The current healthcare reform is confusing at best these days. You have health insurance one day that pays a decent percentage for things like colonoscopy or root canal treatment. Then the next day you go to work and attend a meeting to find your employer has to raise your premium. Or even worse, they are dropping health insurance all together.
So you decide to try the government marketplace for health insurance, but you haven’t been approved yet. From what many are saying, that may take a while too. So what do you do in the meantime? Your spouse was all set for a knee replacement this year while she was on vacation. And your daughter was supposed to get a nose reshaping in a month after that soccer game incident. So does your family have to put everything off until you find private health insurance you can afford?
Pay Out-Of Pocket?
You may not realize it and surprisingly, there are many people that don’t even know that you can have dental and medical procedures done without having health insurance. Minor procedures like laser hair removal are done all the time without health insurance, but you can have major medical procedures like a heart bypass without health insurance too.
And it isn’t because things with health insurance are such a jumbled mess right now either. But you have been able to do this all along – shop around for the best price on dental and medical procedures. In fact, health insurance companies probably wish we would take that approach when they are paying a percentage of our medical bills. You paid your $2,000 deductible, but did you look at what they paid for that hip replacement last year?
They probably didn’t pay nearly as much as what was invoiced because they make deals with clinics, doctors and hospitals all the time. You can do this too it just takes some preparation and research. You begin by talking to the “prescribing doctor” and get a clear understanding of what is really needed by the patient and what are the options. If you don’t get the root canal, what are the consequences?
Shop Around
Don’t be afraid to question your doctor and not be afraid to seek a second or third opinion either. If your prescribing doctor is confident in his diagnosis and recommended treatment he will encourage you to another opinion. If the other doctor has a different diagnosis or suggested procedure other than a knee replacement, your original doctor will be interested in knowing what they found.
Use the internet to seek other doctors. www.docmart.com is a great resource that you can check out to find the best price on some of the common procedures or services. Healthcare Blue Book is another great resource. It works somewhat like the Blue Book for used cars and provides average rate, a fair price rate and what private insurers pay by the area you live in. You may want to compare rates with medicare physician fee schedule, for the government negotiated rates.
You’ll want to ask what the cost is when paying cash and make sure you get all the charges included. Charges like the facility fee, the professional fees which will include not just your doctor but the anesthesiologist and other professionals that may be required. There will most likely be additional cost for blood work for some procedures.
In most cases, the doctor’s office and facilities like the hospital will quote you on the high side. Some will be willing to take payments and others will require full payment upfront before the procedure.
Time To Bargain
Once you have some prices from various sources, it is time to bargain and negotiate. You do this with your auto insurance and your electric service, so don’t let medical expenses intimidate you. You will have to call each group or person that has something to do with the procedure. Meaning, you’ll need to bargain with your doctor, the anesthesiologist, the hospital and so on. Keep in mind also that the doctor who will perform the hip replacement may only be contracted with a certain hospital. If that is the case, you should still try to bargain with them, letting them know what rates you found elsewhere.
Once you have your rate quotes from all areas and come to an agreement, get it in writing. The person that you worked out the agreed rate may not be the person that does the billing. Make sure you get the name of the person you spoke with as well as their email address and phone number so if there are any questions, it can be addressed directly.
Should there be any dispute in what you are charged versus what you were quote, keep notes with the date, name, time you spoke to somebody. The better your note keeping, the better you’ll be protected. Don’t fear not having health insurance. You aren’t alone and as a patient, you need to become your own advocate these days.
