By Mike Winters -
CNBC
Surprise medical bills can be expensive: Of the one in five people in the United States who received an unexpected bill in the past year, 22% owed them more than $1,000, a 2022 survey published by business intelligence firm Morning found. Consult.
While these bills can't be avoided entirely—your health insurance may not cover every last expense—there are questions you can ask your medical providers to avoid paying more and clarify how much they'll charge you before you have a procedure or test.
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Todd Thames, a physician and vice president of clinical affairs at Included Health, a virtual primary care provider that helps clients navigate these bills, poses four questions:
1. How much do I have to pay?
Instead of asking if your insurance covers it, ask your health care provider and insurer how much you will pay for the treatment.
“Hedge can mean very different things depending on how you interpret it,” says Thames.
Being “covered” can mean having partial coverage, that is, paying a percentage of the total value of the invoice.
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When you ask about your out-of-pocket costs, you may not get an estimate right away.
That's because a provider may not be familiar with the dozens of health insurance policies their patients have, Thames explains.
“The doctor or provider may say, 'I don't know right now, but let me do some digging or ask my office manager to do the digging for you,'” he says.
When you get the quote, you can check with your insurer to confirm how much is actually covered, Thames recommends.
2. Is it a diagnostic or preventive procedure?
Preventive care occurs when the patient has no symptoms and there is no reason to believe that the patient is not healthy.
Diagnostic care is when there are symptoms or risk factors that require a diagnosis by a specialist.
Health insurance covers most preventive care.
However, with diagnostic care you are more likely to incur direct medical expenses, Thames says.
There are questions you can ask your medical providers to avoid paying more.staticnak1983 / Getty Images
Although you may not be able to avoid being charged for it, you can take advantage of this question to confirm your out-of-pocket costs while also raising your concerns about affordability with your doctor, as they may be able to find ways to lower your cost. spent.
For example, doctors sometimes order a diagnostic laboratory test called a "comprehensive metabolic panel," which tests for up to 14 substances in the blood.
“It is usually the test that is requested by default, although only a couple of them are necessary,” explains Thames.
If you're concerned about price, your doctor may recommend a more specific lab test
to lower your medical bills.
“It's fair to ask, 'What is this lab test for and how is it going to affect my care?'” says Thames.
3. Is there a generic drug that works just as well?
In almost all cases, generic drugs are cheaper than brand-name drugs, Thames says.
Asking for an alternative generic for reasons of affordability may influence the doctor's prescription.
“A very common drug that we use for patients with diabetes is called Metformin,” he says.
“There are different formulations.
There's Metformin that you can take a couple of times a day, and then there's an extended-release version that's more expensive."
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Although doctors typically prescribe the extended-release version for patient convenience, they may not be thinking of the increased costs, he admits.
“I've had patients to whom we've said, 'let's stick with twice a day, because it's much cheaper for you,'” Thames says.
Most doctors have a general idea of drug prices, so they might suggest an alternative, he says.
4. What is the CPT code of my intervention?
Another way to avoid unexpected medical expenses is to confirm in advance the “current procedural terminology” or “CPT code” that describe medical procedures and are used by insurers to process bills.
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This is a reasonable request that you can make of your healthcare provider, he says.
Once you have the CPT code, you can check with your insurer to confirm if they will cover the service.
“Insurance companies and payers think in terms of billing codes, not procedure names,” says Thames.
“CPT language is confusing, but for any planned procedure, the clinician or someone in their practice should be able to provide the necessary codes.”