By Gretchen Hayden

Gretchen Hayden is a writer creating insightful content across the healthcare revenue cycle. She produces content for Zelis and previously for Sapphire Digital, a leading member navigation and shopping platform. With a deep interest in healthcare finance, Gretchen helps Zelis clients stay current on trends in the healthcare payments market, with an engaging and provocative perspective.

Shopping for healthcare can make it more affordable for all.

Excerpts from a story featured on 5 On your side
“It is amazing how much prices can vary, and again, it’s not related or directly tied to quality and the studies have shown that,” said Gerald Petkau, Senior Vice President of Commercial Markets at Blue Cross North Carolina. “The MRI ranging from $700 to $2,500. The CT scan $600 to $2,500. Again, that’s just in the Triangle region.”

A WRAL ‘Five and your side’ investigation showed the price disparities with a CT scan

They compared rates within the UNC Health System, using the same exact scan, with the same billing code, and same insurance criteria. At 10 Different UNC Health hospitals, they found 10 different prices. That disparity is why Blue Cross North Carolina encourages everyone to shop for medical services.

Members can use their insurer’s website to see the list of facilities, procedures, and the out-of-pocket costs

Another money saving opportunity offered by Blue Cross North Carolina through some employers, the SmartShopper program. It lists how much a test or procedure costs at different local providers. When you use a provider through the program Blue Cross North Carolina rewards you with a cut of the savings. Checks range from $25 to $1,000 for each procedure.

Consumers who shop for healthcare eventually make it more affordable for all

“Obviously we’d like to see consumers shop more for services because it saves them money, it saves their employer money, and ultimately over time makes healthcare more affordable,” said Petkau. While the SmartShopper program has been employer-based (meaning an employer chooses to participate in SmartShopper through their insurer), Blue Cross North Carolina just launched a pilot expansion and now includes members enrolled to the marketplace in the Fayetteville area. Employees should check their insurer’s website for eligibility.

Zelis is poised to deliver on these promises as a strategic technology and strategy partner to heath plans, employers, third party administrators and their membership by bringing payers, providers, and consumers together into one efficient system.

For more information on how Zelis can help, contact your sales representative or Account Manager.