Shopping for Care

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 dye?  is the tonsillectomy with or without an adenoidectomy?  Charges may vary with each patient.  A diabetic patient may need additional services that would not be required for non-diabetic patients.

3) Ask for the total charge for the test or procedure you need.  At most hospitals, charges are separated into facility (hospital) and professional (physician) services.   There may be other ancillary charges as well.  Ask for a detailed written estimate of charges, but be aware that charges may change if doctors adjust your care plan.  Many hospitals may only give you an average or median price since the charge may vary from patient to patient.

4) Ask if the hospital offers discounts for cash payments in advance or your treatment or for prompt payments after the procedure.

5) Once you know the price of a test or procedure, call your insurance company to find out what your actual expense will be.  Hospitals negotiate prices with insurers, so make sure you are getting your insurance company’s rate.  If you are uninsured, bargain for the lowest rate.

6)  You might ask the hospital how it compares on quality.  Hospitals will not have scores for every test and procedure, but they should be able to point you to some measure of their overall quality.  Here are three quality questions:

a) how many procedures of the type you are having does this hospital do every year (more is generally better, practice pays off)

b) what is the average length of stay? Iif the length is much longer in one hospital than another, that is not a good sign.  It could mean that they care for more complicated patients or that they have a higher hospital infection rate or that they aren’t very efficient.

c) you might ask about their readmission rates.

For more on quality scores, go to our Resources page and look “for Hospitals.”

7)  Some patients want to know about the experience of the doctors who will be reading their tests or performing the surgery.  In teaching hospitals, residents and fellows will be part of your surgical team, supervised by an attending physician.

8) Ask how the surgeon will communicate with your primary care provider and when your care is likely to be handed back to him or her.

1 response to Shopping for Care

  1. I was listening to a program on NPR that mentioned a website where you can compare prices for certain medical procedures. Does anyone know of such a website?

Leave a reply

You must be logged in to post a comment.