How your health insurance plan helps save you money
If you pay health insurance premiums for your business, your family or yourself, here’s something you should know: The amount you pay reflects how much providers—doctors, hospitals and clinics—charge for care. As providers increasingly demand double-digit price increases each year, the cost of health care is rising much faster than the overall inflation rate. Regence works hard to negotiate fair prices with providers to minimize cost increases while ensuring you have access to high-quality medical treatment.
But containing provider price increases is an uphill battle. Providers sometimes prescribe unnecessary treatments and tests or recommend procedures in their own facilities when you could get the same or even better care at a more affordable price in other settings. Regence works with you and your doctor to ensure you get the care you need in the right setting to reduce spending on unnecessary treatments. These efforts are not intended to get between you and your doctor; rather, they ensure treatments prescribed are proven effective, and will be delivered safely and cost-effectively.
Making your health care more affordable
By minimizing unnecessary medical care, Regence helps hold providers accountable, making health care more affordable. Pre-authorization (PA)—the requirement for providers to get authorization for insurance coverage before delivering certain medical services to patients—is one way we do that. PA requests are reviewed by our team of doctors, nurses and clinicians to make sure a treatment is safe and effective, and if, in the case of surgeries, there are less-invasive alternatives, before approving treatment for coverage. When PA requests are denied, providers can appeal and request an escalated review or prescribe a different course of treatment.
Another common cost-saving strategy is requiring PA on where a treatment is delivered to make sure it’s done in the most appropriate setting. We evaluate whether a procedure needs to be performed in a hospital operating room, or if it can be done in an ambulatory surgical center, a doctor’s office, or even in your own home. Often getting care at alternative sites is more convenient and leads to better health outcomes and lower costs.
We’re here to help
You have access to online tools to view and compare estimated costs and out-of-pocket responsibility for hundreds of covered treatments and services from any provider. You can sign in to your account on regence.com, select Claims & costs and Estimate costs to access the cost estimator tool. You can also call our award-winning Customer Service team at the phone number on the back of your member ID card.