This is an updated version of an article originally posted in April 2017.
How much will that medical procedure cost? How much of that cost will I have to pay? It’s hard for patients to figure this out. We’ve got you covered.
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 discretionary procedures where you can choose where to go (an MRI, a sore-throat visit, a cardio stress test, a medication, a surgical boot) and less well for emergency or non-discretionary procedures (an emergency appendectomy, a course of cancer treatment).
Also, it’s entirely possible that for lower-cost or routine items — that MRI, an X-ray — you can pay less by putting away your insurance card and paying cash.
If you think about it, most of our interactions with healthcare are subject to our choice — and we have more control over prices than we might initially think. But it does take some work. So the next time you need an MRI — or, really, anything — try asking.
Here are some easy steps:
- 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.
- Ask the hospital, doctor, walk-in center, lab, whatever: “Are you an in-network provider for me?” Make sure you know which network: Not “Big Blue” but the specific “Big Blue Silver Select HMO.”
- 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, on my insurance?” Remember here that you need to take into account your co-pay (usually a flat fee, say $25 for a specialist), your deductible (have you met it?) and your co-insurance, if any (many people have, for example, 20 percent co-insurance, the amount you pay after your deductible is met).
- 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.
- Use a pricing service if you can find one online. At ClearHealthCosts, you can find prices for many common procedures in several cities; these are not up-to-the-second (who can do that?), but helpful. 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, and is often used to open an offer with a provider. Use two or three pricing services to compare results, maybe from some of these sources: Billy will require you to give an email address (which we dislike) and while it looks possibly more accurate than others, we find the interface challenging to use; we’ve tried Turquoise but we think they undershoot prices, and they add “Use the prices above to estimate your out-of-pocket cost. To verify your out-of-pocket cost, contact your healthcare provider”; FairHealthConsumer seems wildly off the mark and includes the notation “Estimates are based on the 80th percentile,” whatever that means; HealthCareBlueBook used to be free, but now they have a free tier that requires registration, and sell their services to employers. Note: Some pricing services are better than others, and some that look like pricing services are actually intermediaries (NewChoiceHealth, MDSave etc.) that get paid behind the scenes for matching you with a provider, so they may send you to a place that works for them — and not necessarily for you. Many of these are based on the pricing data released by hospitals, which can be garbage, so … reliable? Maybe not. Be cautious. But having even flawed knowledge in advance works to your advantage.
- Call two or three places that offer your MRI, so you have context and range of options. If it’s, say, an MRI, make sure you call not only a hospital but also a self-standing radiology center or two — they are almost invariably cheaper, for an MRI and just about anything else. Hospitals are more expensive. Period.
- Ask: “How much will that cost? 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?”
- 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 ar notoriously prone to error – and there’s no accountability. Insist on talking to a representative and getting quotes or estimates in writing. Same as above about deductible and co-insurance, and any additional fees (reading fee? facility fee?).
- 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.” You can also record conversations, sometimes with one-party consent (read more here).
- Pro tip: Some places will not allow you to use a cash price if they know you are insured. 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. (Read more here.) Also, if you are insured and want a cash price, you are entitled to insist that the cash price is available to you, regardless of insurance status, because you are not required to divulge your insured status to anyone. (Read more here.)
I did a longer version of this 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 us at info@clearhealthcosts.com.
Part 2: How to argue a bill.
Part 3: Appealing a denial, or how to turn a “no” into a “yes.”
Also: Negotiating a bill.
Maybe it’s better to put away your insurance card and pay cash.
