Smart Spending: Physician, heal my doctor bills

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by Christina Rexrode
AP Business Writer

NEW YORK (AP)—Few things make me feel as clueless as a bill from my doctor’s office.

I don’t recognize the abbreviations or understand the jargon. I can’t tell when I’m being charged too much. And there’s no screen on the wall, at least not at my doctor’s office, tallying the cost of each extra test I agree to or question I ask.

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SHOP AROUND—Doctors look over X-rays in Chicago. Even people who studiously comparison-shop for their digital camera or winter coat don’t always realize they should do the same for medical services. But prices can vary significantly, so it pays to look around. (AP Photo/Charles Rex Arbogast, File)

But, even if you have health insurance as I do, medical bills can spiral quickly, eating up savings or in extreme cases leading to bankruptcy. Here are ways to protect yourself throughout the process.

•CHOOSING DOCTORS AND HOSPITALS: Even people who studiously comparison-shop for their digital camera or winter coat don’t always realize they should do the same for medical services. Prices can vary significantly.

“You can get an MRI on one side of the street that will cost you $2,000, and the exact same MRI on the other side of the street will cost $4,000,” says Dr. Neel Shah, executive director of Costs of Care, a nonprofit that aims to help patients deflate their medical bills.

He isn’t speaking metaphorically. Dr. Jeffrey Rice, CEO of the Healthcare Blue Book, estimates that there’s an average difference of 300 percent to 600 percent between the lowest price and the highest price for any single medical procedure in any U.S. city.

If you’re thinking you needn’t comparison shop because you have insurance, think again. Many insurance plans will still hold you responsible for a portion of the bill in addition to the deductible. And don’t assume that choosing a doctor who’s in your insurance company’s network will solve the problem: Their prices can vary too.

“The biggest problem we see is patients don’t ask about costs before they get their care,” Rice said. “It’s like going to buy a car and deciding afterward that the price was too high.”

You need to call each doctor’s office or hospital you might visit to learn what they charge. The Healthcare Blue Book website, which is free to consumers, can help you figure out what prices might be reasonable. It collects information about the fees doctors accept from insurance companies.

If you’re uninsured, ask about a “self-pay” discount. Doctors often charge less to patients who have to pay out of pocket, but they generally don’t advertise this.

•AT YOUR VISIT: Tell your doctor you need to watch what you spend. She might not know the exact cost of each procedure or whether your insurance covers it, but she’ll know the relative value of each test she orders. Maybe she can hold off on a few for a couple of months, until she’s certain you need them. Or, if you need surgery, maybe your doctor can do it at an outpatient facility instead of a hospital.

It’s also important to make sure you’ve followed your insurance company’s paperwork procedures, no matter how ridiculous you think they are. For example, if your doctor sends you to a specialist, ask your insurance company whether you’ll need pre-authorization for the visit. The pre-authorization is just another layer of paperwork— maybe your doctor’s office has to fill out an extra form or make an extra phone call—but you want to be sure it gets done.

“There are times when a test is ordered and performed and no one really realized it (needed pre-authorization), and the patient gets stuck with a bill for a test that would have been covered,” said Dr. Stephen Meyers, a physician in Oak Ridge, N.C., who runs SmartMedSavings.com.

Or say you have two health insurance plans—a primary and a secondary—and you need a procedure that your primary plan won’t cover but your secondary will. It’s likely that you’ll still need to file a valid claim with the primary insurer, just to get it denied, to guarantee that the secondary insurer will pay up.

•THE BILL: In most cases, you won’t see any tally of prices until your insurance company sends you a document listing what the doctor or hospital charged, how much the insurance company paid and what’s left for you to cover.

It’s a good idea to ask for a line-item bill from your doctor’s office or the hospital so you know exactly what you’re being charged for. Check for glaring errors: Are the medicines listed on the bill the ones you actually received? Is there lab work listed on a day when you didn’t have blood drawn? It’s easy for a billing office to accidentally key in “11” instead of “1” and charge you for 10 extra pills or to transpose a few digits in a code and charge you for an injection when you really just got counseling.

“You don’t want to assume that everything somebody is charging you for is correct,” said Louis Saccoccio, CEO of the National Health Care Anti-Fraud Association.

•THE APPEAL: If you believe you’ve been charged for something your insurance company should cover, contact the company first. If it still denies your claim, you have the right—under the new health care reform laws—to ask for an independent organization to review your claim. If your health insurer tries to deny you this external review, contact your state insurance commissioner’s office.

Other state agencies also can help you. Check the “Consumer Assistance Program Locator” on the nonprofit Families USA’s home page or HealthCare.gov, a website managed by the U.S. Department of Health and Human Services.

Some for-profit companies also will scour your medical bills for errors and try to get the charges lowered. But these companies will keep a portion of any savings they recover for you, sometimes as much as 35 percent.

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