Important Disclosures and Terms of Use About Cost Estimates
Cost estimates provided in this tool are for active Blue Cross Blue Shield of Massachusetts members. These terms of use are an agreement between Blue Cross Blue Shield of Massachusetts, their members and all users of the site. This tool is intended to assist members in researching the cost of a procedure in order to get an estimate for the amount a procedure or service will cost.
Your use of this tool is conditioned on your acceptance of the terms, conditions and notices contained herein. Your use of this tool constitutes your agreement to all such terms, conditions, and notices, and by using the Site, you are agreeing to be bound by the terms and conditions. Unless otherwise specified, the information on this tool is for your personal and non-commercial use. Unauthorized copying, reproduction, republishing, uploading, downloading, posting, transmitting or duplicating any of the material on this site is prohibited without BCBSMA prior written permission. You may download or copy any downloadable materials displayed on the tool for home, noncommercial and personal use only. Use of information or communications available on this tool for any commercial or research related purpose is strictly prohibited. You agree that you will not use the information on this tool for any purpose that is unlawful or prohibited by these terms, conditions, and notices.
Cost Estimates May Not Reflect Your Actual Cost
This tool calculates the estimated cost of certain medical services. Cost estimates reflect average amounts paid to providers for services; they are not intended to reflect your out of pocket cost. Available coverage and the actual cost you incur will be determined by your health plan rules and benefits. Check your health plan benefits to find out exactly what is covered. In the event there is a difference between the website and your BCBSMA plan documents, your plan documents will control. Your actual cost may include deductibles (amounts you must pay before your health plan pays anything) and co-insurance or co-payments (your share of costs). Cost estimates do not represent a guarantee of payment or prior approval for any service.
Cost estimates do not account for services provided in the emergency room. In addition, cost estimates may not include costs associated with additional services beyond the specific service identified in the estimate (for example, lab tests and x-rays performed before or after a specific medical procedure may not be included in the estimate). Please note that in some cases these additional costs can be quite high, and you may be financially responsible for them depending on your health plan benefits.
Cost estimates and any amounts applied to your deductible and out of pocket maximum are based on the information available to Blue Cross Blue Shield of Massachusetts at the time the estimate is provided. Although we make every effort to keep this information current, estimates are subject to change.
For certain plans, this website provides an out of pocket estimate. This is an estimate of the amount of money you may have to spend "out of pocket" for a specific service. An out of pocket 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.
Out of pocket estimates are based on the information available to Blue Cross Blue Shield of Massachusetts. Although we make every effort to keep this information current, estimates are subject to change. Should 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 provided and the time the member receives the service, the level of benefits may change. For example, the amount applied toward a member's deductible or out of pocket maximum may change.
The cost estimator is not intended to provide you with medical or financial advice. Each person’s health care and financial needs are different and the costs calculated are only estimates. The purpose of the cost estimator is to assist you with understanding your coverage options and provide an estimate for the inquired upon procedure or service. Therefore, you should exercise independent judgment about your health and financial information before relying solely on the information provided from the website.
Please note: Cost Estimates are provided with the assumption that BCBSMA is the primary insurance coverage. If BCBSMA is your secondary insurance coverage, we encourage you to contact your primary insurance carrier for a cost estimate.
Consult With Your Provider About Your Medical Condition
You should consult with your own doctor or other health care provider about your particular medical condition. The information on this website is not medical advice and should not be viewed as a recommendation or endorsement of any particular health care provider or its services. Only you and your health care provider can decide which medical decision is best for you. Do not avoid getting health care or make health care decisions based on the cost estimates displayed on this website. Use this information to talk to your doctor or other health care provider when making medical decisions.
BCBS of Massachusetts does not guarantee that services will be available or will be of any particular quality or cost. The quality of health care services you receive can be different depending on the hospital or doctor's office you choose.
What's Not Included
A cost estimate represents an estimate of the average cost of a service offered by a given provider. Cost estimates may not be generated for every service or for every health care provider that offers a given service. In addition, cost estimates may not take into account all available cost data for a given health care provider. For instance, cost estimates do not account for Medicare claims, emergency cases or complications, or unusually high or low costs for a certain service.
For HMO Blue New England members, no cost data is available for health care providers outside of Massachusetts.
Future Modification to Terms of Use
Blue Cross Blue Shield of Massachusetts reserves the right to change the terms of this policy at any time, for any reason, with or without notice. If material changes are made to the policy a notification will be placed on the login screen of the website notifying you of such changes.