It's hard to delay a procedure that your insurance may not cover when your child is in pain. Ask Holly who has a a high deductible plan and was just informed by her pediatrician that her 3 year old needs a tonsillectomy! In addition, not meeting her son's deductible is a huge burden on her family considering she is still paying off medical bills from 3 years ago. So she called me for help, and the following are some steps we took to avoid accruing more medical debt:
1. Talk to the "prescribing doctor": Be sure you understand what is needed and ALL your options. Is the procedure necessary or do you think you need a second opinion? Never be afraid of "pissing off" your doctor if you get another opinion. A good, confident doctor will always encourage you to get that second opinion because he/she knows you will come back. In addition, if there is a new procedure being used, he/she will want to know about it, and become more educated in that area.
2. Find out the "fair price" for the procedure: We used Healthcare Blue Book, which gave us an average, fair price rate, which is the rate paid by private insurers, of how much a tonsillectomy would cost in her general area. This included: the facility fee (where the procedure is preformed), professional fee (approximately how much the doctor would charge to preform the procedure) and the anesthesia fee. Keep in mind that there may be some extras if the procedure takes longer or there are complications. For those of you wanting to compare Medicare and Medicaid rates, try using CMS's Physician Fee Schedule, for the "government negotiated rates" on medical procedures.
3. Go shopping: Call up the local facilities and start documenting prices. Call when the facility is not as busy (for some the morning is best, for others, mid-morning is even better). Mention that you want the "cash rate" and be honest about your financial situation. You might be surprised at the difference between the insurance rate and the "cash rate." (Many times, a facility will charge more if you have insurance). Be flexible! Many times you can get even more of a discount if you pay for the procedure in full upfront. Some facilities will even give you some "wiggle room" if you can accommodate their times. Holly and I were quoted prices from $2, 800 - $21, 000.
4. Negotiate: You have done it with your car and your house, why not your medical bills! Keep in mind you may be calling a few different groups such as the facility, the surgeon, the radiologist, the anesthesiologist. Holly brought the prices we were quoted back to her pediatrician. To her surprise, the pediatrician contacted "her team," which included the facility, and the sedation team, and matched our price!
5. Get it in writing: Sometimes the doctor forgets to communicate with his/her billing department, or may not even deal with billing. Be sure you get your agreement in writing from the person you negotiated with so you have proof when the billing department sends you a huge bill by accident. Take down names, dates, as well as summaries of all correspondences.
Thanks to a little shopping, a loving, and now empowered mom, and a patient little boy, Holly now has a happy 3 year old, very little debt, and is now an advocate to others.
BONUS TIPS:
- Outpatient facilities tend to be a fraction of the price compared to hospitals due to lower overhead.
- Nurse Anesthetists (CRNA) tend to charge less than anesthesiologists due to education and experience; however, there are plenty of CRNAs out there that are just as good with plenty of experience.