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 practice
