As part of our mission to help you save money by beating back your health-care costs, we’re running a series of blog posts giving practical consumer advice about the marketplace. Here’s the first post about saving money; following is the second.
Even if it’s an emergency, ask the price in advance.
If you’re in a medical emergency situation, it’s hard to have the presence of mind to ask the price in advance, but we suggest that you try anyhow.
If it’s a discretionary procedure, maybe it’s not so hard: what does a colonoscopy cost? What does an MRI cost? But an emergency is more complicated — and yet you should still ask. How much should anesthesia for surgery cost? There could be a lot of answers.
A friend who had an emergency appendectomy not long ago at a hospital that participates in her plan, with a surgeon who participates in her plan, was surprised after the fact to receive a bill from an anesthesiologist who did not participate in her plan. She was billed the sticker price, and not the negotiated or network rate.
The bill was for several thousand dollars, while a participating anesthesiologist would have had a modest co-pay.
I’ve heard several stories about nonparticipating anesthesiologists, and had one such experience myself in the past. I’ve trained myself to ask as often as possible, but it’s not clear to me that I would have had the presence of mind if I was unconscious or in need of emergency treatment.
Legislative and regulatory efforts by states to address these anomalies are not unheard-of, but the problem persists.
My friend addressed the hospital about this issue, and they told her to talk to the anesthesiologist in question. The anesthesiologist insisted on getting paid the full price. The insurance company was unsympathetic.
Eventually, after the bill was submitted several times to the insurance company, the company paid.
The rights and responsibilities of the provider, the customer (oops, patient) and the establishment where the event took place are murky and often decided on a case-by-case basis. Regulations vary by state.
The practice by hospitals and other establishments of using nonparticipating anesthesiologists, radiologists and other pathologists is growing, and it is not always easy to find out who’s participating and who isn’t. It lends to the feeling of mystery in the system. Your part is to keep asking.
If you don’t or can’t ask before, and find yourself billed for a hefty sum after, it’s time to negotiate over your medical bills.
Some people think you shouldn’t ask the price in advance.
My friend S., who has spent a great deal of time in the health-care industry, says she’s cautious about the idea that people should ask in advance.
The price the provider quotes is a sticker price, she says, and it may have no relation to what the payment is.
For example, for a procedure priced at $100, Insurance Company A may pay $50 to Provider X. By the logic of the industry, if you are insured by Company A, even if you haven’t met your deductible, the price to you is $50.
S. thinks that if people ask the price and are quoted $100, they may not choose to have the procedure – because they don’t know the price to them is $50.
I see her point, but I still think you should ask.
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As always, our posts should in no way be construed as offering medical advice. We are strictly about pricing. Our stated mission is to bring transparency to the health-care marketplace. Your decisions about treatment, providers and anything else belong strictly to you.
We’re starting this series with this list of topics. Send us your suggestions to email@example.com!
1. Ask the price in advance.
2. Even if it’s an emergency, ask the price in advance.
3. Some people think you shouldn’t ask the price in advance.
4. Do you really want to make medical decisions based solely on price?
5. Hospital and other rates are regulated by somebody, aren’t they? So there’s not really a great deal of variance. Wait, they’re not regulated?
6. The new movement toward “consumer-driven health care” will change the entire equation, and bring consumers to the fore, thus reducing costs. (Keep a hand on your wallet.)
7. Get someone’s name, and keep it–in general, keep careful records.
8. Know what your plan covers.
9. Read the small print. Ask questions if you don’t understand.
10. Read the doctor’s bill. Ask questions if you don’t understand.
11. Read the explanation of benefits from the insurance company. Ask questions if you don’t understand.
Send us your suggestions to <a href=”mailto:firstname.lastname@example.org”>email@example.com</a>, and thanks!
Jeanne Pinder is the founder and CEO of ClearHealthCosts. She worked at The New York Times for almost 25 years as a reporter, editor and human resources executive, then volunteered for a buyout and founded ClearHealthCosts.
She was previously a fellow at the Tow Center for Digital Journalism at the Columbia University School of Journalism. ClearHealthCosts has won grants from the Tow-Knight Center for Entrepreneurial Journalism at the Craig Newmark Graduate School of Journalism at the City University of New York; the International Women’s Media Foundation; the John S. and James L. Knight Foundation with KQED public radio in San Francisco and KPCC in Los Angeles; the Lenfest Foundation in Philadelphia for a partnership with The Philadelphia Inquirer; and the New York State Health Foundation for a partnership with WNYC public radio/Gothamist in New York; and other honors.
Her TED talk about fixing health costs has surpassed 2 million views.