Members’ Cost Estimates
In accordance with the Transparency in Coverage Final Rule, personalized out-of-pocket cost estimates are available to THP members by using a link available to you when you are logged into the THP MyPlan portal or app. Look for the Healthcare Bluebook logo and direct link to access a self-service price comparison tool provided by our partner, Bluebook. By using the link inside THP MyPlan, the tool is customized to reflect features of your health benefits plan -- for instance, you will see that it reflects how much you have accumulated toward satisfying your plan’s deductibles and out-of-pocket maximum for the year.
Certain types of cost estimates are also available without logging into your MyPlan portal through this link. Using this link means that the price comparison tool does not take into account any specifics of your particular health plan coverage. The tool will show the Bluebook Fair Price Estimate as well as a range of potential costs. This link is not customized to reflect features of your health plan coverage – it does not take into account your plan’s cost sharing requirements (e.g., deductible, copays, coinsurance, out of pocket maximums), nor does it take into account your plan’s provider network or contract terms.
Using a price comparison tool can be a useful tool if you are planning an upcoming procedure – it can help you get an approximate idea of the costs that may be involved. Keep in mind, however, that a price comparison tool provides estimates only – your actual out-of-pocket costs depend on a number of factors that may not be reflected in the estimate, including, for instance, additional services that may be performed during your procedure. The location of care, the type of provider(s) involved, and how the care is billed can also affect what your health plan pays and what you will be responsible to pay. Generally, choosing an in-network provider results in your health plan covering more of a covered claim’s costs, which results in less out-of-pocket costs for you. You should talk with your provider to understand what they expect your care to include for a particular service or procedure.
We know that there are a lot of factors that members take into account in making health care decisions. Expected quality of care is an important consideration. In situations when you are able to compare costs without sacrificing quality, cost estimates can be helpful. Cost estimates can differ from one provider to another and between different facilities. Sometimes, choosing a different provider or facility may significantly change your out-of-pocket costs. You should talk with your doctor to understand the extent to which you can choose where your care occurs and/or which providers are involved. Also, note that cost estimates can change over time – providers may make changes in their pricing, but also your benefits may change, particularly from one benefit year to the next.
Please keep in mind that the fact that a particular service or procedure is included in the price comparison tool does not mean that your health plan will cover the service or procedure. Additional steps may be required before your health plan will cover a service or procedure – for instance, your plan may require prior authorization before a particular service or procedure is covered. Also, certain services and procedures may be excluded under your plan, and whether a service or procedure is covered may depend on particular circumstances. You should review the terms and conditions of your health plan carefully to understand its coverage terms, limitations, and exclusions.
Notwithstanding any other provision, the price comparison tool does not expand, modify, delete or in any way change the terms of your health plan. All benefits are subject to the terms of the applicable health plan document, including but not limited to its definitions, limitations, and exclusions.