High deductible health insurance and price shopping.

[ChiliPepr]

I was wondering if people with "High Deductible" health insurance price shop?

I know that physicals are covered in full, but when you have other claims, do you shop for price? I am not talking about medical travel where you travel to a different location to get something done, but local price comparison.

Let's say that during your physical your doctor says that you really should have a MRI on that creaky knee, do you call all the different MRI places and ask their price? What was your success in actually getting what the cost is?

 

[audreyh1]

I've tried. It's hard. We did comparison shop for a colonoscopy that we didn't expect to be covered. We had to visit the facilities and we did get a couple of quotes and made a choice.

Yes, I would shop for the MRI. You might have to visit the facilities.

In general hospitals charge far more for imaging services than stand alone facilities, but your plan will limit your in network choices anyway. So you might just have a very few to visit.

 

[pb4uski]

We do for some services, such as PT... our local hospital is ridiculously expensive so we drive an additional 15 minutes in the opposite direction (30 minutes west rather than 20 minutes east).

 

[Texas Proud]

If it is something that I can price shop for...


But, one of the things that is hard is to get a price... most places will not give them out since they do not know what the insurance will 'pay'... IOW, there is a negotiated price and I usually do not get to know what that is until after the procedure...

What I am hoping (and I might be wrong) is that the 'insurance' price is similar for all locations...

 

[audreyh1]

If it is something that I can price shop for...


But, one of the things that is hard is to get a price... most places will not give them out since they do not know what the insurance will 'pay'... IOW, there is a negotiated price and I usually do not get to know what that is until after the procedure...

What I am hoping (and I might be wrong) is that the 'insurance' price is similar for all locations...

That's why I went to the facilities. One called my insurance company, got a number for the "allowable" and discussed what would be the options for what was owed before the procedure versus paid later. But we had to register to do this. Since registration didn't obligate us, we went ahead. The other hospital gave us more of a ballpark idea at the registration desk, but we didn't go on to speak to any "financial counselor".

You can also call your insurance company and try to get this "allowable" and discuss the facility options.

My experience is that this "allowable" isn't identical to the final insurance determined price, so I try to pay the minimum up front, and the balance once the insurance paperwork has gone through.

 

[zinger1457]

My local Urgent Care facility is very open about the cash prices they charge for the services they provide, the front desk has a sheet with cash prices for common services. Unfortunately their services are limited. Last year I had a cut that required a few stitches, Urgent Care quoted me $80 cash. I told them to bill my insurance company, I figured the negotiated rate wouldn't be any higher. That was a mistake. They billed my insurance company $210 and the negotiated rate was $150. I called Urgent Care billing and explained the initial $80 quote I received and they were willing to accept $80 cash payment to close out the bill.

 

[MichaelB]

It's been difficult to get this information. BCBS Fl has a "cost estimator" tool which gives an "average price" for a procedure seems to be what they would pay. When I've asked for price info from a provider, all I get is the list price, which is not helpful. Here in S Florida DW and I have seen more than one healthcare provider that has confirmed a price as "the negotiated insurance rate", including an upfront payment, only to discover from the EOB that they were overcharging.

 

[CardsFan]

Recently I needed a hip x-ray. My PC doc asked if I had a high deductible, when I said yes (although it is not very high, I was still well below for the year), he referred me to a local imaging center. He said the hospital would be several hundred, the imaging center costs $44.

After the procedure, I checked on line and they have an on-line pricing estimate that was very close to what I paid.

I will go back there, when needed.

 

[bingybear]

If it is something that I can price shop for...


But, one of the things that is hard is to get a price... most places will not give them out since they do not know what the insurance will 'pay'... IOW, there is a negotiated price and I usually do not get to know what that is until after the procedure...

What I am hoping (and I might be wrong) is that the 'insurance' price is similar for all locations...

It is hard to get a price from the doctor's office. I've found some insurers have web tools that will let compare prices after insurance. This assumes not complications and they don't find anything new. This worked well for my last diagnostic colonoscopy where they did not find anything.

 

[Sangiovese]

I have found it nearly impossible to obtain a price quote up front. I am usually met with long pauses, blank stares and a lot of stammering when I ask how much a procedure will cost. The system is just not set up to figure out prices until AFTER the services are rendered.

Traditionally, nobody cared because someone else was paying between 80% and 100%. Now, I REALLY care because I'm paying 100% (up to my outrageous deductible) and I no longer have a j*b to replenish the money I'm spending.

 

[Texas Proud]

It is hard to get a price from the doctor's office. I've found some insurers have web tools that will let compare prices after insurance. This assumes not complications and they don't find anything new. This worked well for my last diagnostic colonoscopy where they did not find anything.

Yes, I did have one insurance company that DID list the prices on their site... I did use it to look at colonoscopy prices and there was a big difference... this was at the beginning of ACA and their was still questions on who would pay if something found...

I wish all companies would do that...

 

[audreyh1]

An important thing - the price is probably already set by your insurance company. So it may well be that they allow the same amount across providers.

I remember wondering after doing our price compare whether it was going to matter because the insurance company had already decided what they considered to be the negotiated price for the procedure.

One glaring exception though - they probably have a higher allowable for hospitals than for non-hospital facilities, and the difference could be large.

I couldn't believe how much they charged at a local hospital for an ultrasound. I never made that mistake again. My doctor's office has ultrasound available on Fridays, a technician comes in to do them, and they are about 1/4 the price.

 

[Jerry1]

My experience is that once I get burned the next time I shop. Now I'm in an HSA and I try to shop. It has been mentioned, but the easiest, biggest bang for the buck is to stay away from hospital services if a freestanding alternative exists. It's difficult to shop healthcare especially if it is anything more than a basic service. A lot of people like to compare shopping for healthcare services to a retail experience - show me your price, I decide whether or not to buy. The problem is that healthcare is more like car repair or builder contracting. Since every job has the potential to be different, it's unlikely that the quoted price is the price you'll actually pay.

 

[woodguy00]

I'm struggling with this now. I need a new CPAP machine. The reimbursement amount will cost me $900 against the $2600 annual family deductible which we haven't hit the past few years. I can buy it online for $600. Not sure which makes more sense. Rolling the dice.

 

[Texas Proud]

I'm struggling with this now. I need a new CPAP machine. The reimbursement amount will cost me $900 against the $2600 annual family deductible which we haven't hit the past few years. I can buy it online for $600. Not sure which makes more sense. Rolling the dice.

Do you need it right now or can you wait to the end of the year

One of the things that I do if I can wait and know there is a cost difference is buy late in the year... if you are not close to the deductible then buy for the $600... if you are close and net it will cost less... then use the insurance...


The other option is to pay the $600 and then put in a 'claim' to insurance and try and force them to credit that to your deductible....

 

[pb4uski]

....The other option is to pay the $600 and then put in a 'claim' to insurance and try and force them to credit that to your deductible....

That is what I was thinking, though I'm not sure of any need to force... if you have proof of payment then it shouldn't be a problem and it is moot if the poster doesn't exceed their deductible for the year.