Launching in 20 de janeiro21, SmartShopper encourages members to select high-quality, cost-effective options for routine medical procedures. Now more than ever, employers are looking for new ways to improve their employees’ health while managing their healthcare costs. At the same time, BCBSRI members are looking for tools to help them make smart choices about where to receive care. With SmartShopper, members can plan care with confidence—and at the right price.

SmartShopper is a member-facing program that rewards members for shopping for care, comparing providers on cost, and selecting lower-cost healthcare options for a specific set of clinical services and procedures—such as ultrasounds, MRIs, mammograms, and colonoscopies. Members and their dependents can earn up to $500 in rewards every time they use an eligible lower-cost clinician or facility for designated services. The program is included with all fully insured plans (with the exception of HSA-qualified high deductible plans) and available as an enhancement for self-funded plans. Medicare plans are also excluded. It is managed by Sapphire Digital (Sapphire), an independent company that also manages BCBSRI’s Find a Doctor and Cost Calculator tool.

How SmartShopper works:

• Once a provider recommends a procedure, the BCBSRI member logs into their myBCBSRI account to access SmartShopper. (Or, they may call the SmartShopper Personal Assistant Team for help.)
• The member enters the service and geographic area they want to search.
• SmartShopper displays the estimated cost of the procedure across all participating clinicians and practices in the area. It then highlights low-cost practices or facilities in that area that would enable the member to earn a SmartShopper incentive payment.
• The member can then schedule an appointment with a reward-eligible provider/facility. If needed, a Sapphire representative will contact the member’s primary care provider’s office for help obtaining a referral.
• If a reward-eligible provider/facility provided the services, Sapphire mails the member a reward six to eight weeks after the claim has processed.

Care decisions still rest with members and their providers

While members can earn rewards by selecting SmartShopper options each time they need an eligible procedure, the program is entirely voluntary. The final decision of where to get care remains with the member. You are your patient’s trusted advisor, and BCBSRI encourages providers to identify lower-cost clinicians and facilities to whom you can refer your patients with confidence. Similarly, we encourage our members to work with their primary care provider to get high-quality referrals.

As noted earlier, a member of the Sapphire Personal Assistant Team may call you on the member’s behalf to facilitate a referral if one is needed to see the specialist of their choice. If you are not comfortable with the specialist or facility that the member is requesting, please share this information with the Sapphire Personal Assistant. BCBSRI strongly encourages clinicians and provider organizations to contact the BCBSRI Provider team to verify benefits and eligibility as well as referral and authorization requirements.

Please contact the BCBSRI Provider team at (844) 707-5627 for more details regarding SmartShopper.