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February 26, 2019 | Value-Based Care
Imagine you are buying a car. Where do you start? Like many people, you’ll probably begin the process by identifying which type of car will fit your needs. If you have children, you might consider a minivan or an SUV. If you have a long commute, you may want something with good gas mileage. Once you’ve decided the make and model of the car you want, chances are you won’t buy the first one you see. Instead, you’ll likely shop around and see how prices differ among dealerships in your area before making a final decision.
You probably use a similar decision-making process when making any major purchase, but did you know you can use the same method when it comes to healthcare? People today have more choices than ever when it comes to how, when and where they receive healthcare, so to get the highest quality care at the best cost, we have to approach our healthcare the same way we would approach making any other financial decision. If you’re not sure where to start, use these tips.
When people think about the “cost” of healthcare, many factor in the monthly premium they pay for insurance, but that is not the only cost associated with care. Other things to consider include copays and deductibles, as well as co-insurance and out-of-pocket maximums. In addition, some treatment may not be covered by your insurance or may be considered “out of network”, which affects what you would owe for the treatment or service.
When getting healthcare services, make sure you know what is covered, what providers and facilities are in and out of network, and what costs you will owe at the time of service. If you have questions about your coverage, contact your insurance provider.
Many employers and insurance plans offer incentives for healthy choices. Some programs may reimburse the cost of your gym membership or give you discounts on wearable fitness devices. Other programs may even pay you for getting preventive screenings. Ask your insurance provider or employer if they offer similar programs and take advantage of them.
Before getting a procedure or other service, ask your healthcare provider about what price you can expect. Although the exact price will be different for each patient (usually depending on insurance coverage), every healthcare system has a list of charges for all of the services it provides called a “chargemaster.” Think of it like the sticker price for a healthcare service.
You most likely won’t pay the sticker price if you have insurance, but knowing the amount on the chargemaster does give you a ballpark estimate of what the service will cost. Many healthcare systems also offer discounts for patients who self-pay (meaning they do not go through insurance). In some cases, self-paying may be even more cost effective than going through your health insurance and you can request to be self-pay prior to receiving the care.
Hospitals often charge more for services, like laboratory testing and CT scans, compared to freestanding or outpatient clinics, so it pays to shop around for the best price. Many insurance providers offer online tools to estimate how much a service will cost with different healthcare providers. You can also use sites like Healthcare Bluebook to find what a fair price is for a service. If your provider doesn’t offer the choice of getting your imaging done at an outpatient imaging center or outpatient surgery at an ambulatory surgical center (ASC), ask them if that is an option; if it is an option, it could save you a lot.
Before the Affordable Care Act (Obamacare), many insurance providers did not cover routine screenings and preventive care. Now, insurers are required to cover most preventive care services in full. It’s crucial to stay up to date on your routine screenings because that is the best way to detect health problems before they become serious and expensive to treat. Plus, preventive care doesn’t cost anything extra to you or your family.
Note: If you have a history or symptoms of the condition you are getting screened for (such as colon cancer or glaucoma), your screening may no longer be covered by insurance because it would be considered “diagnostic.” Talk to your doctor about whether your routine testing is simply a screening test or a diagnostic test.
Patients are responsible for more and more of their medical costs each year, so it’s important to be aware of those costs and how to make smart healthcare decisions to not only save money but also be healthier.
“Understanding health insurance costs makes for better decisions.” HealthCare.Gov
“Cracking the Code: 10 questions to find what that medical procedure will cost you.” NOLA.
“4 steps to be a smart healthcare consumer.” Benefit Resources.
The Live Better Team
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This information is not intended to replace the advice of a medical professional. You should always consult your doctor before making decisions about your health.