And now, in this age of high health insurance deductibles, many of us want to do the same thing and get a cost estimate before receiving services when our bodies need a test, a tuneup or major repair.
Medical Care Shopping 101
Let’s say you need an MRI of your knee. Ask your doctor a few questions up front:
“What is an MRI likely to cost me?”
“Are there places that charge less?”
“How can I shop around and compare prices for an MRI?”
Unfortunately, your doctor might not know the relevant pricing information for your MRI since prices differ quite significantly based on facilities.
Follow these 5 tips to get the best care at the best price.
1. Get the full name and CPT code for what you need
Ask your doctor for the name of the service and the code for the procedure (for example, a knee MRI.) There’s a standard “CPT code” for every medical service you can think of. A knee MRI scan, which looks at both soft tissues like muscles and bone tissue, is code 73721. The code is how doctors and hospitals bill insurance companies. Knowing this information will help you accurately ask the price of your upcoming procedure when talking to hospitals or doctor’s offices.
2. Check the ratings and reviews
Put together a list of places you might want to go for your procedure. How? Websites like Angie’s List are offering members doctor reviews. Healthgrades.com, ratemds.com, vitals.com and zocdoc.com provide a similar service as previous paitents are rating and reviewing their experiences with particular doctors.
And if you know you need hospital care, check out the government’s Hospital Compare site, or the private hospitalsafetyscore.org. They’ll show you your local hospital’s score on preventing medical errors and infections and other important measures of quality.
3. Find out the price range.
Healthcare Blue Book helps you find a “Fair Price” for many medical services in your area. They concentrate on medical services you can plan for, such as lab tests, MRIs and CT scans, ACL surgery, etc. Seeing the range of prices docs and facilities charge, you’ll find out that the same service, the same CPT code, can cost drastically more in one office or facility than it does a few miles away.
TIP: The biggest price differences almost always come from what the hospital or surgical center or lab charges, not from the doctor’s charges.
4. Call and price check.
The Healthcare Blue Book will give you the lowest priced option in your local area but it’s always a good idea to call to double check and make sure that your insurance provider is covered. Once you know what a fair price is, and you have the CPT code for the service you need, you can call the facility that you intend to use and ask, “How much do you charge for a 12345?”
Be prepared – the place you call may send you right back to your health insurance company to get the “allowed amount,” which is the fee that the facility has agreed to accept from your insurer.
5. Use a medical cost estimating tool.
Good news for more and more of us – health insurance companies are starting to provide their members with online tools that let you look up the service you need, find physicians and facilities that do that service near you, compare costs, and show you what you personally would pay now, today out of our pocket based on your plan, deductible, co-pay, etc.
Watch this video to see how Priority Health’s Cost Estimator works:
It makes sense, doesn’t it? Insurance companies are the ones paying the hospitals, labs, radiology centers and physicians – they have the data on what these health services cost. And they know the information relating to their member’s health plans and how much each will be expected to pay when they incur a cost.
Once you’ve checked for quality and price, you can set up your procedure. Or let your doctor know you want to go to X facility, and they’ll set up the appointment for you. Either way, there’s a good chance you’ll have saved yourself a couple of hundred – and maybe even a couple of thousand – dollars.
As our doctors and hospitals get better at answering questions about what they charge, and our insurance companies get better at letting us know what costs to expect, there’s no more just waiting for the bill. No more buying blind.
