A few months ago, I went into a medical procedure worried.
Thankfully, I wasn't concerned about my health. I wasn't stoked to be getting a colonoscopy at age 32, but it's about as routine as it gets, and my symptoms were hardly life threatening. Rather, I was worried about what it might cost.
How did I step foot into a surgical center not knowing what the bill would be? It wasn't for lack of trying. I asked the doctor if the procedure was covered, and he said yes. But my insurance company said I'd be on the hook for a percentage of the cost since I was under 45.
I called the clinic to ask what the full price was, and they told me to call my insurance company. My insurer told me to get in touch with the clinic's billing department. Billing said they'd call me back. They didn't. By the time the day of my colonoscopy arrived, I threw my hands up.
The doctor had told me I absolutely needed it. I would just have to eat the cost, whatever it was.
It's not an uncommon situation, says Carolyn McClanahan, a physician and certified financial planner with Life Planning Partners in Jacksonville, Florida.
"Our health-care system is so broken," she says. "And the billing system is so opaque."
When the bill came in the mail, I breathed a sigh of relief: $50. But it could have been much worse. The internet is full of horror stories of seemingly routine procedures running patients thousands of dollars and crippling their financial plans.
If you're concerned that medical care you need could do the same to you, McClanahan recommends taking the following three steps.
Step 1: Get to know your insurance
My first instinct when it came to my procedure — checking the details of my insurance plan — was the correct one, says McClanahan.
"The first step is, you need to understand your insurance coverage, which is so convoluted. Most people have no idea what's covered under their insurance."
Start by determining what kind of plan you have. Many standard employer-sponsored plans are co-pay plans, which come with some level of coverage from the first dollar. "For example, you may pay $40 for your visit — that goes toward your deductible — and the insurance picks up the rest," says McClanahan.
If you're in a high deductible plan, though, you have to hit a certain monetary threshold out-of-pocket before coverage kicks in.
You should also be familiar with which doctors are in your network, what kinds of procedures are fully and partially covered, your annual out-of-pocket maximums and whether your copay varies depending on whether you're visiting a primary care physician or a specialist.
Step 2: Shop around for the best price
Even if you have an understanding of what you owe under your insurance plan, it still may be difficult to figure out exactly how a prospective treatment is priced, says McClanahan. I knew I had to pay a certain percentage of the total cost of my procedure, but no one could tell me what that total cost actually was.
"The issue is, especially for people with high deductibles, that the insurance company has already negotiated a rate with the provider," says McClanahan. "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.'"
Who exactly you direct that question to can get murky, since some medical providers have their own billing department while others may outsource it to an outside firm. You may have to be more diligent than I was and start earlier in your inquiries if you want to get to the bottom of things.
While working to get hold of someone who can give you a concrete answer can be a pain, it can also come with a big financial payoff. If you're going in for something relatively straightforward, like an MRI, you can call around to different providers within your network to see who offers the best rate, says McClanahan.
You may also be able to save if you offer to pay in cash rather than filing a claim through your insurance. That will mean the money you put down won't count against your deductible, but it could also trim your bill significantly. McClanahan recalls a recent doctor visit to receive some diagnostic work that would have cost her $3,200 through her insurance.
"They said, 'If you pay in cash, we'll do it for $1,500.'"
Step 3: Negotiate your bill
Sometimes a bill is just going to be unavoidable. Maybe you had an emergency. Maybe physicians in your network that could treat your ailment were few and far between. Maybe you needed care quickly and couldn't afford to be on the phone negotiating prices all day.
If the bill comes and it's higher than expected, your first move is to review the charges.
"Ask for an itemized bill and see what they're charging you for," says McClanahan. "There are a ton of bills that have mistakes. And if you believe you're paying too much — even if the insurance company is billing you correctly — you need to talk to your insurance company and say, 'I don't think this bill is right.'"
Ideally, you will have done some negotiation up front and even gotten some assurances about what you could expect to pay in writing, says McClanahan.
Barring that, you'll have to haggle after the fact, and some situations will have more room for negotiation than others. If you're adequately insured and being billed for a couple thousand dollars, "the hospital will fix things that are wrong, but they're not going to negotiate with you," says McClanahan.
By medical providers' logic, she says, "if you have good insurance and can't cover your $2,000, that's your fault."
If you're being charged thousands for a medical procedure and the cost isn't making much of a dent in a very high deductible, however, you may be able to ask for a lower bill. "It's in their interest to negotiate with you because they would rather get paid something as opposed to nothing," McClanahan says.
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