What you need to know
The cost for healthcare services varies depending on where you go — and better care doesn’t have to be expensive care. It’s important to compare cost and quality and seek the right care at the right time to save on healthcare expenses.
Here are some guidelines to help you be a smart shopper.
Use in-network providers
Doctors in your network have negotiated rates and work with the insurance company directly, which saves money (known as in-network charges). You can see doctors outside your network, but you’ll pay more. In addition to higher coinsurance, you’ll also pay the difference between the provider’s charge and the network allowable charge.
Note: if you are in the Highmark PPO 1000 HPN or CDHP 2250 HPN or Kaiser HMO, there is no coverage for out-of-network providers unless it is for urgent care or emergency services.
Find out what you pay when you need care based on your medical plan.
Keep up with preventive care
Your medical plan pays 100 percent for annual exams, routine screenings, and immunizations when you see in-network providers. See what’s covered in the Summaries of Benefits and Coverage (SBCs) for your medical plan.
Note: If you’re enrolled in the critical illness or hospital indemnity insurance plan, health screenings like mammograms, eye exams, immunizations, colonoscopies, Pap smears, and routine health checkup exams receive a $100 benefit. Learn more here.
Know where to get care
Should you go to a doctor’s office, urgent care clinic, or the emergency room? Going to the right place based on your situation can save you money. For example, urgent care and walk-in clinics provide a lower-cost alternative to the emergency room when it’s not an emergency.
If you’re enrolled in the PPO, CDHP or HPN through Highmark, you can also save money by using CirrusMD, which allows you to connect to a trusted doctor in 60 seconds, 24/7/365, through an easy-to-use app. Telemedicine visits through CirrusMD are free of charge.
Additional resources
Care Paths Program – Earn pharmacy discounts for managing your chronic conditions.
Express Scripts Preventive Drug List – See which preventive medications are covered under your Highmark medical plan.