By Julie Workman
Medical testing can be scary. Overwhelming, in fact. When a simple visit to your family doctor turns into an urgent visit to a specialist or sends you to the emergency room for tests that you don’t understand, it can feel like your whole world has turned upside down before you ever even find out what’s wrong.
On the other hand, sometimes routine medical tests are a part of your annual check-up, and the thought of “testing” doesn’t bother you at all.
Whether it’s an unexpected emergency situation or a routine screening, one thing is for sure: sooner or later, you’ll get a bill.
In today’s rapidly changing health care environment, it’s often hard to be sure if a particular procedure, doctor, or care facility is included as part of your insurance coverage.
Even if the procedure is covered, will there be a co-pay? How much will it be? What if your doctor’s services are covered, but the next doctor isn’t in your network?
Once you start thinking about it, it doesn’t take long to panic over how you’re going to pay when that statement arrives in the mail.
The good news is that, in most cases, you have some control over that part of the experience. As the world of health care has changed over the past few years, consumers have actually gained more control over managing the cost of their own care.
It’s your responsibility to be well-informed, to understand your individual providers and coverage, and to shop around to manage your own health care costs. Insurance companies base the rates they charge, in part, on how much they’ve paid out in previous years, so when consumers take the time to shop around for the best prices, they’re effectively saving themselves money on insurance premiums for years to come.
The wealth of information available on the internet is making it easier than ever to compare rates for different health care services, as is the increasing availability of outpatient surgery and imaging centers. Almost everyone will need X-rays, a CT scan, or an MRI sometime, so be sure that when you do need medical services, you take the time to shop around for the best prices. Start by asking questions like these:
- Make sure your provider is in-network. In-network providers have negotiated with the insurance company to provide services, usually at a lower rate than other providers. Networks change often, so be sure to check every time.
- If the services of a specialist are recommended, ask about the billing and insurance coverage:
· Which doctors will be involved in this treatment plan? Are they in your network?
· Does the cost of this treatment apply to your insurance deductible?
· Is there a price difference if the test is performed at an outpatient clinic instead of at a hospital? Tests like imaging services may be less expensive at an outpatient clinic. - Ask if you should expect one bill or a separate statement from each provider.
· Some facilities offer a global billing service, and will itemize all the charges from all providers on just one statement. - Is there a discount for self-pay patients or for paying in cash?
- Are there options for setting up a payment plan?
Most doctors and health care providers have staff members who specialize in insurance and medical billing. While they can’t always tell you if a particular procedure or option is covered or not, they can usually tell you where you can go to find out.
Most health care plans, including the Affordable Care Act, offer comprehensive websites that make it easy to find out which providers participate in their networks. Many insurance websites offer cost estimator tools, which allow patients to enter the exam they’re having and see which covered facilities offer it, and how much it costs at each place.
Ultimately, it’s up to you to manage your health care plan and all the financial concerns that go with it. You do have a choice when selecting your health care providers, so choose wisely. These suggestions offer a great place to start:
- Set Yourself up for Success:
· Eat right, exercise, don’t smoke.
· Do your best to prevent medical conditions that will require expensive treatments. - If you have insurance coverage through your employer, set up a Health Savings Account (HSA) or a Flexible Spending Account (FSA).
· HSAs help fill the gap if you have a high-deductible medical plan
· FSAs allow you to pay for qualified medical expenses using money you saved tax-free. - If you’re currently uninsured, investigate your options under the Affordable Care Act (ACA). Wherever you stand on the politics of the ACA, you’re better off having some kind of insurance coverage than not having any.
It’s important to remember that the purpose of insurance coverage is to spread the risk of having to pay for an insured event over a large number of people. It is in everyone’s best interest to manage our health care costs individually so that, on balance, it ends up being less expensive — and less scary — for everyone.
More resources:
To find the fair market value of a test or procedure: www.healthcarebluebook.com
To learn more about the Illinois ACA Exchange: http://getcoveredillinois.gov/