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Knowing Healthcare Costs Before Incurring Them

Healthcare costs have become insane since the Affordable Care Act became law. I don’t blame the law itself. I blame the fact that the law is based on a market system that allows health insurance companies to set rates and rake Americans over the coals in terms of premiums, deductibles and out-of-pocket costs. The system is broken because it is based on a false premise: That healthcare should be attached to profit and that insurance companies get to gamble on the 100-percent risk that people will get ill at some point in their lives, often through no direct fault of their own.

I just visited a local hospital for a follow-up test. I had a sense that the test wasn’t actually necessary. It was just meant to assuage feelings of making sure “everything” was done from the perspective of the medical providers. During check-in, before the test, I asked, “How much is this procedure going to cost?”  The response I got was, “I don’t know.”

And, there is one of the many problems with our healthcare system. Consumers aren’t allowed to know the costs before incurring them. As my husband said, it’d be like going into a grocery store with no prices on the shelves, with none of the staff knowing the prices, and the only indication you have of what you’re going to pay is when your groceries are bagged and ready to go and you have no other choice. That isn’t a fair market.

After receiving one of the bills for this test (because don’t you know there are 2 bills – one for the procedure and one for someone to read the results, which are printed off a computer), I went to the hospital billing department to make arrangements for payment. While there, I mentioned that I had asked for the price ahead of time. I was told that no one in the hospital has access to the costs. (WTF?!? Aren’t their computers all connected to the same system?)

I was, however, given an important tip. When a doctor suggests or orders a procedure, ask for the CPT code, which is the billing code. With CPT code in hand, call your insurance company to get an estimate for the procedure. It won’t be an exact cost because sometimes conditions change within the course of a procedure and other CPT codes may come into play, but at least you won’t be operating completely blind in regards to the cost.

I would also ask your doctor how necessary the procedure is. Let him or her know that you are concerned about the cost and ask if you can take a wait-and-see approach to your problem. In America, we are far too quick to accept tests for conditions that are likely to resolve themselves or that have straightforward solutions that don’t require testing.

Obviously, if you are in an emergency medical situation, you are not going to be asking how much your bill will be, but we are never going to rein in our outrageous healthcare costs if we don’t start demanding (nicely!) the price of procedures up-front. Here’s a way we can do that. And, if enough of us do this, hopefully healthcare costs won’t be kept a big secret.