Discussing Costs

FIRST!! If asking your doctor about the cost and quality of health care makes you nervous, here’s guidance from CommonHealth blogger Carey Goldberg.

When you are ready to ask…

1) Your doctor, nurse of office staff member where to find the best care at the best price.

If your doctor recommends an MRI or a stress test or knee replacement surgery, you might ask:

1)   How much will this cost?
2)    Where will I get the best care?
3)    Is it worth is to go to the hospital with the best reputation?  I know that some of these hospitals are more expensive and the quality isn’t any bettter, but isn’t peace of mind worth something?

Many doctors, nurses or the nice people at the front desk don’t know the cost of tests or procedures, but they may be able of offer guidance.  We have suggestions about how to use that guidance from Lynda Young, M.D, president of the Massachusetts Medical Society. More…

2) A hospital how much a test or procedure will cost.

Many of us don’t choose a hospital; we go to the hospital our doctor recommends or the one where he or she admits patients.  But with high deductible health insurance and plans that charge higher co-pays for treatment at “high cost” hospitals, more patients are starting to shop for the best care at the best price.

If you are shopping for hospital care…

1) Find out if your insurance plan limits which hospitals you can use or will charge you more to use one hospital than another.  If you have an HMO plan, your doctor will have to authorize the treatment or procedure at the hospital you choose.

2) Make sure you know exactly what tests or procedures your doctor is ordering, starting with the specific name.  You may even want to get the billing code.  Are you, for example,  having an MRI with or without contrast die?  Is the tonsillectomy with or without an adenoidectomy?  Charges may vary with each patient.  A diabetic patient may need additional services.  More…

3) A lab how much a test will cost.

 If you are shopping for an MRI, CT Scan, mammogram or another test…

1) Make sure you know exactly what you need.  Ask your doctor for the name of the test and how it is performed.  Some MRIs, for example, are done with an IV injection for contrast. Tests have specific billing codes.  Some billing offices may ask you for the code so it would not hurt to get it from your doctor,  but be sure you have the full name of the test.

2) Make sure you get the total charge for the test you need.  At some labs you will receive separate bills for lab and physician services.  There may be other ancillary charges as well.  So make sure you ask for the total cost of the bill you would receive.

3) Once you know the price of a test, it’s a good idea to call your insurance company and find out what your actual expense will be.  You may be responsible for the total charge, a portion of the charge or your co-pay.  More…

4) Your insurance company how much you’ll pay for a test or procedure.

If you have insurance, it’s  a good idea to call your insurer or check their website before you make any moderate or expensive health care spending decisions.  Members can log in on most health plan sites, using their member ID #, and review their benefits, claims,  etc.

Once you are on the site or on the phone with someone from your insurance company:

1)  Make sure the lab or hospital you want to use is covered by your insurance plan.

2)  Find out if you need a referral from your primary care doctor for the care you are seeking.

3) Ask what your total charge will be (there are many reasons that this will vary from person to person and plan to plan)  More…

5) Your doctor if s/he’s on a budget for your care and how that affects his or her decisions.

Some doctors are on a budget for their patients’ care. If you are in an HMO plan, this might include you.  Supporters say that giving doctors a lump of money, instead of paying them for each office visit, test of procedure, lets doctors design the best care plan and spend more money on prevention.  But some patients worry doctors will be less likely to recommend tests, prescribe brand name medications and some authorize some procedures.

We’ve asked the Massachusetts Medical Society (MMS) to answer these common patient questions.  James Feldman, M.D., chair of the MMS Committee on Quality of Medical Practice, has offered these responses. Dr. Feldman is Professor of Emergency Medicine at Boston University School of Medicine.

1)     Why are doctors setting budgets for patient care?

The cost of health care continues to rise at an unsustainable rate. As a result, insurers and employers – those who pay for health care – are driving the decision to explore options to control costs, not necessarily to reduce costs but to slow the rate at which health care costs are increasing. More…

Leave a reply

You must be logged in to post a comment.