Cost Estimator Tool
Wellmark has resources to assist you in finding lower costing options when seeking services or facilities. This in turn will help you by keeping your costs down, and when you keep your costs down, the premiums for the self-insured health plans stay low too.
Information on this page is provided for informational purposes and is not meant to substitute for the advice provided by your own physician or other medical professional. You should not use the information contained herein for diagnosing or treating a health problem or disease, or prescribing any medication.
Through your myWellmark account, you can access Care Finder and the Cost Estimator Tool. This tool can provide you insight into how much a procedure, service, or doctor's visit will cost depending on where you seek service. This will not only show your out-of-pocket cost, but also what the service will cost the health plan.
The Iowa Hospital Association also provides an Iowa Hospital Charges Compare tool that allows you to compare the cost of service offered by Iowa Hospitals.
The costs of services cost more when a member seeks services out-of-state. This is to portray the differences in costs for the UNI PPO (Alliance Select), as the UNI Blue Advantage (HMO) only has coverage out-of-state for accidental injuries or emergencies.
Wellmark also has a helpful guide on questions you should ask before a procedure, during a hospital stay, and after receiving care.
Steps to Access the Cost Estimator Tool
- Log into your myWellmark Account.
- Choose 'Find Costs' under Latest Claims
- Click on either Medical or Drug Costs
- Select 'Estimate your costs'
- Enter the name of a procedure ("MRI") or a billing code ("73221") to compare costs
|Services & Responsibility||Out-of-State||In-State|
|Well Child Exam - Your Out-of-Pocket||$0||$0|
|Well Child Exam - Charge to UNI Self-insured Plan||$173||$132|
|Adult Checkup - Your Out-of-Pocket||Your Plan Co-pay||Your Plan Co-pay|
|Adult Checkup - Charge to UNI Self-insured Plan||$236 - $280||$98 - $158|
|Eye Exam - Your Out-of-Pocket||$0||$0|
|Eye Exam - Charge to UNI Self-insured Plan||$158 - $234||$96 - $200|
Transparency in Coverage Rule
In 2020, the Federal Government finalized the Transparency in Coverage Rule (TCR), which requires health insurers of self-funded plans to provide cost-sharing data to consumers via machine-readable files as of July 1, 2022 for plan years beginning on or after Jan. 1, 2022. These files provide pricing data for covered items and services based on in-network negotiated payment rates and historical out-of-network allowed amounts. Information in these files must be updated and published monthly.
Machine-readable files are not meant for users. Those enrolled on the UNI self-insured health plans should use the Cost Estimator Tool provided on the myWellmark Account.