When high deductibles increase your out-of-pocket medical costs, billing experts recommend a few suggestions to help avoid paying more than you should for a medical procedure or doctor’s visit.
Asking questions before, during, and after you receive your bill is the key to making sure you won’t be paying for unnecessary services or amenities.
ASK FOR ITEMIZED LIST OF CHARGES
“Always double check your bills,” said Allison Livensparger, a Mesa mother who learned the importance of asking for an itemized list of charges after she was injured in a traffic accident a few years ago.
“I was almost nine months pregnant,” said Livensparger describing her large belly at the time of the crash. She said it was obvious that she was pregnant, and medical professionals were aware of her status as they were caring for her.
However, someone gave her a pregnancy test while she was receiving other medical treatment.
Livensparger said her family doctor instructed her to ask for an itemized hospital bill. When she did, she found a $136 fee for the pregnancy test.
“Ridiculous!” Livensparger said. “I mean - common sense!”
“Never pay for anything before you know exactly what you’re paying for,” Livensparger recommended. She said her doctor and her insurance company protested the fee on her behalf.
“My doctor actually wrote a note saying that was not a necessary part of the treatment,” she added, explaining how she was not held responsible for the fee.
ASK WHETHER THE SERVICE IS NECESSARY
According to Jason Beans, the CEO and founder of Rising Medical Solutions , a medical bill review and medical cost containment company, every patient should ask a few simple questions before their medical service.
“Before is the time to address everything,” he advised. What is the price? Any discounts? Any payment plans?
“If you cannot afford the prescribed path, what are the options?” he said.
He offered other questions to ask too:
*Why are you doing xxx(be it a test, surgery, etc.) What is the risk of not doing it? What is the benefit of doing it?
* What is the cost of xxx?
* Are there any other alternatives to solve the issue that are more cost effective?
*Is this or any service out of network or not covered by my plan?
* Does this require pre-certification? If so, will you file on my behalf?
“You will often be shocked by what you hear,” he said, explaining how patients have the right to know whether a less-expensive service might be available instead of the recommended treatment.
“It is your health and money. It is up to you to decide what is necessary,” he said.
ASK FOR MEDICAL BILLING CODE AND WHAT FEES ARE COVERED
John Metz, CEO and Executive Director for JustHealth , a non-profit company aimed at helping patients fight unfair bills, said a patient can find out more about the cost of their treatment by learning the medical billing code for a medical service.
By asking for the CPT code ahead of time, Metz said, a patient can find out how much their insurance company will cover for the procedure at a particular facility.
The code can help the patient learn how prices may vary at different locations.
“If you have insurance, ask your insurer how much the cost will be, how much the insurer will pay, and how much you will have to pay,” Metz said.
If you have insurance, it is important to understand your agreement and the provider's agreement with the insurance company.
ASK FOR A DISCOUNT UP FRONT
Beans suggested asking for a discount if you are able to pay in cash.
“Look online for appropriate rate ranges,” he said. “Knowing what others will pay helps peg the conversation at a reasonable rate.”
He recommended fairhealth.org as a resource.
Arizona hospitals are also required to report information about billing rates:
Knowing how much a medical facility will accept from Medicare or other insurers for the same procedure could also be valuable information if you are attempting to find a fair price.
“If you have any concern about the amount of the bill(s) after the services are received, request a copy of your entire ‘designated record set’,” Metz said. “Where appropriate, ask the provider to promptly correct any errors and make any refunds."
Beans said it would inappropriate to dispute a fee after the service, if a patient agreed to the fees and the procedure up front.
"There is an implied contract. Any issues should have been addressed at the time" he said. "If the bill comes in after and is excessive or has charges you were unaware of, that is the time to do research and negotiate."
Metz also suggests keeping a file of medical records well organized. Keep them “(a) in one place; (b) in chronological order; and (c) do not give originals to anyone, unless required by law to do so,” Metz said. “Keep a diary of all interactions/events connected with a medical service. Be sure to note what you are actually told,” he added.
“If you still feel that the bill is wrong,” he said,