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And how much does that cost….?

  |   Health Insurance
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When was the last time you asked about the cost of a medical visit or procedure in advance?  If you are like most people, especially those with good health insurance, the answer may be never.  It is not something health care consumers are accustomed to asking, and medical professionals have historically not been proactive in sharing the information.  The result is patients are surprised, and often horrified, when the bill arrives.  Medical professionals are frustrated when patients can’t and/or insurance providers won’t pay for the services provided.

A simple web search will result in report after report on the increasing cost of health care, especially for seniors, and the frustrations of many medical professionals caught between providing excellent care and earning a living.  While it is true that increasing costs are a big concern, we, as consumers, do have some control over the situation.  We have to ask questions and do a little homework.  Below are some tips to consider the next time you need medical care.

Tip 1: Ask the Health Care Provider/Health Insurance Company Questions

  • Are you in my network? (This is different than asking if the doctor is in your plan.  A doctor can be in your plan as an out-of-network provider, and out-of-network generally means more money out-of-pocket for you).
  • Is the recommended test/labwork/procedure covered by my insurance policy? Is preapproval required?
  • Is the testing facility for the tests/labwork in my network? What about the doctors who will review the results..are they in network?
  • Is this prescription covered by my prescription benefit plan? Are there equally effective but less costly alternatives?
  • Are the emergency room doctors covered in my network (remember, just because a hospital is in your network doesn’t mean all of the doctors are). Of course, it may not be top of mind to be asking questions during an emergency, but if time allows…

Tip 2: Read and Write

  • Read your medical insurance policy/handbook. Know what is covered.  If you have to read a section two or three times and you are still confused, don’t settle for not understanding.  Call whomever you need to call to get clarification.  Ask for specific examples based on medical situations you have previously faced.
  • On your hospital paperwork, if you only want in-network care, indicate that you will only allow in-network care – write it on every page if you need to. Get a copy of the paperwork and remember where you put it.
  • Write down the name of everyone you communicate with, the date of the communication, and all important information provided. If your situation is complicated, use an app, store a document in the cloud, or get an old-fashioned notebook to keep a detailed log of the information.  (Extra tip – If you share responsibility with others for helping an ill family member, keep the important information in a file that can be easily accessed by all involved.  A shared document in Google, Dropbox, etc. will simplify communication among family members and be a good resource when meeting with doctors. )
  • Review your bills and those pesky explanation of benefits statements. Keep an eye out for discrepancies, services you didn’t receive, and $40 aspirin.

Tip 3: Become an Empowered Patient

  • Figure out what type of doctor you prefer and find one that fits your needs.
  • Prepare for your appointments.

    • Write up a summary of how you are doing and list your current symptoms, medications, prior major medical issues, diet, and allergies. If it takes more than a page or two to document this information, you likely have complicated issues.  Request a longer appointment.
    • Write down your questions and make sure you get answers you can understand…a bunch of medical jargon likely won’t be too helpful once you leave the exam room.
  • Know what is going to happen next, why, and when.
  • Understand what the doctor hopes to learn from any tests that are ordered and understand how the results may change the approach to treatment. If the answer is not clear, ask if the test is truly necessary.  Ask about the most cost-effective way to obtain the test (remember that hospital services are generally more expensive).
  • Ask about the benefits and risks of any medication that is ordered (and, MAKE SURE the doctor is aware of all of your current medications), the expected course of treatment, and if there are alternatives to the prescribed.
  • Find out what you can do to improve the situation (and be honest with yourself…there’s likely quite a bit you can do…)
  • Request an in-network specialist who can better assist you.

On a related note, as of January 1, 2019, all hospitals must post their prices online. While many (including me) see this as a small step in the right direction to help consumers make better-educated decisions about the health care they receive, it is clearly a work in progress.  For more information, click here for an interesting read from Kaiser Health News.

AUTHOR - Tammy Wener

As co-founder of RW Financial Planning, Tammy oversees the financial planning process for all clients and manages the day-to-day operations of the firm. She truly enjoys getting to know her clients and is not shy about asking questions. Tammy has 15+ years of experience in the financial planning and estate planning fields and has worked with a broad range of clients including: couples simultaneously planning for financial independence, caring for their parents, and saving for college; newly widowed and divorced women looking to become more financially literate; young couples just starting out; families juggling the demands of a child with special needs; and financially independent individuals and couples exploring “what comes next.”