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PATIENT COMMENTS summarized by Robin Martinez, community coordinator at Smart Patients.
A common topic among our Smart Patients communities is the cost of procedures and drugs. A recent conversation involved internal radiation therapy which would not be covered by insurance for a patient coming from overseas. The patient wondered how to ascertain the price.
Someone mentioned their treatment had been billed for $120,000, with an American insurance company paying $90,000. Another person said she thought $15,000 was the hospital’s actual cost. The patient from overseas still needed to get an actual price for the procedure at the desired facility.
In case it might be helpful to others, here’s a summary from members at smartpatients.com on finding actual prices for procedures:
Our conversations about medical costs show prices for the same procedure vary crazily in the USA depending on who’s paying and where the procedure is performed. If you have to pay for something yourself, shop around. The best thing to aim for is the Medicare price plus a percentage.
The price that matters is what the procedure will cost you as an individual. This is very different than the price that’s on the books — imagine if a car manufacturer’s list price were 30 times what a dealer actually would accept for the car! The price paid by insurance companies can be much less or much more than what an individual would pay, depending on how well the insurance company has negotiated with the provider. The price Medicare or Medicaid pays is typically the rock-bottom price.
Find out the total amount the hospital receives when working with a typical insured patient. Then explain you are without insurance but could pay that same amount. Also ask if the hospital will agree to bill you for all services at the rate for a typical insured patient. This will protect you in case there are complications that require further care.
It may not be easy to get this information. Billing clerks probably don’t know what the cash price would be; they may never have dealt with such a situation. Find a senior staff person who understands the situation, who can negotiate firm figures, and who is willing to give you costs in writing.