As health care consumers endure higher deductibles and reduced insurance benefits, it is becoming more important to understand and even negotiate prices before receiving medical treatment.
Dr. Kathryn Stewart, medical director of care management at Mount Sinai Hospital in Chicago, believes that patients can and should be more proactive about seeking the best prices for their services.
"Hospital costs are probably 40 (percent) to 50 percent of what their (list price) charges are," she says. But when it comes to billing, "most hospitals are happy to break even or have a little bit of profit."
This means there is plenty of room to negotiate and reduce your out-of-pocket expenses.
Shop for hospital care as you would any other consumer service, but with more effort since costs can run really high. You can save yourself a bundle using these strategies.
10 ways to reduce your medical bills
- Ask your doctor to be your ally
- Compare costs by using the CPT code
- Find friends in the billing department
- Negotiate lower prices, payment arrangements
- Ask if recommended services are necessary
- Explore state-sponsored hospital Web sites
- Check your insurance company's Web site, too
- Ask for the Medicare rates
- Go generic
- Sweat the small stuff
1. Ask your doctor to be your allyIf you're shopping around for medical services, you probably have a primary physician who directed you to seek the service in the first place. "You have to get diagnosed by somebody," says Stewart. "So let that person be your advocate."
She advises patients to ask their doctors where the best hospitals are for the recommended procedures, which centers will work with patients to lower out-of-pocket costs, and to even ask for help communicating with that facility's finance department.
"If the hospital where a physician admits is approached by that physician on behalf of the patient, I think (the patient) might get somewhere with the hospital. Let's say I have a patient in my practice who has one of these really high-deductible (insurance) plans, and they need to have a hysterectomy. (I could) approach the finance department and say 'I've got this patient, but they don't have (enough) insurance and they can't afford to pay full price, but they can afford to pay something. Can you work with them?'"
2. Compare costs by using the CPT codeThough your doctor might be willing to initiate a conversation with the hospital finance department, you can still expect to have several conversations with them on your own. Before calling, make sure you have the "current procedural terminology," or CPT, code for the procedure you are seeking.
"CPT is the industry term for the 'billing code.' It's a five-digit number that is used to bill the procedure," says Jane Cooper, president and CEO of Patient Care, a health advocacy company based in Milwaukee. Cooper says that your physician or physician's office can provide you with the code, and the number is the same across hospitals. With this code, you can call multiple medical centers to compare prices for the same procedure.
3. Find friends in the billing departmentWhen calling different medical centers, ask for the billing department, and then ask what they charge for the procedure you want.
You should be able to get (the pricing information), by being persistent, about 80 percent of the time," says Cooper. "If the representative does not give you the answer you need, ask for his or her manager. And keep asking for the manager." Your success in this area can help determine whether you ultimately choose to use this facility for your medical treatment.
"If the hospital or doctor won't tell you what they charge, then my advice would be to go to a different doctor or hospital," says Cooper.
4. Negotiate lower prices and payment arrangementsIf you're fortunate enough to get comparative information and an alternative hospital is cheaper, go to the original hospital to see if it can match the lower price. If all the hospitals you contact charge similar amounts, see if you can negotiate a prompt payment discount with one of them.