How (and When) to Get a Better Deal on Medical Care
More than half of Americans are postponing or forgoing medical treatment due to cost concerns, according to a 2013 Kaiser Health Tracking Poll. Many, like Glicksman, hesitate because of high deductibles and the inability to browse prices: Most people don't have a clue what a CT scan or a strep test will cost until the bill comes. Adding to the confusion is a widespread discrepancy in rates. "There's roughly a two to ten times price difference for virtually every procedure within every market," says John Santa, MD, medical director of Consumer Reports Health.
Now healthcare companies are publishing the prices of various procedures and tests. Online tools, like OkCopay.com and ClearHealthCosts.com, are searchable by zip code, so you can see that a chest MRI that costs $2,200 at one Chicago hospital may run you $350 at a freestanding radiology center down the block. "Hospitals typically charge more because they can negotiate the highest payment rates with insurers, and those costs get passed down to patients," says Touré McCluskey, founder of OkCopay. "Smaller practices have less negotiating clout, so they're willing to charge lower rates for the same services."
Other sites, like Guroo.com and HealthcareBluebook.com, compile millions of insurance claims and show the average price for a range of services. "So if you live in Miami and need to have your ACL repaired, you can see that the average surgery there costs between $5,800 and $13,200," explains David Newman, PhD, executive director of the Health Care Cost Institute, which created Guroo. "If your doctor tells you her practice charges $15,000, you might want to shop around."
The key word: might. Experts agree that price transparency tools are great when you're in the market for something routine, such as an X-ray, a blood test, or a travel vaccination. "But if you need physical therapy or surgery, the equation gets more complicated," says Robert Wergin, MD, president of the American Academy of Family Physicians. "Experience and skill matter. If a physical therapist isn't effective, you might wind up having to pay for extra sessions." Similarly, if you're getting a complex procedure, Maureen Lamb, a medical billing advocate, suggests sticking with a physician who has intimate knowledge of your health history. "In some cases, trust and comfort are more important than saving money."
Still, with any provider, you may have room to haggle, especially if you're uninsured. After you research prices, Santa advises calling the office's business manager and being forthright. Try this script: "There's a doctor in town offering the procedure for quite a bit less. Can we discuss your price?" Simply starting the conversation can make a difference in your final bill. Santa says, "With an honest discussion and an offer to pay in cash up front, you can save 30 to 50 percent."