Getting affordable healthcare is often challenging. Health insurance is complicated, and medical costs seem completely unpredictable. But, while it may be difficult to understand, knowing how your health insurance works and how to shop around for medical costs could save you hundreds – or even thousands – of dollars per year.
Know your health insurance
It seems like my wife's health insurance through work changes in one form or another every year. It's hard to keep up with, but it is essential that we understand it. The worst part is, my wife works for a hospital. You would think their insurance would be the best and the least complicated. Unfortunately, that's far from the truth, as we've found out.
In our particular situation, my wife has multiple tiers of service providers, each of which costs us different amounts of money to use. During my wife's pregnancy, she was required to get ultrasounds. You would expect an ultrasound to cost the same, no matter where you get it done, right? That couldn't be further from the truth.
When we got an ultrasound done at the doctor's office, it cost us $150 out-of-pocket. But if my wife gets the same ultrasound done at her hospital, it is completely free. Crazy, right?
Understanding how your health insurance works is super important. If you don't understand the basics – as we clearly did not – there is no shame in asking for help. If you work for a company, your human resources department may be able to help. However, the best resource is usually the insurance company itself.
Give the company a call and ask questions until you understand how to get the best value from your plan. If you hate talking on the phone, some insurance providers – like my wife's – have a live web chat feature. Web chat is super helpful because everything you talk about is in writing so you can refer back to it later. If we had done the research and kept up with her health insurance, we could have saved $300 by getting the first two ultrasounds done at the hospital instead of the doctor's office.
Shop around for services
Shopping around for services can save you a decent amount of money. Many insurance providers now offer cost estimator tools on their websites. While they aren't always accurate, they're a good starting point to find out how to get the best price for a medical service. Generally, you enter your location and the particular service you are shopping for and the insurance company will give you a list of medical providers, along with an estimated cost for service.
Another option is to call in-network providers and ask them for their rates. This is probably the most difficult, but it’s possible if you are really persistent. If you just talk to the receptionist, they'll probably think you're crazy. Receptionists, for the most part, have no clue how medical items are billed. Sadly, most doctors don't know, either. So instead, ask to speak to the billing or insurance clerk. You'll need to have the medical billing code for the procedure you're considering and ask for the cost of that particular procedure. If you don't know the billing code, you may be able to call your health insurance for help.
Of course, there is no guarantee the medical provider will bill your visit using the same code that you're asking about. You could end up getting different services than you had shopped for. Or a doctor may add additional codes and services without asking your permission in advance.
The best advice I can give is to be proactive – make the provider aware that you're trying to keep your costs down and only want necessary services.
Medical emergencies are a different beast
Keep in mind, shopping for healthcare services should only be done when you have a planned procedure coming up. If you're having a medical emergency – such as a heart attack or a broken bone – you should be more focused on getting your problem fixed. However, if you understand your health insurance prior to an emergency, you can at least make an educated guess about what type of facility will be able to give you service at the most reasonable price.