Making health care costs transparent

As part of Massachusetts legislation, Chapter 224 of the Acts of 2012, health plans will be required to offer its members a way to get cost estimates for a health care service, procedure or admission. Placing more cost information into the hands of members will allow them to make more informed medical decisions and help them better understand and plan for potential out-of-pocket health care costs.

Educating members on costs

With the goal of providing clearer, more complete information about health care costs, we've created a webpage for members which explains the different types of cost-sharing along with cost estimates for common medical services like office visits, emergency room visits, and imaging. The webpage also explains how members can get more information about their specific copayments, coinsurance, and deductibles. See the "Costs" member webpage.

Estimates of medical costs

If members have additional questions about costs, they can call our Customer Service Department, use our online cost estimation tool, or they can request a cost estimate by sending us a completed Massachusetts Medical Price Transparency Law and Cost Estimate Worksheet (pdf). To complete the form, the member will need to ask for service- and provider-specific information from their provider, including:

  • Name and description of the service(s)
  • All applicable CPT codes
  • All applicable diagnosis codes
  • Rendering provider name and National Provider Identifier (NPI)
  • Pay-to-provider name and NPI
  • Expected date of service

How does this affect me?

It’s likely that your patients will contact you for to complete the form. Please make your best effort to assist them in getting this information. If you have any questions, please call your Provider Relations Representative at 1-866-275-3247.

Updated on March 6, 2015