How to make more informed medical decisions
When planning a medical procedure, making a well-informed decision is really important. While this is not always possible during an emergency medical scenario, having as much information as possible for elective procedures can help you get the best care, as well as avoid surprise bills or inflated charges.
You may not be able to get an accurate estimate of how much a procedure will cost ahead of time, but there are several questions you can ask to minimize your exposure to financial risk.
Here are five questions to ask before having a medical procedure.
1. Would the doctor have this procedure?
Most consumers will naturally ask their doctor, “Do you think I should have this procedure?” Instead you might try asking, “If you or your family member was having the same problems as I’m having, would you recommend this procedure?” Perhaps ask the question both ways. If you are embarking on a long-term treatment path, having as reflective of a conversation as possible is worthwhile.
2. Does this facility provide good value?
Value is a function of price and quality. If one hospital charges more than other hospitals in the area, but performs more procedures and has better outcomes, consumers might think the increased cost is valuable.
But often, hospital pricing varies for reasons other than quality metrics. Some expensive facilities do not have better outcomes than lower-priced hospitals. In Nashville, consumers can use Healthcare Bluebook’s search tool to get price and quality estimates.
For example, for a total mastectomy, Healthcare Bluebook lists TriStar Skyline as high quality and at or below fair price. TriStar Centennial, meanwhile, is listed as good quality, but highest price. Vanderbilt University Medical Center is listed as lowest quality and highest price. Across these three, TriStar Skyline may provide the most “value” for the service.
3. Is this hospital in-network?
Unless it is a dire emergency, you should always confirm that the hospital you are visiting is in your insurance plan’s network. Otherwise, you may be on the hook for out-of-network bills you are not expecting.
Some insurance plans cover a portion of out-of-network costs, while others do not cover out-of-network care at all. This is why double checking that the hospital is included in your network is so important.
4. Will everyone I see be in-network?
A frustrating but common experience is being treated by an out-of-network doctor at an in-network hospital. How can a physician be out-of-network if they are treating you at an in-network hospital?
Many anesthesiologists, radiologists and other specialists are not actually employed by the hospital or in your insurer’s network. You may wind up with a separate bill from these physicians that is not covered by your insurance plan.
While you may not be able to avoid being treated by an out-of-network physician, asking about this ahead of time may reduce your risk.
5. What does this admission form mean?
Many patients don’t realize that hospital admission or "consent for services" forms often also include an element of financial liability. In some cases, signing the form is confirming that you will pay what the hospital bills you, especially if your insurer doesn’t have a network agreement or does not cover the full amount of billed services.
In this case, be sure to ask what the “chargemaster” price for the service is. This is the “list price” hospitals have for their services and from which they negotiate discounts with insurers. You may not be able to get an accurate price estimate, but it’s worth noting that you have asked. This may help you negotiate your bill later if you are overcharged.
Asking these five questions can help consumers make better, more informed health care decisions and avoid unexpected bills. Further, hospital bills can often be negotiated, and keeping records of your inquiries around costs and services can strengthen your position in the event that you do have to negotiate a bill.