Options for lower cost settings
As a CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc. (CareFirst) member, how you use your benefits can reduce your health care costs. Use the information below to make smart choices to help you keep more of your money.
Additional resources can be found by visiting www.carefirst.com and clicking on the For Members tab, then Managing Health Care Costs.
After Hours Care
It is important for you to understand your options before you need care – so you can get the right care, at the right time, for the right cost.
Please note: If you are experiencing a medical emergency, please call 911 or go to the nearest emergency room immediately.
Convenience and urgent care center costs are significantly less than emergency room visits. We’ve compiled estimated cost comparisons for treatment of some of the most common ailments.
CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. are both independent licensees of the Blue Cross and Blue Shield Association. ® Registered trademark of the Blue Cross and Blue Shield Association. ®’ Registered trademark of CareFirst of Maryland, Inc. Description Emergency Room Urgent Care Center Convenience Care Center Potential Savings
Acute Bronchitis $795 $123 $69 85%-91%
Acute Pharyngitis (Sore Throat) $593 $94 $74 84%-87%
Acute Sinusitis $589 $105 $67 82%-89%
Acute Upper Respiratory Infections $576 $113 $68 80%-88%
Conjunctivitis $390 $101 $56 74%-86%
Cough $681 $93 $66 86%-90%
Influenza $804 $128 $83 84%-90%
Otitis Media (Middle Ear Infection) $467 $94 $69 80%-85%
Streptococcal Sore Throat $678 $112 $76 84%-89%
Urinary Tract Infection $940 $108 $55 88%-94%
This information represents a sample of conditions commonly treated in all three settings and includes all patients with these diagnoses, but does not take into account the severity of their illness. Costs are based on average CareFirst member’s costs in 2013 and may not represent your patient’s actual cost of care for the same services.
MPCM014 (6/15)
Note: The doctors and other medical providers are independent providers making their own medical determinations and are not employed by CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc.
When and Where to Go
The information below also may be used as a guide to help you decide where and when to go for care.
Unless you are having a medical emergency, always contact your doctor first for advice. Many doctors offer phone access 24 hours a day, 7 days a week. Even if you’re only able to reach the provider on-call, they may be able to see you in the office or direct you to a convenience or urgent care facility.
Illness/Injury Convenience Care Center Urgent Care Center Emergency Room Major Illness or Injury (Broken Bones,
Burns, Bleeding)
x Chest Pain, Shortness of Breath, and Other
Symptoms of Heart Attack or Stroke
x
Significant, Uncontrolled Bleeding x
No Pulse x
Spinal Cord or Back Injury x
Labor x Poisoning x Minor Fracture x x Animal Bites x x X-Rays x x Stitches x x Back Pain x x
Sprains and Strains x x
Nausea, Vomiting, Diarrhea x x
Mild Asthma x x
Minor Headache x x
Foreign Object in Eye or Nose x x
Blood Work x x
Allergies x x
Bumps, Cuts and Scrapes x x x
Rash and Minor Burns x x x
Fevers x x x
Ear or Sinus Pain x x x
Eye Irritation, Swelling, Pain x x x
Vaccinations x x x
Minor Allergic Reaction x x x
Coughs and Sore Throat x x x
How to Find an Urgent Care Center Near You
For a complete listing of Urgent Care Centers, visit our Provider Directory, select your health plan and click continue. Next you will need to enter a zip code or city/state and select Urgent Care under Search by Type of Provider or Facility, and click continue.
You also can download our free mobile app, which allows you to find a doctor or urgent care center anytime, anywhere. Visit our mobile app page for more details on how this app can help you.
National Laboratories
The choices you and your doctor make about where you have lab work and outpatient surgeries performed can help reduce your health care costs. The information below shows the cost differences between freestanding and hospital-based facilities.
The following table represents a sample of the most frequently performed tests. Diagnostic Test Outpatient Hospital (Freestanding) National
Laboratory
Potential Savings
Assay Thyroid Stimulating Hormone $45 $16 65%
Comprehensive Metabolic Panel $38 $10 74%
Glycosylated Hemoglobin Test $41 $9 78%
Urine Culture/Colony Count $37 $8 78%
This information does not take into account the severity of a member’s illness. Costs are based on average CareFirst member’s costs in 2012 and may not represent your actual cost of care for the same services.
LabCorp and Quest Diagnostics are the national laboratories for CareFirst and are a cost-effective choice. You can easily schedule appointments online through LabCorp and Quest Diagnostics websites.
■ LabCorp: https://www.labcorp.com/wps/portal/
(Note: LabCorp is the only network national lab that BlueChoice (HMO) members can use.)
■ Quest Diagnostics: www.questdiagnostics.com
(Available for PPO members only.)
Outpatient, Radiology and Freestanding Facilities
Radiology CentersThe costs of common radiology procedures vary widely between outpatient hospital and CareFirst-contracted freestanding radiology centers. The following table represents a sample of the most frequently performed tests.
Diagnostic Test Outpatient Hospital (Freestanding) Radiology Center
Potential Savings
CAT Scan, Head/Brain without Dye $307 $200 35%
Diagnostic Test Outpatient Hospital (Freestanding) Radiology Center
Potential Savings
X-Ray, Chest (2 views) $113 $35 69%
Urine Culture/Colony Count $37 $8 78%
This information does not take into account the severity of a member’s illness. Costs are based on average CareFirst member’s costs in 2012 and may not represent your actual cost of care for the same services.
Ambulatory Surgery Centers
An Ambulatory Surgery Center (ASC) are health care facilities that specialize in providing surgery and diagnostic services in an outpatient setting. The following table represents a sample of the most frequently performed tests.
Diagnostic Test Outpatient Hospital Ambulatory Surgery Center
Potential Savings
Cataract Removal 3,560 $1,682 53%
Colonoscopy $1,557 $846 46%
Decompression, Carpal Tunnel $2,753 $1,212 56%
Repair of Inguinal Hernia $3,654 $1,936 47%
This information does not take into account the severity of a member’s illness. Costs are based on average CareFirst member’s costs in 2012 and may not represent your actual cost of care for the same services. Outpatient Surgery represents the total cost of all services except anesthesia.
CareFirst offers a wide range of accredited Ambulatory Surgery Centers that are appropriate in various situations.
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To find an in-network facility or other network provider, use our Find a Provider search.Cost of Prescription Drugs
Understanding when to use generic drugs may save you 20%-80% on your prescription costs. In the table below, we’ve provided a sample of brand-name versus generic drug costs. If your medication doesn’t have a generic equivalent, ask your doctor if there’s a generic alternative that will work for you.
Brand Name Brand Name Monthly Cost* Average of Brand Average Monthly Cost* of Generic Monthly Savings if using Generic
AMBIEN (10mg) ZOLPIDEM TARTRATE $329 $2 $327
COUMADIN (2mg) WARFARIN SODIUM $50 $3 $47
LIPITOR (20mg) ATORVASTATIN CALCIUM $239 $5 $234
SINGULAIR (10mg) MONTELUKAST SODIUM $177 $7 $170
To help you get the most savings, we will notify you by mail about opportunities to save with generic drugs. If you fill a prescription for a non-preferred brand drug you will be notified of lower-cost generic alternative options.
Visit www.carefirst.com/rx and click on Ways to Save in the Drug Coverage section for tips on how to save on your prescription drug costs.