Jeanne Pinder is the founder and CEO of ClearHealthCosts. Previously she worked for The New York Times for 23 years as an editor, reporter and human resources executive. This article originally appeared on ClearHealthCosts.com.
How much will that medical procedure cost? How much of that cost will I have to pay? It's hard for patients to figure all this out.
Medical prices might be lower if they were more transparent. If we all ask about and compare the costs of care, we can hope to make that behavior the norm. You might also save hundreds, perhaps even thousands, of dollars.
Comparison shopping works well for procedures where you can choose where to go (an MRI, a sore-throat visit, a cardio stress test) and less well for emergency or non-discretionary procedures (an emergency appendectomy, a course of cancer treatment).
Here are some easy steps:
1. Find out the exact name of the procedure and the Common Procedural Terminology code — often a 5-digit number from the health care billing system. It will help you compare apples to apples (not "What does an MRI cost?" but "What's the price for an MRI of the lower back without dye, CPT code 72148?"). Here's more about those procedure codes.
2. Ask the hospital, doctor, walk-in center, lab, whatever: "Are you an in-network provider for me?" Make sure you know which network: Not just "Big Blue" but the specific "Big Blue Silver Select HMO."
3. Ask specifically about that procedure by code: "I need an MRI of the lower back without dye, CPT code 72148. How much will that cost? How much will that cost me?"
4. Ask: "What's your cash price for that? Is there a prompt-pay or other discount?" We hear more and more that people can get a better price by paying cash. That's right — put away your insurance card and save money. This seems counterintuitive, but we hear this a lot. Read more here.
5. Use a pricing service if you can find one online. At ClearHealthCosts, you can find prices for many common procedures in several cities; ClearHealthCosts also supplies the Medicare price in your locale, which is important because what Medicare pays is the closest thing to a fixed or benchmark price in the marketplace. Some pricing services are better than others, and some will charge you for matching you with a provider. Be cautious. Here's a list of resources nationwide that may be a help — but don't expect these state and other databases to give you The One Clear Answer.
6. Call two or three service providers, so you have context and range of options.
7. Ask: "Will there be any additional charges — reading the X-ray, receiving results, any technical or professional fee or the like, from you or anyone else?"
8. Ask your insurer, if applicable: "How much will that cost? How much will that cost me?" If they send you to their "cost calculator," tell them you'd like to talk to a representative. The cost calculators are notoriously prone to error — and there's no accountability. Insist on talking to a representative and getting quotes or estimates in writing.
9. Tell both service provider and insurer: "Please put that in writing and email it to me/send it to me." If they decline, you should take notes, take names and take numbers: "Sue Smith in billing said it would be $528. We talked by phone April 1. Her phone: 555-123-4567."
10. If you are insured and choose to pay a cash rate, know this: you might save money, but it's likely that cash payment will not be credited against your deductible. Feel free to ask your insurer. (You should be able to use your Health Savings Account or HSA, if that applies.) On the other hand, many of us don't meet our deductibles. I bought an MRI for $450 cash toward the end of a year in which I knew we would not meet our deductible, and saved at least hundreds if not more than a thousand bucks.
You can read a longer version of this post here.
It's a little easier sometime to find costs of medications in advance. Here's our prescription-buying page, with a number of resources.
Even with this, though, doctors and patients often don't know what's covered under a patient's insurance. So it can be a complicated process. Here's an example from Martha Bebinger at WBUR public radio in Boston, of the search for insulin.
Let us know how it goes. We're interested in your successes — and we're also interested in knowing if providers and payers are not stepping up with the information. Email ClearHealthCosts at email@example.com.