FAQs

Q. Why did Priority Health create the Common Costs tool?
A. Priority Health's core purpose is to "improve health by providing all people access to affordable and excellent health care." To accomplish this, we must empower you with tools and information to help you make smarter health care purchasing decisions. This Common Costs information can help you learn about the true cost of common procedures and conditions here in West Michigan.

Q. How are the costs shown here different from the costs shown on other websites?
A. Many other websites show a fee schedule just for their part of a treatment - hospital websites may show room charges or charges for an operating suite, for example. We show estimates of the total cost of an event. For example, the cost range for "Appendicitis" we offer includes not only costs for the hospital stay, but costs for your physicians, lab work, radiology services, and even drug costs as well.

Q. How often is the data updated?
A. We plan to update cost data every three months. This may change based on feedback from users and improvements to Priority Health's computing and business environments.

Q. How are costs calculated?
A. Estimates for specific health conditions, such as diabetes, are calculated using special computer software that analyzes patterns within claim data. This software organizes data by health condition and gathers all costs including doctors, surgeons, x-rays, lab tests, hospital fees and prescription drugs together.

We present costs based on the claims we've received from health care providers over the last 18 months. They represent the amount Priority Health paid to participating physicians, hospitals and other health care providers for our members who have coverage through their employer. We don't include Medicare and Medicaid patient data, or data on patients who have their primary health care coverage through another insurer such as Blue Cross.

The costs provided are only estimates and may or may not represent your actual costs. Treatments for each individual person vary based on the intensity of the condition, the complexity of treating the condition, individual physician practices and physician rates - so costs will vary, too.

Q. How did you choose which items or conditions to include?
A. Priority Health's Medical Director decides what is included based on how common a procedure or condition is within the community. Additionally, the Medical Director looks at procedures or conditions that may not happen often but, when they occur, have a substantial impact on our members. We analyze usage and medical data from our members to help make this final decision.

Q: I can't find cost information on the condition I'm looking for.  Where else can I go?
A: Your medical care team will help you determine the actual costs of procedures or medical care you need.

Q. Will there be more cost and quality information available in the future?
A. Priority Health is considering different ideas, such as showing the costs associated with episodes of care, physicians and hospitals. In addition, we are experimenting with how to show (and let consumers compare) the quality of physicians and hospitals.

Q. How do I seek out the services listed here?
A. Your physician is the best person to advise you on when, how and where to go for health care services.

Q. Who can I contact for more information regarding this feature?
A. If you're a member of a Priority Health plan, call our Customer Service staff. If you are in the media and wish to talk with a data expert, contact our media representatives.