The recent post “How To Haggle With Your Doctor” in the New York Times prompted many thought-provoking comments by readers.
I decided to put my two cents in, as well . . .
Wow! This brief article has elicited emotions and accusations from all directions. The submitted comments highlight both the significance of healthcare costs and heated frustrations with the complexity of the payment system.
Comments by readers relate to a vast array of healthcare services (outpatient office visits, lab tests, pathology, major surgery, radiologic imaging, endoscopy, emergency department visits, hospital stays, anesthesia, etc.) Each of these services involves separate players, and is handled differently in terms of cost and payment. Unfortunately, there is no single universal approach to reducing one’s cost in all of these settings.
Taken as it is presented, the article is very accurate and provides tips that are indeed helpful for the selected situations. For that, I would like to thank Ms. Parker-Pope, Ms. Konrad and Dr. Kullgren.
A few comments/observations related to both the article and reader responses . . .
- In terms of timing the discussion of cost during an office visit, it depends on what you hope to accomplish. If you are hoping for a streamlined or reduced-cost visit, you can politely mention at the start of the encounter that you are trying to watch expenses. Although you may never know that it occurred, most compassionate medical providers will take your concerns into consideration as they conduct the visit and determine their charges. You can wait until later in the visit to discuss the cost implications of prescriptions or tests that might be ordered.
- It is usually not possible to determine an exact price when calling to schedule an office visit because the receptionist/scheduler cannot predict the complexity of the encounter. However, you often can get a fairly accurate idea of charges for a discrete service, such as for a specific procedure or test.
- A medical practice can only provide insight about cost for services rendered at that facility. In general they can inform you of the full, unadjusted charge. If you are covered by an insurance plan that they are very familiar with, they also may be able to tell you the out-of-pocket charge for your particular situation. However, costs for prescriptions, tests or outside procedures will likely be beyond their control and knowledge.
- Although it might seem logical that medical providers should know the costs for drugs and tests that they order, there are simply too many ever-changing variables for them to be able to keep up with, too. This is also why a menu of costs usually can’t be posted in the waiting room. Providers may be able to provide rough ballpark figures, though, and can ask staff members to try to come up with more accurate numbers for your specific situation.
- It is true that providers are bound to charge (and many times to not charge) certain fees for services when government programs such as Medicare are involved. It is not an understatement to say that running afoul of government regulations can result in severe penalties for the provider, should an audit discover them. It is also true that uniformly offering discounted fees to the uninsured, or those currently within a deductible, tends to violate contracts between the medical provider and insurance companies. In other words, there usually can’t be a policy of charging uninsured individuals a different fee than those with insurance. However, with the exception government coverage, the medical provider does have discretion in charging for his or her services on a case-by-case basis. That is why it can pay to make your cost-related concerns known.
- Unfortunately, there are many situations when one simply can’t proactively examine costs, the best example being emergency care. Cost analysis must then be performed retroactively, such as scrutinizing hospital bills.
In the end, there definitely are cost-saving opportunities for individuals interacting with the medical system. It takes vigilance, and a bit of work, but knowing the right questions can pay off.
Stephen Meyers, MD