How we’re advancing our commitment to price transparency

An important part of making the best decisions for your health is knowing and understanding the costs you’ll pay for your care.

That’s why we’re dedicated to improving how we help you check and control your healthcare costs. While we’ve had Find Care features in place to help you learn about your costs, when the Consolidated Appropriations Act (CAA) became a federal law in 2021, we started making upgrades to those features as well as the way we cover certain care. If you haven’t heard of this act, it lays out several new rules that are designed to help protect individuals from receiving unexpected, high-cost medical bills and make healthcare costs more transparent.

New surprise billing protections

To better help you control costs, we’re now protecting you from certain types of surprise billing under the new No Surprises Act, which is part of the CAA.

Surprise billing (sometimes called “balance billing”) is when you get an unexpected bill for care you’ve received from doctors or hospitals not in your plan (commonly known as out-of-network). They bill you for the difference between the amount they charge and the amount your health plan pays.

In the following cases, you often can’t control who is involved in your care. To protect you from surprise billing, we’ll never make you pay more than your regular share of the costs for in-network care (such as a copay or percentage of the costs), even if the care you receive is from an out-of-network doctor or hospital.

• Emergency services: In a medical emergency, you could receive emergency care from an out-of-network doctor or facility.
• Services at a hospital or outpatient surgery center in your plan’s network: If you receive care at a hospital or outpatient surgery center in your plan’s network, there could be some doctors or specialists who treat you and are out-of-network.

In both cases, the doctor or facility cannot charge you more than the regular in-network share. We will negotiate with the doctor or facility, and handle any dispute over the difference between, what the doctor or facility charged, and what you pay. The amount you pay will go toward your deductible and out-of-pocket limit.

More cost transparency features

Right now, the Find Care & Cost feature in the Sydney^SM Health app and at empireblue.com is available to help you check cost estimates ahead of time. We’re also working on more improvements that will make it even simpler to understand exactly how much a service, treatment, or care will cost, including the following:

1. Enhancements to the existing Find Care & Cost feature: Beginning on January 1, 2023, Find Care will include rate information for 500 specific services, as defined by the federal government.

Stay tuned for more updates from us as we work to deliver you an even better member experience.