Heath Care Pricing Transparency and Consumer Rights: Asking about costs
Be proactive with conversations about costs. Bring up the topic with your doctor and let them know if you prefer to research prices before scheduling services or filling prescriptions.
Discussing costs during a visit
TIPS FOR SCHEDULING CARE...
- The government has passed laws allowing some preventative care services at no charge. Check your insurance policy coverage and additional details at CDC.gov. You can schedule a preventative care or "wellness" visit, but be sure to mention it to your doctor as well, because some types of conversations go outside the preventative care boundaries, and you could be charged for the visit.
- If the doctor wants to schedule a test or procedure, ask for the billing codes. Then, do any or all of the following:
- Tell the doctor you would like to get a good faith estimate
- See if it is included in the provider's shoppable services
- Check your health insurance cost estimator website to compare prices with other providers
- Search for the billing codes in the provider's machine-readable standard charges file
- Read this patient guide to surprise medical billing protections you can use now (source: PIRG)
WHILE WITH YOUR DOCTOR...
- If the doctor starts to write a prescription, use your phone to check the price for that drug on your pharmacy benefits website or app (for example, Express Scripts). Also check GoodRX, Capital Rx or CostPlusDrugs for competing prices. If the drug seems too expensive, you can ask the doctor if there are less costly alternatives that would work just as well for your condition. GoodRX allows searching by health condition so that you can see more drug options that might be relevant.
- Some doctor visits use time-based billing (priced by the number of minutes). In other settings, charges are based on the complexity of medical decision making. If possible, you could raise this topic while with your doctor so that when the bill comes, you'll know what level of medical decision making to expect on your bill.
Additional resources
- Patient guide to surprise medical billing protectionsTip: ask "Are you part of my plan's network," not "Do you take my insurance?" The latter could get you billed at out-of-network rates. Source: PIRG.
- Be aware of facility feesDoctor offices, urgent cares, imaging centers and other such centers owned by hospitals may add an unexpected hospital "facility fee" to the bill. This article from PIRG tells more.
- Be aware of "Case rates"A case rate means you'll be charged a flat fee for the visit regardless of services provided. For example, $600 for a flu test or $1,800 for ear wax removal (see news story). Although providers and hospitals keep case rates secret, you can check Google Reviews, Yelp reviews and the Better Business Bureau for reports of exorbitant bills from previous patients.
What your doctor wants you to know to crush medical debt by Written in an accessible style by an internal medicine physician and former health insurance executive.
