More than ever consumers are being asked to cover more in health-care costs through increasing premiums, co-pays, and deductibles, and as a result are becoming more cost-conscious. The cost of one in-network procedure alone can fluctuate as much as 400%. The health-care price structure is fairly complex, but consumers are pressing for answers as to why hospitals don’t provide an estimated cost of medical procedures and why there isn’t a price transparency for the consumer?
The first issue with financial disclosures from a doctor or hospital facility to patient is a basic one. Doctors are seldom aware how much their patients actually pay. Consumers are covered by a variety of insurers, all of whom offer different health plans, for which there are different co-pays and deductibles (which may or may not have been met) at the time of the procedure.
Then it gets even more complicated, as doctors, surgeons, and anesthesiologists may all be in different networks from those covered by the health insurance plan. For example, this can happen if a doctor doesn’t join the same network as the hospital he/she works at. Or you may find that both the doctor and hospital are in-network, but your anesthesiologist may be out-of-network, forcing you to pay a heftier price. It’s common for anesthesiologists, pathologists and radiologists to not accept certain health plans. When possible, you may want to consider requesting an in-network provider. Or you may also come across a situation where your doctor is in-network, but operates at a center that isn’t, leaving you to deal with the “facility charges” that your insurer may refuse to cover. Again, if you are aware of this ahead of time, you can ask your doctor if he/she works at another facility that is in-network.
Regardless of all these facts there are however still, ways to get an approximate value of your procedure. Even though it can be complex, start by figuring out the details with your insurance company. Do they cover your procedure? What is your co-pay and how much are you required to pay? If you are getting a quoted figure, ask if it’s a chargemaster or a negotiated rate by the provider and the insurance company. Being familiar with your plan will let you know if you’ve met your deductible and the percentage your insurer will cover. Don’t be afraid to ask, and if you’re still unclear, ask again. You can discuss the fees and your questions with both the insurer and your provider. Sometimes you may also need a “pre-authorization” from your provider before scheduling your procedure to assure you’re covered.
If you’ve tried everything and you still can’t get a definite estimate before your procedure, you can at least ease your mind by using sites like as healthcarebluebook.com and newchoicehealth.com that will give you a ballpark estimate based on your geographical area and the medical procedure needed. Doctors and insurers are continuously working to improve online techniques to provide a better price transparency system, even though they still have a longs way to go.
But on the other hand, life also happens and you may not have time to get an estimate or agree to the marked up fees. Imagine you’re perfectly healthy and go into work, only to injure yourself accidentally. Hopefully your workers’ compensation can cover the costs of your emergency room visit; otherwise that emergency room visit alone can cost you approximately $8,502.43. Either way, when you walk-in to the emergency room, bleeding and in excruciating pain and you’re given a form to sign that legally states you agree to pay the bill, which not only you haven’t seen but can’t get an estimate on. That’s in my opinion, unfair – legal contracts pushed on individuals at the time they are most vulnerable, a voracious pricing tactic, with outrageous markups.
After you’ve signed the contract you are liable for paying the service received. If you can’t afford your bill, your medical facility may have a creditor or their in-house collection department who deals with unpaid medical bills and may be able to help or at least agree to set up a payment plan. Even though there is no definite time frame, most medical offices will submit your bill to collections after three to six months. If the medical facility is unsuccessful at collecting your payment, they will sell your debt or transfer it to debt collectors, who are more aggressive in pursuing past-due debts. According to Experian, debt collector agencies can input a collection account on your credit report, which can drop your credit score by up to 125 points. After that, civil action may follow, where a medical facility may pursue wage garnishments, place a property lien on your home or a bank levy to force payment.
Don’t be afraid to discuss a payment plan that is suitable for you with your doctor. If you are struggling to afford your care, you can ask for a discount. When paying cash, providers will work with you and may be likely to give you a discount. There may also be charity care programs available to help. And more often than not, payment plans can also be arranged. However, do beware of health care credit products, as they often come with very high interest rates.
Written by Vania Silva. Vania is a patient advocate who specializes in medical and legal issues.