How a North Carolina insurer posted what it pays providers on the Web

Until this year, it was impossible for healthcare consumers in North Carolina to find out the average out-of-pocket cost for medical and surgical procedures.

But in January, Blue Cross and Blue Shield of North Carolina unexpectedly launched an online site that allows the general public to see how much it pays particular providers for certain services. The insurer's move was spurred in part by a state price transparency law. 

BCBS of North Carolina assembled the guts of its online price transparency tool in 2012, said Dr. Brian Caveney, the insurer's medical director. Members were able to log on, find providers and see a detailed estimate of how much they would owe out of pocket for particular services.

The online, searchable database was made available to the general public in January. It covers 1,200 nonemergency procedures, showing the average total of how much the insurer pays particular providers for an episode of care. The figure is drawn from the insurer's claims data and includes all costs—the discounted payment, physician fees, facility fees, drug and medical supply costs, as well as consumers' cost-sharing.

For example, the average cost of knee replacement surgery at providers in Raleigh, N.C., ranges from $20,300 at North Carolina Specialty Hospital to $31,542 at Rex Hospital. The average payment to providers in the Charlotte area for a screening colonoscopy ranges from $791 at Queen City Gastroenterology & Hepatology to $9,555 at the practice of Dr. Bryan Blitstein at Carolinas Medical Center-University.

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