diagnostic high-tech radiology |
| Inpatient care |
| Outpatient day surgery |
| Outpatient physical, occupational & speech therapy |
Examples
| Blood tests, strep test |
| Ultrasounds, non-routine mammograms |
| CT scans, MRIs, PET scans, nuclear cardiac imaging |
| Maternity care, joint replacement |
| Arthroscopic knee surgery, hernia repair |
| N/A |
* Preventive care is provided at Lower Cost Share level if you have any cost sharing for preventive services.
Care at in-network freestanding labs and imaging centers, such as Quest Diagnostics or Shields MRI, is always provided at the Lower Cost Share level. Freestanding labs and imaging centers, sometimes referred to as non-hospital based facilities, are often a convenient, economical alternative to hospitals for services like lab work, MRIs, and outpatient surgery.
Emergency Care
In an emergency, you should go directly to the nearest medical facility or call 911. You'll pay an emergency room copayment
per visit for emergency room services. Check your summary of benefits for your emergency room copayment amount. This copayment is waived if you are admitted to the hospital or for an observation stay. The amount you will pay for care during an emergency is the same regardless of the hospital you visit.
** Your actual costs and plan design may be different from the illustrations provided here. Be sure to check your benefit documents to see your actual out-of-pocket costs.