It's hard to get health-care prices in advance. These 10 questions can help
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 when 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 appendectomy, a course of cancer treatment).
Here are some suggestions:
Find out the exact name of the procedure and the common procedural terminology (CPT) code — often a five-digit number from the health-care billing system. It will help you compare apples to apples. Here's more about those procedure codes.
Ask the hospital, doctor, walk-in center, or lab: "Are you an in-network provider for me?" Make sure you know which network: Not "Big Blue" but the specific plan, such as "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 me?"
Ask: "What's your cash price for that?" Find out whether there is a prompt-pay or other discount.
Use a pricing service if you can find one online. On philly.com/healthcosts, you can find prices for many common procedures in the Philadelphia region, as well as the Medicare price, 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 careful.
Call two or three service providers, so you have context and a range of options.
Ask: "Will there be any additional charges from you or anyone else? You might find that there are additional fees for reading an X-ray, receiving results, or any other technical or professional fee.
Insist on talking to a representative. If you ask your insurer, "how much will that cost me?" and they send you to their "cost calculator," tell them you'd like to talk to a representative. Cost calculators are notoriously prone to error – and there's no accountability.
Tell both a service provider and insurer: "Please put that in writing and email/send it to me." If they decline, you should take notes, take names and take numbers. For example: "Sue Smith in billing said it would be $528. We talked by phone April 1. Her phone number is 555-123-4567."
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. (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 find a longer version of this guide to determining costs here.
Let us know how it goes. We're interested in your successes — and we're also interested in knowing whether providers and payers are not stepping up with the information. Email us at firstname.lastname@example.org.
Jeanne Pinder is founder and CEO of Clear Health Costs, which is Philly.com's data partner in the Philly Health Costs project.