Shopping Around Is Complicated In Health Care
Megan Hart; Megan Hart [email protected] |
Shopping is usually relatively simple: you decide what you want, look up a few prices online to find out where you can get the best deal, buy and move on with your day.
It isn't nearly that easy when what you need to buy is health care services, for a host of reasons. The possibility of complications, questions about your insurance and the way billing is set up all can make it difficult to figure out what you will pay for a procedure, but there are steps you can take to try to lower your costs, or at least have an idea of what they should be before going under the knife.
"The charge is not the same as what you're going to end up owing," he said.
Health care reform requires hospitals to make their charges available to patients. Average charges don't account for different services that a patient might need along with a procedure, however, Han said.
"There is a lot of variability in the services performed even if the procedure is pretty much the same," he said.
Officials with
The provider, such as a surgeon or obstetrician, also bills separately, so patients who know they are going to have a procedure in advance should get an estimate from their provider, Han said. All of the Cotton-O'Neil clinic physicians have the same contracts with Stormont-Vail, but independent doctors who use the hospital might have a different arrangement, he said. The anesthesiologist also bills separately, if one is needed for the procedure.
Insurance plans vary in the types of charges patients are responsible for. Three of the most common are copayments, co- insurance and deductibles. Copayments and co-insurance both are a portion of a service the patient has to pay for. The difference is that a co-pay is a flat charge, such as
How much a patient pays can change from month to month if he or she hasn't yet met the insurance deductible, Han said. If you have a procedure before you have used many health care services this year, you may pay more out of pocket than if you can have it done after you have met your deductible.
"That's why you see a lot of procedures done at the end of the year," Han said.
Patients won't get their bill until it has been "adjudicated" with the insurance company, meaning the hospital and the insurer have settled any disagreements about what services should be covered, Han said. Rates are set in advance, so the issue usually comes down a piece of a procedure that the insurer wants more documentation for or has questions about, he said.
"It's not uncommon to have to go back and forth," he said.
Hospitals negotiate for their rates with insurers, using the number of patients they have and any special services they offer to try to get a higher reimbursement rate from an insurer, Han said. They also can use quality metrics and patient satisfaction surveys to prove it is in the insurer's interest to offer a healthy reimbursement and keep the hospital in their network, he said.
People in health care markets like
One of the best things people can do to lower their health care costs is to make healthy lifestyle choices, like exercising and not smoking, Chambers said. They also shouldn't skip preventive care and screenings, because they can catch a problem when it is easier (and cheaper) to treat, she said.
"We don't want them to save dollars by not getting services they need," she said.
Some people also inadvertently drive up their health care costs by using the emergency room when they could go to an urgent care clinic or call their family doctor, Chambers said. The emergency room is only necessary if a person is at risk of death or serious disability from an injury or illness, she said.
"A lot of times, people with flu or maybe a sprained ankle will go to the emergency room," she said.
Copyright: | (c) 2015 ProQuest Information and Learning Company; All Rights Reserved. |
Source: | Proquest LLC |
Wordcount: | 838 |
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