When considering a service or procedure, you may request a written cost estimate. We will work directly with health care providers in Massachusetts to get the necessary information to complete your estimate request. Once your request is complete and we have confirmed all necessary information, we will respond within two business days. The Written Estimate Checklist can help you gather the information needed.
Information to provide with your request
Medical Procedure or Treatment Description
Please be ready with a description of the procedure(s) for which you are requesting an estimate. (Example: I am requesting an estimate for a left knee replacement)
Servicing Provider Information
Please provide the full name and phone number of the servicing provider. If available, please include the servicing provider NPI (National Provider Identifier), a ten-digit number used to identify the health care professional rendering the service (for billing purposes). You can find the NPI number by looking up your provider or facility with Find a Doctor.
If service is being performed at a facility, such as a hospital or freestanding MRI or lab facility, please provide the facility name, phone number, and address. If available, please include the facility NPI (National Provider Identifier), a ten-digit number used to identify the facility (for billing purposes). You can find the NPI number by looking up your provider or facility with Find a Doctor.
If you have procedure codes, please provide up to 10 to identify the treatment or services being performed i.e. Either CPT (Current Procedural Terminology) or HCPCS (Healthcare Common Procedure Coding System) codes.
For each procedure code, please provide a matching diagnosis codes, if available, to identify diagnosis. i.e. ICD Code (International Classification of Disease).
Important Details About Your Written Cost Estimate
To request an estimate, a member must meet eligibility guidelines and be an active member. An estimate does not guarantee coverage. Each admission, procedure or service must be a medically necessary covered benefit and meet medical policy guidelines. In addition, all prior authorizations and referrals must be obtained, if necessary.
Estimates are based on the information provided to Blue Cross Blue Shield of Massachusetts and medical information available at the time the estimate is requested. Should this information change or should unforeseen services arise out of the proposed admission, procedure, or service, the actual amount you will be responsible for may vary. If additional services or claims are received between the time an estimate is requested and the time the member receives the service, the level of benefits may change. For example, the amount applied toward a member’s deductible and out-of-pocket maximum may change.