Monday, November 30, 2015

I'm retiring soon and plan on purchasing a plan. How can I get provider price information?

A reader asks how she can get provider price information before purchasing a plan.
A reader asks how she can get provider price information before purchasing a plan.

QUESTION: I am planning to retire soon. I'm 63. I'm considering a high deductible, lower premium plan. The deductible is $3,000. I do visit doctors regularly and take a prescription. I understand the price I will pay for visits, meds, etc will be the price negotiated by the insurance company. But no one there is able to tell me where I can get those prices. I think its important to be able to estimate when/if I will hit the deductible. The best answer I could get from them is to use this years charges as estimates. That maybe helpful for future known healthcare, but what about something new and unexpected? Any ideas? Thanks!


ANSWER: Provider price information is notoriously difficult to come by. If your insurer is unable to supply it, you can try contacting the individual providers directly. Your doctors should be able to give you their negotiated prices for services rendered under your plan, although it may take some persistence on your part to get it. For prescription medications, you can ask your pharmacy or the company that administers your pharmacy benefit plan. There are also a few websites that provide a general idea of health care prices in your area. Try Healthcare Bluebook.

Additionally, if your income is less than 2.5 times the federal poverty level ($28,725 for an individual), you will be eligible for a subsidy to reduce your copayments and deductibles, if you purchase a silver level plan on an exchange.

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  • Robert I. Field, Ph.D., J.D., M.P.H. is a professor of law at the Earle Mack School of Law and professor of health management and policy at the School of Public Health at Drexel University. He also writes for The Field Clinic blog. Ask Rob your questions about the new healthcare law.

    Professor, Drexel University Kline School of Law & Dornsife School of Public Health
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