There was a recent article in The Gazette, written by Linda A. Johnson about getting cost estimates before hospital care or tests. A brilliant concept that I think most people don’t consider before procedures or tests happen. We did reach out to The Gazette and to Linda A. Johnsons twitter account but after a few weeks of not hearing back we decided to summarize the article for your benefit.
The Kaiser Family Foundation poll found that 67 percent of people worry about unexpected medical bills, more than they dread insurance deductibles, prescription drug costs or the basic staples of life: rent, food and gas. (Kaiser Health News is an editorially independent program of the foundation.)
Hospitals already have to make prices for procedures available on request, but a new rule requiring them to post the information online goes into effect on Jan. 1, 2019.
After hearing this you may think that the new law is great and can help reduce the stress of medical bills, however the rates online are not entirely clear and can still leave the consumer confused. The example Johnson gives in her article is that a “posted charge for a surgery doesn’t include separate charges like room rates for overnight stays. They don’t include fees for every doctor involved in a patients treatment, and doctors outside a patients insurance network could send bills separately.” Not only that but hospitals use different formats for finding out charges.
So what is the consumer supposed to do?
If you know you are going to need a procedure call your insurer and check charges at multiple hospitals. Make sure you have an exact description of your procedure and billing codes. Check with your insurer to see if you need preauthorization and confirm the hospital and doctor are in your network. Ask the hospital and each doctor what their rates are, try to get it detailed and written.
The last bit of advice from Johnson is if you are charged more than your estimate (by a significant amount), “appeal to the hospital and insurer to adjust your bill. If you don’t get results then contact your state’s insurance regulator.”