Sunday, September 21, 2014
Inquirer Daily News

How to keep your medical costs down

Experts say the trick to managing high-deductible insurance plans is to use techniques that you would when buying any other product - shop around and negotiate.

Here are some tips from Healthcare Blue Book.

How do I shop around?

If you have insurance, "in network" providers are usually cheaper than "out of network." The following general tips apply with or without insurance. These tips assume that cost is the main issue. There may be a reason to choose a higher-priced provider, such as a hospital setting for a tricky procedure.

  • Outpatient: If there is a choice of location for the same treatment, outpatient is usually cheaper than inpatient.
  • Diagnostic tests: Scans, blood work, and other tests are typically less at independent facilities than in hospitals.
  • Walk-in clinics: Places like MinuteClinic offer some of the same services as a doctor's office at lower prices - and urgent-care centers are cheaper than ERs.
  • Generic drugs: They always cost less than brand-name.

How do I ask about price?

To get over the fear of asking, prepare in advance.

  • Know specifics: Write down the exact name of what you will be inquiring about. Also ask your doctor to provide billing codes, known as CPT (for doctor's office visits) and DRG (for hospital treatment).
  • Find out what others charge: Call around. Web tools, while far from perfect, offer examples. See below.
  • Call the office: Ask for the person who can discuss pricing (generally not the doctor).
  • Insurance: If you have it, tell them your company and plan. If you don't, ask for a self-pay discount.
  • Be thorough: Ask for all components of care; for surgery, that would include at least the surgeon, hospital, and anesthesia. Ask if there is more.
  • Get documentation: You may want to get the price in writing, or via an e-mail that you can print out.
  • If it is after the fact: Unexpected sticker shock can still be addressed. Try to get the bill reduced following some of the above steps. If you can't afford it, say so. If they say no, ask for a higher-level manager.

How do I determine a fair fee online?

Use these web tools as a start - they may not do much more - and then call at least three places to compare:

  • Healthcare Blue Book: For a wide range of services, gives "fair" prices by region for cash payment, purportedly similar to what insurers pay (which is two to five times less than the "billed" amount).
  • New Jersey Hospital Association's NJ Hospital Price Compare: Gives "billed" amount for various procedures at each New Jersey hospital, and averages; 90 percent of the time, they are paid less.
  • Pennsylvania Health Care Cost Containment Council's Medicare outpatient database: Gives Medicare payments in Pennsylvania for outpatient procedures in hospitals and in ambulatory care centers; Medicare pays uniform rates within counties, and always below cost.
  • U.S. Department of Health and Human Services' Hospital Compare: Gives Medicare payments for various inpatient procedures at many individual hospitals; amounts are below cost.
  • Insurance company sites: Some insurers provide detailed help to subscribers who register on the site, although the tools may be hard to find. Aetna's cost estimator gives average prices in the area for various procedures as well as specific costs you pay under your plan for specific providers, but not in Pennsylvania; that should be added this year. Independence Blue Cross subscribers can get detailed drug pricing under their plan and average costs for various other services, but not specific providers; they should be added this year as well.

- Don Sapatkin

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