In retail purchases, you have a choice in where you spend your money; this is also true with healthcare decisions. Having several healthcare options to choose from is great, but sometimes comparing those options can be confusing and intimidating.

That’s why, if you plan to call around to compare pricing, you should arm yourself by knowing the right questions to ask each provider and be ready to answer their questions. That will help you get more accurate cost estimates.

Have your information ready!

The facility you are considering will likely ask the following:

Insurance Plan Information

  • Who is your insurance provider?
  • What is your deductible and how much
    have you met?
  • What is your co-insurance? Is your plan 80/20, 90/10, 50/50?

Diagnosis/Procedure Information

Be prepared by knowing the CPT (Current Procedural Terminology) codes that will be used in your care. Each individual exam, surgery or procedure is assigned its own code, which is used in the billing process. Your referring doctor will be able to provide this to you.

Ask the right questions:

What will my out of pocket cost for the following CPT code(s)?

The confusing world of healthcare pricing results in vastly different dollar amounts used in estimates (e.g., “chargeable amount,” “contracted amount,” “billable amount”). Often you will find yourself comparing apples to oranges which clearly will not give you accuracy when you want it most.
Asking specifically for your “out-of-pocket” cost gives you the ability to make accurate comparisons and ensures that your specific payment plan is taken into consideration. Insurers have different cost arrangements with providers, which is an important factor that affects the amount that you pay.

Is there anything not included in that estimate?

There may be other costs associated with your procedure that are not included in the facility’s estimate. For example, if you are having an MRI, the radiologist (physician who reads the images) will bill separately. Likewise, if you will be undergoing surgery, your surgeon and your anesthesiologist will be sending separate bills. In addition, you may have separate charges from a pathologist or durable medical equipment company, depending on your care.

How do I pay?

Ask the facility what forms of payments are accepted. It’s also good to find out ahead of time how much you will be asked to pay upfront. This helps to alleviate the stress of financial worries the day of your procedure.
Some providers offer a discount for paying your bill in full. If this is not an option for you, ask about available payment plans.

Always keep in mind that the quoted price is just an estimate. Many variables may occur throughout the course of a procedure or exam that could affect the cost. The more information you provide, the better the estimate, but the exact cost of your procedure still may vary.

When you are ready to do your comparison shopping, give us a call at Summit Medical Center, 307-232-6600.

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