Finding Answers

A recent article in the Wall Street Journal on 28 October 2009, discusses different ways you can find and compare pricing for medical procedures.  This is the beginning of what needs to be a more open and transparent marketplace when it comes to pricing.

One question that we have received from our readers is “How can I find out about pricing?”

Here are a few ways:

1. Have a candid conversation with your provider or the  practice manager prior to your visit.  Find out how they are reimbursed from your insurance company and what is their average negotiated rate.  Let them know that you will be paying in full and you would like a discount.  If they are unwilling to work with you, shop around to other providers.
2. Your health insurance company website will give you an idea of their negotiated rates with providers in your area.  You will have to do some digging but it is buried in there.  If you have any explanation of benefits statements from your insurance provider, you will see what the provider charged and what was paid by the insurance.  This information can be used to negotiate with your healthcare provider.
3. Many insurance claims submitted by a medical practice do not get paid immediately.  It is not uncommon for bills to sit unpaid for 60 days or greater.  You can leverage the need for the practice to have a steady cash flow for it to pay the salaries and bills.  You can use this information to ask for discounts because you will be paying in full.
4. Do not be afraid to share pricing information you have learned as you’ve researched around.  Let your provider know that you can get a better deal someplace else and see if they will negotiate with you.

Remember that in the end the medical practice is providing you a service.  If they are unwilling to work with you, it is okay that you fire them and find someone who will.

Additional Resources Can Be Found Here