Want to get a fair price on a medical procedure? You’re not alone there. More people than ever are shouldering the cost of healthcare on their own, either because they have astronomically high deductibles or no insurance at all. Unfortunately, the U.S. healthcare system isn’t built on transparency. Many people are left in the dark about the price of a medical procedure until they get the bill.
When you buy a TV, you probably shop around and compare brands, features, and cost. Same goes when you purchase a car or a house or anything that can be considered an investment. Some people even spend hours looking at restaurant reviews before deciding where to eat.
Why should healthcare be any different?
Keep reading to find out why it’s so hard to get accurate cost quotes and how you can ensure you’re getting a fair price for a medical procedure every time.
Why is it so hard to find out how much a medical procedure will cost?
The reality is that there’s not a straightforward way to understand medical procedures and the costs associated with them. Sure, you can look up “knee replacement surgery” and get a good overview of what the procedure itself entails. It’s unlikely that you’d find a clear, fair cost estimate, though.
This is largely due to systemic problems within the U.S. healthcare system — none of which can be changed without a major overhaul. Still, understanding why things are the way they are can give us a good foundation to build on.
There are a lot of variables when it comes to healthcare.
Which hospital will you go to? Is that hospital in- or out-of-network? Do you have health insurance? How much is your deductible?
In those four questions alone, you can see how many potential variables exist. That truly is just the beginning. Every single choice you make (or someone makes for you) about healthcare — where you go, when you go, who treats you, your insurance — affects the cost.
With dozens of health insurance companies, over a million healthcare providers, and over 5,500 hospitals (not counting outpatient centers) spread across 50 states and the 323 million people who inhabit them, it’s easy to see why nailing down the cost of any given medical procedure can be difficult.
Doctors, hospitals, and insurance companies keep the cost of care to themselves
In order for a doctor or hospital to be considered “in” an insurance network (i.e. an in-network provider), they negotiate a discounted rate with the insurance company. This is why you usually pay less when you see an in-network provider at an in-network facility.
It’s common for the contract between an insurance company and a doctor or hospital to have a gag clause. This makes it illegal for either party to talk about the rates they’ve negotiated as part of their network agreement.
Yet another barrier to finding out the cost of a medical procedure.
Healthcare costs can be inflated — for no reason
Typically, if something costs more, we tend to think it’s of a better quality than it’s less expensive alternative. This may be true in some cases (like when you’re buying dish soap) but not in healthcare.
Hospitals and clinics can inflate the cost of a medical procedure since there are no regulations that prevent them from doing so. A high price tag doesn’t necessarily mean better care; that’s something that can only be measured by things like readmission rates, infection rates, and patient satisfaction.
People don’t know where to look (or who to trust)
In 2015, Public Agenda surveyed 2,010 Americans on how they use prices in healthcare. 50% of the people who had not checked prices didn’t know how to find price information — that’s a significant portion of people who have no idea how to even find out if they’re getting a fair price on a medical procedure.
If you can’t get a straight answer about the cost of care from your doctor, your healthcare facility, or your insurance company, where can you get one?
Third-party websites like New Choice Health have developed systems that help consumers find and compare pricing information for different types of medical procedures, without having to jump through hoops. We compare the cost of a procedure across different facilities who take your insurance, so you can get an accurate picture of what you can expect to pay — and choose where you get care accordingly.
What determines if the price of a medical procedure is “fair”?
With so many variables that affect the price of healthcare, determining what is and is not fair isn’t always clear. There is no universal formula for determining a fair price on a medical procedure because each procedure is unique.
New Choice Health determines the fair value of a medical procedure by collecting and analyzing medical claims data and pricing data provided by healthcare facilities. The claims data include government data, as well as commercial and private payor data (that is, from insurance companies). This information is used along with specific procedure volume data to estimate three price points: great, fair, and expensive.
These are estimates; however, they are a very good guide for most patients who are trying to understand if the rates they are being quoted by providers are reasonable.
How to make sure you’re getting a fair price on a medical procedure
With such little access to cost information from hospitals, doctors, or insurance companies, you may be wondering if there’s anything you can do to make sure you’re getting a fair price on a medical procedure — even when there are so many factors that make price transparency a challenge. The short answer is yes, you can. The longer answer is, yes but it can take some patience, especially if you’re doing it on your own.
Here are some tips for making sure you get the best price on medical procedures, every time.
- If you’re paying for healthcare on your own, let your doctor know. Some doctors will offer interest-free payment plans or a lower rate if you’re paying for the procedure out-of-pocket.
- Shop around. Two hospitals in the same city could offer the same procedure at radically different prices. The same goes for doctors, surgeons, and every other type of medical provider. It’s always smart to compare rates.
- Don’t be afraid to travel for care. If you live in a rural area, it may be more affordable to head to your nearest city for a procedure. On the other hand, if you live in a city where healthcare tends to be more expensive, you may want to consider getting your procedure done at a hospital in a nearby region.
- Look for outpatient centers, instead of hospitals. This won’t be possible with every medical procedure but many can be done at outpatient centers, which tend to cost far less than hospitals do.
- Use a price calculator from your insurance company. Large insurance companies have a lot of data on the cost of different medical procedures. The calculators aren’t always updated but they can give you a rough starting point.
Use New Choice Health Patient Assist
Still having trouble finding a fair price on a medical procedure? We’ve done the research for you, on behalf of you, and leveraged our experience to negotiate and bundle provider services so you can get more affordable care. Request an appointment to get started!