Do you consider yourself a savvy healthcare consumer? I do, but a couple of summers ago, I made some mistakes that cost me $905 – and it could’ve been much worse! Here’s my story and hopefully it will help you, too.
It was time for my annual mammogram and my doctor thought it would be good for me to have one additional diagnostic test based on some issues I was having (I’ll spare you the details – you’re welcome!).
I made my normal appointment at my normal imaging center. No big deal, right? The week prior to my appointment, they called to let me know that the cost would be $745 for my mammogram. Wait…WHAT?! This is a 100% covered procedure under my medical plan and shouldn’t be any cost to me. Not so fast! They nicely explained that they were an “out-of-network” provider for my plan. In other words, they didn’t have negotiated pricing with my insurance company, therefore, I would be paying their full price. Because my out-of-pocket cost went from $0 to $745, I opted to find a different provider.
TIP: if you change insurance companies or plans from year to year, don’t expect your providers to be “in-network” and don’t expect to pay the same price you paid under your previous medical plan.
I heard from a friend who really liked the imaging center she used and we have the same insurance company. To be sure, I checked my insurance company’s website to see if it was an in-network provider. Check. Good.
TIP: Always check with your insurance company’s “in-network” list when you’re in need of a new medical provider. OR, if you have an Advocate who helps with these things, ask them to do it for you.
I made my appointment and off I went. I loved the location and atmosphere - felt like I was at a spa. The customer service was amazing. I had my 2 procedures and was in and out within about 40 minutes. I even had “green light” results on my tests before I left. WOW, impressive!
AND, then I got a bill for $382. I repeat: wait…WHAT?! I expected to pay something for the additional test my doctor ordered, but I didn’t know how much it was going to cost. Why didn’t I know? Because I didn’t ask! Why didn’t I ask? Honestly, I didn’t have time to do the research and I really didn’t think it would cost much for a little additional diagnostic test.
At this point, I thought, “Well, it’s worth $382 for the peace of mind and knowing that all is OK with ‘the girls.’ After all, I was seen by a few highly-trained technicians. I’m sure all that imaging machinery and equipment is expensive. Don’t forget the behind-the-scenes professionals who evaluated the tests. There are a lot of costs that go into the additional procedure I had.” I was weighing my perception of the cost of the service I received versus the amount I paid and found it to be a fair price.
AND, then I got a bill for $523. I repeat: wait…WHAT?! At this point, I was calling the imaging center to ask, “What the heck? Surely there was a billing error.” Unfortunately, they explained this was the correct cost – one bill was for the facilities cost and the other was the technician cost. UGH!
TIP: NEVER assume the cost of any medical procedure, no matter how quick or insignificant you think it is. After all, we hear stories of people who were charged thousands for a 45 minute visit to the ER and a bottle of Pepto Bismol. If you’re conscious and have the ability to request pricing up front, do it! I know better - click here to read a story about how I handled this the RIGHT way (using my Advocate) in the past.
TIP: Discuss every procedure with your doctor. Obviously, your doctor doesn’t know your medical plan or the cost you’ll pay for the prescription they’re handing you. Additionally, it’s been estimated that 30% of healthcare spending is unnecessary and it’s your doctor who is likely the prescriber. That fact should give you more confidence about questioning your doctor. Had I known the cost of this procedure, I may have opted not to do it. I would’ve had a very different conversation with my doctor.
Gary Fradin, president of The Medical Guide, an organization that educates Americans about unnecessary care, notes that “only about half of all medical treatments are beneficial – while some treatments make biological, theoretical and logical sense, they are proven ineffective in clinical tests about half the time.” He counsels people to ask their doctor, “How good is the evidence that this care will benefit ME?” In other words, focus discussions with your doctor on medical evidence and outcomes. Had I asked, “What if I don’t have this procedure? Is my issue THAT concerning?”, I may have avoided this additional cost for an unnecessary procedure.
Now it’s your turn! Have you ever had to pay for a medical procedure after-the-fact without knowing the cost up front? Do you have questions? Feel free to post them in the comments below or email me at firstname.lastname@example.org