fold of hundred dollar bills

People ask us a lot: what can I do to cut health-care costs?

There are different answers, depending on your perspective: patient/consumer, provider (hospital, doctor), payer (insurance company or government or whoever) or someone else.

The most important thing: ask what it costs.

This is not an easy question to ask: many of us are unaccustomed to asking. Asking doesn’t always get an answer.

But ask anyway. And insist on an answer.

Rest assured, everyone wants to know.

Know further: Women make 80 or 90 percent of health-care decisions, depending on which survey you choose to be guided by. Women run health-care decisions for their families, their spouses, their kids, their parents and themselves. Women pay the bills, women question the insurance company. If you want to know a lot about this problem, ask women. In fact, you could ask someone like Casey Quinlan, of MightyCasey Media, who is absolutely passionate on this subject, as she writes in this blog post.

Five suggestions follow.

1. What will this cost me? Ask the question.

Given my insurance, my chosen provider — what will this cost me? Often this question is complicated — we don’t know your deductible, your co-pay, you haven’t met your deductible, we don’t know, we no longer take your insurance, we never took your insurance, whatever. We’re the insurance company and we can’t tell you what it costs at this provider, at this time.

Frank Lalli, a longtime business journalist who tried to find out the answer to this question had a terrible time, and wrote about it for The New York Times — his 70 phone calls to 16 different organizations didn’t

bring clear results. But he kept trying, and so must you.

What will it cost me? Insist on an answer. We’re trying to start a movement here, people.

2. What’s the sticker price?

O.K., now that we have answered Question 1, is there another price that will be charged to other people? Could that price be charged to uninsured people? Or will it be charged to me, in case of a mistake? (We happen to know that there are oodles of billing mistakes.) Also prices vary widely, and this question can be a real eye-opener.

3. Is this covered by my health insurance plan?

We have heard a lot lately about people who found out only after the fact that something wasn’t covered by their insurance plan.

These are folks who pay insurance premiums to get coverage, but find out only after a service is delivered, for example, that the service wasn’t covered, the provider wasn’t participating in the plan, or something else. The New York Attorney General, Andrew Cuomo, commissioned a report on this topic that was delivered in spring 2012; you can read it here.

For a lot of people, that seems like a cruel “gotcha” — you quite possibly are being treated for something unpleasant and anxiety-inducing, and then to get socked with a big bill is doubly and triply unpleasant.

4. Can I have that in writing?
Truly, a  lot of times the person at the insurance company or the provider who’s delivering this information may not be right, or they may be overruled later during the impossibly convoluted claims process, or whatever. Even if you can’t get it in writing, get a name and a date. Keep notes. If you have a name and a date of someone who quoted you a price or a benefits explanation, it’s easier to argue later.

Also, as my friend Dave DeBronkart, also known as EPatientDave, has found, questioning charges and putting those charges in writing can be revealing. He put out an RFP for treatment for a spot of skin cancer, and blogged about it here; he also shopped around for a CT scan, and blogged about that here. It’s hard work, but rewarding.

5. If the cost or the reimbursement diverge from what you’re told, ask questions and challenge the results.

We know, it’s hard. The system makes it difficult for you to challenge, and all the parties — providers, payers, the government, Big Pharma, device makers, retailers — blame someone else.

Challenging a payment or a reimbursement doesn’t always bear fruit, but it can, and you should do it.

Not in every case will you get the answer you want, but it’s important to take ownership. Once I was charged $1,419 for a drug I found I could buy wholesale for $2.49. My argument with a hospital and an insurance company over this — and the resulting charges to me — took about a year, and I blogged about it here. It wasn’t wholly satisfactory, but the charge was egregious, and well worth challenging. And I felt better.

The truth is that the system is broken, and we all need to take ownership.

Oh, and if you have a story to tell us, please write us at info (at) clearhealthcosts (dot) com. The more information we share about this, the better off we’ll all be.


Jeanne Pinder

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...