Tips for questioning costs in today’s health care system

by Joanna Fief

About two years ago in the wee hours of the morning, I found myself in a local emergency room with severe stomach pain, incessant vomiting and dehydration.  It wasn’t pretty, and I was desperate for something – anything – to ease my pain and stop my vomiting.

Gratefully, within minutes of receiving an IV with medications for pain and nausea, my symptoms subsided.  After a couple of blood tests that all came back normal, I was discharged.  The ER doctor said I probably just had a virus.  I wish …

Over the next six months, I lost 20 pounds, and had repeated bouts of stomach pain and vomiting.  After another ER visit, countless doctor visits, an ultrasound, an x-ray, a CT scan, an endoscopy and a gastric emptying study, I was diagnosed with gastroparesis.  Gastroparesis is a disorder where food moves slowly – or sometimes not at all – through the stomach and digestive tract.

Thankfully, today my condition is well-managed, and I feel pretty good.  However, it took me until last month to finish paying my medical bills – and that’s with good insurance.  Although I definitely don’t mind paying for the care that I received, I do wish medical pricing was more straightforward and transparent.

My mother is a nurse and I work for a health insurance company. Until I got sick, I considered myself pretty savvy about the health care system.  Over the course of my medical journey, though, I realized even with “insider’s knowledge” it can be extremely difficult to navigate the system, know the right questions to ask, and make informed decisions about cost and quality of care.

Not until after I got my first emergency room bill did I find out that while the hospital was in-network, the doctor was out-of-network.  Only when I was lying on the gurney getting ready to be sedated for my endoscopy did it occur to me to ask the doctor how many of these procedures she had done (thankfully, more than 5,000).  And, not until a few months ago, did I even consider that I might have shopped around for the best price on a CT scan.  I always felt like I was one step behind.

The new health reform law promises to change the health care experience, but we shouldn’t underestimate the power each of us holds to drive that change.  If I had it to do over again, I would ask more questions about the cost and reason for each procedure – while there was still an opportunity to influence the outcome.  The questions might make others uncomfortable, or as I found, the answers might not be readily available, but it’s the best way to be your own advocate.

Learn from my experience.  When your doctor suggests going to the ER for a non-emergency x-ray just because it’s faster, you might think twice before going along with it.  Below are five simple questions you can ask to create options and protect your pocketbook.

  1. How much does that cost? It’s a simple question with a complicated answer. Costs can vary depending on your insurance (or lack thereof).  Be sure to ask up-front how much it will cost for you.  I had to talk with a couple of people at my doctor’s office and insurance company to get an answer.  Be persistent!  It’s your money!
  2. Is that really necessary? Do you really need two MRIs in the same month? Although, at first it might feel uncomfortable, it’s okay to ask this.  It can help protect you from unnecessary physical risk (think excess radiation exposure) and financial hardship.
  3. Is there a cheaper option? The newest and most expensive technology is not always the best option.  Many times there is an equally safe and cost-effective alternative that can save you hundreds – even thousands – of dollars.
  4. Is there a generic for that? One of the simplest things you can do to save on medical expenses is to ask your doctor or pharmacist if there’s a generic alternative for any prescription drug you are taking.  The generic may look different, but the FDA requires it to meet the same strict standards of safety and effectiveness as the branded version.
  5. Has anybody out there had this before? Ask your family and friends what their own experience has been with a particular condition or treatment.  Their insights can also help you ask good questions of your provider and care team.

Joanna Fief works at Regence BlueCross BlueShield in Portland, Oregon. The company’s blog about health care costs is What’s the Real Cost.

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