Can you imagine buying a car a piece at a time — and trying to figure out what the total cost is? One person sells you the tires, another a steering wheel — oh, and a specialist will give you a transmission. And you need an engine? The cost will depend on which network you’re in.
That is, of course, how health care is sometimes sold in the United States. You want to know the price of your surgery? OK, but that doesn’t include the operating room, the anesthesiologist or the pathologist . . . they’ll be billing you separately.
But things are beginning to change, partly because Americans are now demanding answers. Motivated by high-deductible health plans and other health care changes, we want to know what we are paying for, and whether the services we receive are competitively priced. And the health care world is responding.
Stephen D. Neeleman, MD, founder and vice chair of HealthEquity, which offers health care savings and spending accounts, says many consumers don’t yet know how to negotiate for the best prices.
And to understand how to work within that system, it’s important to know a few things. First, hospitals may bill for about twice what they actually expect to receive, he says. Networks with negotiating power have agreements with the health care providers that allow them to pay less than the price you’ll see on your bill. So the amount you are billed can depend on whether you have insurance and which network you’re in. Different people pay different prices for the same service. Why can’t you get the best discount? The good news is, you may be able to. Here are some of Neeleman’s tips.
1. Offer a lower lump sum cash payment instead of payment in monthly installments. Yes, they give up a little money, but they are assured of payment and that there will be no need to write off the bill or send it to collections.
2. Talk to the right person. The right person is typically the office manager, and you can open the conversation with, “I’m here, and I’m ready to pay. I realize there are other patients that get better discounts because they are in bigger networks. I want the best deal you give anyone if I pay right now.” Even if your plan has a negotiated rate that is on the high side, the health care provider is free to charge you less than that, Neeleman said.
3. Call at the right time. The right time is as far ahead of your procedure as you can. Having surgery? There can be a dramatic difference in what facilities charge. You have time to find out where your surgeon performs surgery and if having it done at facility X on Tuesday is cheaper than having it done at facility Y on Wednesday, you’ll want to know that. Explain that you want to understand how the charges are determined because you will be paying for a lot of your expenses yourself. (Neeleman said you may be surprised to discover that many conditions don’t require emergency treatment, citing an example of a patient who, on a doctor’s advice, flew cross-country with a complex fracture so that she could be treated within her network, for a much lower price.)
4. Request that your services and procedures be recoded and verified for accuracy. You can look online to check the meanings of the CPT codes. Make sure those agree with what you believe the diagnoses and services were, and ask questions if they do not. Mistakes happen. Neeleman compares it to when grocery store cashiers keyed in prices and now when items are scanned. There is no scanning of medical procedures, and you need to check your bills at least as carefully as your mother checked her grocery receipts.
5. Know what the cost should be before making any payment. Your insurance company may have a tool to help you figure it out. You can find similar information here:
6. Don’t pay your bill right away. Give yourself time to be sure the bill is accurate, checking codes and expected prices carefully. However, you do want to pay on time. Medical bills can affect your credit. If you don’t pay, the account may be turned over to collections. (In fact, try to figure out which providers should be sending you bills, and ask questions if you don’t get one. Even bills you never received can wind up as collection accounts.)
7. Be nice. Understand that patients and providers who actually know what things cost is a fairly new phenomenon. So ask rather than demand, and let them know that you’re looking for a solution that will benefit both parties. Your mother was right: It pays to be polite.
Health care is changing, Neeleman said, but it’s slow. In some cases, charges are now being bundled so you DO know the final cost of a procedure. But it’s a whole new world. He compares it to being an early buyer of a Model T — you have the car, but where are the roads? Where are the gas stations? Concerned consumers are forcing a new transparency, though, and that can only be good in the long run.