Finding the Cost of a Medical Procedure in Advance

February 2, 2024 at 8:20 a.m.

An article by Ryan Ermey on CNBC caught my attention. The headline read: "I couldn't find the cost of a medical procedure before I had it, so I asked a doctor the steps to take next time." 

Before I had Medicare, I experienced this same problem, and was interested in what the writer learned.

The young writer, only 32 at the time he scheduled a coloscopy, thought he'd done his homework by asking the doctor if the procedure was covered. When the answer came back "yes" he thought he was covered. Then he learned that his insurance company would not cover the procedure since he was under age 45.

When he asked the clinic what the full price would be, they told him to call his insurance company. The insurance company told him to contact the clinic's billing department. Billing never called him back. When he couldn't get the information he needed, the young man wanted to cancel the procedure. However, due to symptoms and family history, the doctor said he absolutely needed the procedure and that he would have to pay the costs no matter what they were.

The author interviewed Carolyn McClanahan, a physician and certified financial planner, about the situation to learn what steps he should take in the future. This is what he learned.

Step 1: Get to know your insurance.
Check first with your insurance coverage and ask these questions: What kind of plan do you have? What are the co-pays? Does the insurance company pick up the rest of the bill after the co-pay? How does your deductible work?

If you are in a high deductible plan, you will pay all costs until you hit that out-of-pocket level before coverage will begin.

Step 2: Shop around for the best price.
Even if you can find out that your insurance pays a certain percentage of the cost of the procedure, you still won't know how much you'll have to pay unless you know how a procedure is priced. Individual insurers negotiate rates with providers. 
McClanahan advised: "If you don't have a copay plan, it's good for you to call up and say, 'I have a high deductible plan and I want to know how much you charge my insurer to do this procedure." She warned that knowing exactly who to ask this question "can get murky, since some medical providers have their own billing department while others may outsource it to an outside firm." Be diligent.

Calling different providers within your network can pay off. For something straightforward, like an MRI, you should be able to find the best rate.

If you can afford to pay in cash rather than going through your insurer, you may save money.

Step 3: Negotiate your bill
Always review the charges on your bill. "Ask for an itemized bill and see what they are charging you for," says McClanahan. Billing departments can make mistakes. Ideally, she adds, you will have done some negotiation up front and gotten in writing what you can expect to pay. 

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