CareCost Estimate provides a solution for infusion centers and specialized medical practices to address a common patient query: what will the treatment cost?
By selecting the medication, dosage, and insurance details, staff can utilize CareCost to swiftly determine the patient's out-of-pocket expense, typically within a 90-second timeframe. This calculation considers various factors such as Medicare Part B coinsurance, any applicable secondary insurance, Medigap, weight-based dosing, and potential vial waste (JW/JZ). Furthermore, it incorporates any manufacturer copay assistance programs and foundation grants the patient may be eligible for, ensuring that the figure presented reflects the actual financial responsibility of the patient.
In addition to cost estimates, the platform provides insights into the prerequisites set by payers, including necessary prior authorizations, step therapy protocols, and site-of-care stipulations, all directly sourced from the payer's policy along with relevant links for reference.
The pricing information is derived from the CMS Average Sales Price files, which are refreshed quarterly, and since the estimates are processed directly in the browser, patient data remains secure and does not get transmitted to external servers.
Moreover, CareCost also offers complimentary resources related to billing and coding, including infusion CPT codes, J-codes, and modifiers, along with a quarterly Infusion Reimbursement Index to assist healthcare providers further.