What to Ask your Doctor

Posted on by Diane in Health, index | 1 Comment

Traditionally, a person would not walk into a doctor’s office and ask how much this service or that service costs. Health care is unique, in that there are no price tags on services, no prices posted when you walk through the door. How much is that immunization shot? How much will that blood test cost me? How much is that MRI?

As transperancy becomes more of an issue in health care, it is important for consumers of health care services to ask about price. Afterall, a physician states that it is your responsibility to know what your insurance plan does and does not cover. Do you not have the right to know how much a procedure will cost prior to agreeing to accept that procedure?

I’m not suggesting that if you are in the hostpial, you would ask what every procedure or pill costs before you accept it. But, perhaps that is the wave of the future.

I went to the gynocologist recently and was handed a cup by the receptionist, who pointed me to the restroom. “Why do you need a urine sample?” I asked. The receptionist said it was “standard procedure;” every patient is asked to provide a sample. I had just had a urine test at another doctor recently; why did I need another, and how much would it cost? When I asked if the sample was absolutely necessary, and if I did choose to participate, how much would it cost, the receptionist called in the office manager to speak with me.

A good policy is to ask when you set up the appointment what will happen at the visit. Will a urine sample be required? Are you or your child due for any immunizations; if so, which? What blood work might be taken? You may need to speak with a nurse on staff, as the person setting the appointment may not have this information. You may also need to return to the doctor, if he or she recommends a procedure or test, and you do not know if it is covered  by your insurance company. I have called insurance companies while in a doctor’s office to see what is and is not covered.

It may be helpful to follow up with your insurance company prior to the visit. You might say, “My physician is telling me that an annual blood test is standard procedure. Is that covered under my plan?” Or, “My physician is recommending a specific immunization for my child, what would my cost be for that?”

Check every time, as plans and coverages change frequently. Some insurance companies, for example, are only covering pap swears every two years now. Your physician may recommend it annually; he or she may just go ahead and do the procedure. If it is not covered and your physician recommends it annually, you might wish to have a conversation with your doctor: “I called and my insurance will not pay for that procedure. How much do you charge for that?”

Asking initiative questions up front, checking with your insurance company in advance, and questioning your health care provider about costs may turn some heads, but it will make you a more informed consumer in the long run. It may even become standard one day soon!


Understanding Your Health Insurance

Posted on by admin in Blog, Health, Health Insurance, Mental Health, Uncategorized | Leave a comment

Understanding Your Health Insurance

Undoubtedly, you have entered a physician’s office and read a sign stating: “Knowing your health insurance policy is your responsibility. Any unpaid balance or non-covered charges will be billed to you!”

But, who’s to know what is covered and what is not? How much does insurance pay, and how much will you be expected to pay? What is the bottom line bill going to be?

Here are some keys terms you should know related to health insurance:

– Deductible. The deductible is the amount you are required to pay before your benefits kick in. If your deductible is $1,000, that means you have to pay $1,000 out of pocket before your benefits apply. This amount need to be paid regardless of whether you are using an in-network or out-of-network medical professional. Co-pays are not included in the deductible.

– Allowable rate. This is the amount your physician is allowed to charge for services, based on his or her contract with the insurance company. For instance, a health care professional might typically bill $300 per hour for a particular service. However, when he or she contracted to be “in network” with a particular insurance company, he or she might have agreed to accept only $150 for the same service. This is called the “allowable rate;” it is the amount the health care provider is allowed to charge you because you are using an in-network health professional.

This is also the amount the health care professional should be charging you if you have a deductible to meet before your benefits kick in. You might want to ask your health care professional the “allowable rate” for services you receive. This rate is going to differ substantially depending on the physician’s contract with insurance companies. With one insurance company, the service may cost $100, and with another $120. This is a private contract between the physician and the insurance company, which is why allowable rates vary.

– Co-pay. This is the amount you will pay per visit to your primary care physician, gynocologist, mental health professional, specialist, etc. There is typically a different co-pay for primary care physicians and for specialists. If you go to a specialist, the co-pay may be higher. Co-pays can vary from $10 to $50 or more per visit.

– Co-insurance. This is the amount you are responsible for when you finally get a bill and once your deductible is satisfied, in addition to your co-pay. Sometimes the co-insurance is 10% of the ALLOWABLE rate, sometimes 30%, sometimes 40%. The Affordable Care Act has termed plans “Platinum, Gold, Silver, and Bronze” as a way to determine the co-insurance amounts easily. Platinum plans pay 90%; your contribution is 10%. Gold plans pay 80%, Silver plans 70% and Bronze plans 60%.

Next: Tips on what to ask your health care professional regarding insurance.