With all of the significant changes to the health insurance industry over the past two years, it may be hard to determine the best steps to take when it comes to comparing the "net" costs to you and your family of various medical procedures. Even if you are paying less in monthly health insurance premiums than you have in past years, you could be paying more in out-of-pocket expenses when you undergo a medical procedure.
Take for instance Sandra, who received a call from her doctor's office following a routine mammogram. She was told that her test results were questionable and that she should schedule an ultrasound. After Sandra's ultrasound, the results were still unclear and her doctor's office told her to take the next step of scheduling a biopsy. Sandra is single and a business owner. She pays for her own insurance and is naturally concerned about keeping out-of-pocket costs to a minimum.
Sandra called various medical clinics to compare the costs of a biopsy. This turned out to be an extremely frustrating task. She didn't have the right medical codes for the procedure to give to the clinics, plus the clinics could not provide her with a cost estimate unless she actually booked the procedure there, since booking the appointment meant they had access to the paperwork that outlined the exact details of her procedure.
So what's a better way to approach this process? If you are insured, consider starting your research with your health plan. Most of the big national insurance companies offer pricing tools for their customers. Call an in-network provider, listed in your provider directory, and ask what the "in-network rate" is for the service you require. You may need to call several providers to find one that charges what you consider a fair price.
Some online resources are also available. Three of the more popular ones to help you shop for fair prices are healthcarebluebook.com, fairhealthconsumer.org and opscost.com. In all three cases, estimated costs are given once you identify the procedure and enter your zip code.
According to Health Care Blue Book, the costs for certain in-network procedures can vary by over 400 percent, depending on where the care is provided. And major discrepancies can happen whether you are part of an insurance network or paying cash. If you do not have health insurance coverage, you should also consider calling providers and asking if they offer discounts for self-pay patients and what their price is for the service.
If you've already had a medical procedure and feel your bill is unreasonable, researching healthcare pricing online can help if you need to dispute the bill, negotiate a lower fee or figure out if you've been overcharged.