Having health insurance is an important first step to protecting yourself from medical expenses, but cost continues to be a concern even when you have health insurance. It is disheartening to receive an unexpected health care bill, which can easily reach hundreds and thousands of dollars. Our health care system doesn’t make it easy to anticipate and control these costs, but there are some things you can do to take better control of your health care expenses.
Try to get some estimates of how much your health care will cost.
For non-emergency health care, it makes sense to try to find an estimate of how much will be coming out of your pocket.
It’s not always easy to get this information. The doctor’s office or hospital most likely won’t know the answer to your cost question, because health providers negotiate different prices with every insurance company. They won’t know what yours is until they submit your claim—after you’ve had the service. That’s doesn’t help you.
But you may be able to get an estimate from your insurance company. Some insurance companies have an online tool that allows you to select the procedure or test you are trying to budget for, and get an estimate of how much the insurance company will typically cover and how much will come out of your pocket. Use this as a guide rather than a firm guarantee of what you’ll have to pay.
You can also use an online tool available in Maine to help you see what a certain procedure or test costs in different facilities across the state. Maine Health Cost shows you average cost of specific medical procedures at over 50 different health care facilities and hospitals around the state. These are “average” costs because the facilities negotiate different rates with each insurance company. So what costs $40 for one insurance company might cost $35 for another and $50 for yet another.
Stay in your network, and be careful not to go out-of-network by mistake.
Every health insurance plan has a network of providers—not just doctors but hospitals, pharmacies, imaging centers and any other health service. If the doctor or facility is not in your plan's network, you may have to pay a larger share of the cost or the insurance company may not cover the bill at all.
Take the initiative to find out from your insurance company if a given doctor is in your network because the provider won’t always tell you. Some providers will accept your insurance even if they are not in your plan’s network, and you will just have to pay more.
Anticipate all costs: professional fees, facility fees, and fees for other doctors like anesthesiologists.
Depending on the procedure or test, there may be several bills. The doctor who is doing the procedure or test has one bill; this is the “professional fee.” If the procedure or test is done at a hospital or other facility, there will also be a “facility fee.” Depending on the procedure, it may be worthwhile to ask if it can be done in the doctor’s office to avoid a facility fee. And, in general, freestanding surgery centers have lower fees than hospitals.
If the procedure or test requires an anesthesiologist or radiologist, there may be a bill for them, too. Try to confirm with the facility that all professionals involved in the procedure or test will be in your network.
Consider quality, too.
Cost is an important factor to consider when planning a procedure or test, but it is not the only factor. You want to be sure you are getting the best care possible from a doctor who understands your preferences and has experience doing this procedure or test. To learn more about how to find the best care for you, visit Maine Quality Forum. To compare doctors or hospitals in Maine, visit Get Better Maine.
Find some help.
Researching quality and cost can be a big job, so it is important to have some help and support. Contact a health educator if you are not sure how to find the information you need. If you are looking for cancer screening or treatment, contact the MaineHealth Cancer Resource Center for help with finding the right care for you. Finding health care cost and quality information is not always easy, and you may have to do some diligent detective work to find what you need. But your health—and your financial health—are worth the time and effort.