If you have the time, researching the cost of a healthcare procedure before your appointment may save you money, or at the very least ensure you aren’t surprised when you get the bill.
When dealing with a health condition, people can be consumed with their health as it may be a crisis or unexpected news. We’re more concerned with the implications of a diagnosis on our health than what it may cost us. For some, it’s the cost that will prevent them from taking the next step and getting the necessary treatment. That’s the time to pause and confirm what may be ahead of us financially. Having a clear picture of out-of-pocket costs can help to remove stress and allow you to focus on making the right decisions about our treatment.
Take radiology for example. The cost of an of x-ray can vary by provider. Health insurance plans negotiate the cost of procedures by provider in a given region further modifying the cost of a procedure. Many factors influence the negotiated price such as volume of care, clout and geographic area.
You may find if you’re willing to do a little research, you could save yourself a few bucks. You may need to travel a few miles, but the cost difference may be worth it. Often, we’re referred by our primary care doctor or specialist to a particular facility because they may be part of their network or practice. Don’t feel obligated to go where your doctor says you should go if your research uncovers a better negotiated price at another facility. Let your doctor know your situation; they should be understanding.
Use the Cost of Care Search Tool Offered by Your Insurance Plan
Most health insurance companies provide a search tool on their website allowing you to search for the cost of care for a particular procedure, and also give you a listing of providers in your zip code area who offer that procedure along with the cost. It’s essential that you ask your doctor for the full description and CPT Code of the procedure. The search tools require you be specific in your search. Otherwise, you may get incorrect results.
When you find the cost estimate from the online search tool, it typically applies the negotiated rate and any plan design features including whether you’ve met your deductible, giving you an estimated out-of-pocket cost for the procedure. If getting that test or procedure at another facility can save you money, go back to your doctor and ask them to give you the referral to that new facility. Your doctor will still get the results of the test sent back to them.
Use your EOB for Prior Costs
If you’re planning to get a test or procedure you received in the past, check out how much it cost. The EOB, or Explanation of Benefits, is the statement created when a claim is processed by your insurance plan. Log into your account on the insurance plan to search for old EOBs. If more than a year or two ago, the cost could go up due to inflation or other factors, but at least it can give you a ballpark to estimate the potential cost if performed by the same provider.
Price Transparency Tools
Over the past few years, efforts to increase price transparency to patients has yielded new sources of information the cost of care. While your insurance plan will provide the most accurate estimate on cost of care, there are other sources which can offer estimates which are not necessarily based on your specific health plan, but will offer an average cost of care.
Fair Health provides provides tools to estimate the cost of care based on claims for medical and dental services paid for by private insurance plans, including the country’s largest insurers.
Clear Health Costs is a journalism company from New York City bringing transparency to the health care marketplace by telling people what stuff costs using shoe-leather journalism, data journalism, investigative reporting and crowdsourcing.
Guroo.com was created by the Health Care Cost Institute (HCCI), an independent, nonprofit research organization. Guroo is powered by claims data contributed by some of the nation’s key health insurance providers.
GoodRx helps you search for drug prices at different pharmacies and provides coupons. Insurance is often not used in conjunction with GoodRx.
Blink Health and BlinkRx offers discounted prescription prices on medications and can analyze your insurance, copay, and deductible to find your lowest prescription price.
Review and Compare
At the end of the day, you are in the drivers seat of your health care. Being health insurance literate means understanding your choices, finding the right care and knowing what your costs will be. You may not have the luxury of time to research costs in advance. Ask the doctor’s office or treatment facility what the potential cost may be. They should be able to provide that, especially if they are In-Network with your insurance. You can always call your insurance plan and ask them for insights on costs.