How to Clarify Unclear Healthcare Costs
4 min read •
30 sec brief
Finding out the cost of healthcare can seem almost impossible with insurance, co-pays, and whether or not something is covered by your plan. We've identified a few ways for you to help clarify your healthcare costs so you have a better understanding of how much you'll be paying.
With the rising cost of premiums, copays and deductibles, medical care is becoming (if not already) an increasingly large household expense. Adding to that financial stress is that the system does not proactively divulge out-of-pocket costs in advance of care.
It’s no wonder why two-thirds of Americans say they are concerned about the financial hit of being slammed with unexpected medical bills. With good reason. Another survey found that about half of people were surprised to get a bill for something they thought their insurance would cover, or they were surprised at how large their share of the bill was.
That said, there are steps you can take to learn about costs ahead of non-emergency treatment and to reduce the odds you will be hit with “surprise” bills for tests and treatment.
Ask for an estimate before any treatment.
Whether it’s a doctor’s office or a hospital, you can request an estimate of your out-of-pocket expenses. There’s no guarantee the estimate will hold, but it’s better than going in completely blind.
Get a sense of whether the estimated cost is in-line for your area.
The quality of care and the confidence you have in your providers comes first, but if you are in a region with abundant quality care, you might want to do some comparison shopping.
The Fair Health Consumer website is a non-profit that provides average local costs for medical procedures. The Clear Health Costs website lists specific providers and costs by zip code, relying on crowdsourcing and data journalism.
Try to confirm every caregiver will be in-network.
If you need tests or a procedure, confirm that any facility you step foot into is covered by your plan.
The more involved your test or procedure the trickier this becomes. Need an MRI? Even if you confirm that the test will be in-network at your chosen facility, that doesn’t guarantee that the radiologist who reads the test will be. Or you may have chosen an in-network doctor for a procedure or surgery, only to find out after the fact that the anesthesiologist the doctor brought in, isn’t in-network.
Be proactive and ask doctors (especially surgeons) who else will be involved in your care. If you find out one is out-of-network, you might ask the surgeon if they have equal confidence in an in-network colleague.
Make sure all treatment has been pre-approved by insurer.
Your doctor may confirm for you, but it doesn’t hurt to double-check.
Ask about generic medications.
Your doctor may have a very good reason for prescribing a specific medication, but if the price is very high, ask about potential alternatives, including generics.
Check what emergency rooms are covered by your plan.
Emergency room visits are the biggest source of surprise medical bills, as the facility and often the doctors are not in-network. In a critical situation, you (or the ambulance transport) will head to the nearest care. But in less critical situations knowing in advance what E.R. is in-network can help you bypass a nasty billing surprise.
Don’t fold if you are hit with surprise charges.
Request an itemized bill that includes the service code for every charge. You can decipher the codes with some quick online searches. Compare your final bill to estimates, and don’t be shy about asking for explanations of anything that doesn’t make sense to you. If you can’t resolve a dispute with the billing department, escalate to your insurer. If that’s a dead-end you contact your state’s consumer health office. Consumer Reports has links to help you contact the right people on the matter.
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