When was the last time you made a major purchase? I bet (and hope) you checked for the best price and features before making any decisions. A trip, perhaps? A washer/dryer combo? Maybe even a new car? It’s confusing, takes a LOT of time, and usually comes with a healthy dose of sticker shock.
Have you ever tried getting a great deal and firm price on an MRI, outpatient procedure, or knee replacement? It has always been difficult to get a “real” dollar amount for healthcare. And the real shock is getting a bill in the mail you didn’t expect for something you thought was already covered or paid for.
Healthcare costs are continuously rising and all of us are responsible for a larger portion of those costs these days. As a result, we’re all required to be better consumers, but we need the information available to make informed decisions. The demand for more details and pricing information BEFORE a service or procedure just makes sense.
The problem is that price information can be vague and vary significantly and you want to get your procedure without surprises. You can spend days on the phone and internet – time you don’t have - trying to figure it all out!
I’ve worked in the benefits consulting industry - specifically, health insurance - for 25+ years, so I get it! Since I have some experience that might be helpful, below are my 4 tips to help you the next time you need a “real” price on a procedure…
TIP #1: Know your procedure
Let’s say you injured your back and your doc says you need an MRI to determine next steps. To get a true cost, you need to know exactly what test is needed and what procedures are being recommended from your doctor. Don’t forget to do your homework and get the details! Ask your doctor for the Current Procedural Terminology (CPT) codes. There are over 13,000 codes and they vary a bunch, so you need the exact code for your procedure(s) in order to get at accurate pricing.
TIP #2: Get an estimate
The average American can make a close guess on how much a car costs, but how about a knee surgery? You can use Cost Estimators provided on your health insurance company’s website or other sites such as www.FairHealthConsumer.org. Use this to get a ballpark price for your procedure. Cost estimator websites allow you to review price ranges on common procedures and at different providers in your city. A procedure at one hospital that’s 5 miles from your home can vary by thousands of dollars compared to a hospital that’s just 7 miles from your home. One example is the dreaded colonoscopy where costs can vary by thousands of dollars!
Tip #3: Be aware of the whole picture
Knowing there may be several bills related to one procedure will eliminate the surprise in your mailbox. Typically, the whole picture includes anesthesiologists, surgeons, lab tests, and more. It is typically NOT a package deal. Most providers bill separately as they are contracted separately to provide the services. Don’t forget the costs you may have for durable medical equipment (wheelchairs, walkers, crutches, etc.) which are usually billed separately as well. Pricing estimates for these items can sometimes be determined by your doctor’s office.
Tip #4 Get help
Consider subscribing to an advocacy service. Members are assigned a personal advisor to help with a wide range of medical and insurance queries. While surfing the internet can get you a random estimate, and advocate can review your insurance plan, in-network (or out-of-network) providers with quality ratings, and location to get you a pretty darn good idea of what you’ll be paying out of pocket. They can help with scheduling and organizing the whole she-bang, too (whew!). You can concentrate on your health and leave the rest to the experts. AND, if you happen to get a surprise medical bill in the mail, you have someone to help figure it out and negotiate on your behalf!
Now, it’s your turn! Do you need medical procedure or surgery? Have you recently had a procedure and now the bills are piled up? Did you have something done that you look back and question?
Do you have questions now? Feel free to post them in the comments below or email me at firstname.lastname@example.org.