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10 Steps To Finding Out What That Medical Procedure Actually Costs
By
Caroline Lewis
and
Jeanne Pinder
Published Dec 11, 2019
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By
Caroline Lewis
and
Jeanne Pinder
Published Dec 11, 2019
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There are countless ways in which our health care system could be made less frustrating to navigate, but in the meantime, we’re posting how-to’s and explainers like this one to help you figure it all out (and hopefully save some money). This post is part of #PriceCheckNYC, the health care cost transparency project Gothamist and WNYC are undertaking in partnership with ClearHealthCosts.
So, it’s not exactly an emergency but you should probably go in for that test/minor surgery/procedure you’ve been putting off. The good news is you don’t have to go in without a sense of what to expect on the bill.
As daunting as it may seem, there are ways to find out how much medical care costs ahead of time, and doing so may allow you to comparison shop, or even use the lower rate at one health care provider to haggle with another (sometimes embracing the fact that the health care marketplace is like a chaotic bazaar in a country where you don’t understand the language can be beneficial). And while the estimate you receive isn’t guaranteed to be identical to the final bill, having one in hand will make it easier to identify and fight any outrageous charges later.
Comparison shopping works well for procedures where you can choose where to go (an MRI, a sore-throat visit, a cardio stress test) and less well for emergency or non-discretionary procedures (an emergency appendectomy, a course of cancer treatment).
Here are 10 steps to find out what stuff costs:
- Find out the exact name of the procedure and the Common Procedural Terminology (CPT) code--often a 5-digit number from the health care billing system. It will help you compare apples to apples. You don’t want to ask, “What does an MRI cost?” but, “What’s the price for an MRI of the lower back without dye, CPT code 72148?”
- Ask the hospital, doctor, walk-in center, lab, whatever: “Are you an in-network provider for me?” Make sure you know which network: Not “Big Blue” but the specific “Big Blue Silver Select HMO.”
- Ask specifically about the procedure you need by code: “I need an MRI of the lower back without dye, CPT code 72148. How much will that cost? How much will I have to pay?”
- Ask: “What’s your cash price for that? Is there a prompt-pay or other discount?” We hear more and more that people can get a better price by paying cash than by using their insurance. This seems counterintuitive, but it’s surprisingly common.
- Use online pricing tools to get a sense of the average cost or price range you’re looking at, but not to give you The One Clear Answer. ClearHealthCosts offers cash prices for some common procedures and also supplies the Medicare price, which is important because what Medicare pays is the closest thing to a fixed or benchmark price in the marketplace. Also try FAIR Health and Healthcare Bluebook.
- Call two or three service providers, so you have context and a range of options.
- Ask each one: “Will there be any additional charges--reading the X-ray, receiving results, any technical or professional fee or the like, from you or anyone else?”
- Ask your insurer: “How much will this cost? How much will this cost me?” If they send you to their “cost calculator,” tell them you’d like to talk to a representative. The cost calculators are notoriously prone to error and there’s no accountability. Insist on talking to a representative and getting quotes or estimates in writing.
- Tell both service provider and insurer: “Please put that in writing and email it to me.” If they decline, you should take notes, take names, and take numbers, so you can say, “Sue Smith in billing said it would be $528. We talked by phone April 1. Her number is 555-123-4567.”
- If you are insured and choose to pay a cash rate, be aware that while you might save money, it’s likely that the cash payment will not be credited towards your deductible. Feel free to ask your insurer about this. (You should still be able to use your Health Savings Account or HSA, if that applies.) On the other hand, many of us don’t meet our deductibles, anyway.
You can share information about what you have paid for recent medical services—and search for the cost of a given medical procedure at different health care providers in your area below. You can also email us your tips at [email protected] and read our other #PriceCheckNYC coverage here.
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health care
pricechecknyc
clearhealthcosts
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Caroline Lewis
Caroline Lewis is on the health care beat for WNYC and Gothamist. She has covered COVID, a nurses' strike, the overdose crisis and New York’s marijuana legalization effort, and spent a year investigating patients' medical bills. She always wants to hear about how everyday New Yorkers experience the health system. Got a tip? Email [email protected].
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Jeanne Pinder
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Gothamist is funded by sponsors and member donations
Gothamist is funded by sponsors and member donations
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