How To Learn The Price Of Health Care
Following are several methods to learn a fair price for a medical service in your area:
- If you have health insurance, check your company's web site to find out if it lists average prices for various treatments, tests and procedures.
- Check on line. The following websites provide prices of services in local areas based on insurance company databases and patient crowdsourcing. Type in your area code and the treatment, test or procedure at:
- Ask your doctor's office for the "CPT code" for the service. A CPT code is the numeric code used by the American Medical Association to identify health services. Once you have the CPT code, you can look up what Medicare would pay for the service in your area at: www.cms.hhs.gov/apps/pfslookup/step1.asp or https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp or you can call Medicare at 800.MEDICARE (800.633.4227). Ask to speak with a claims representative.
- If you do not find the information you need, consider the following:
- Call other health care providers in your area who provide the service you need to find out what they would charge. Include providers who are not close by, but that you can reasonably get to.
- Contact your local disease specific nonprofit organization.
- If you received or used a product, try to find out what it cost the doctor. For example, if the doctor administered i.v. drugs, how much did they cost the doctor? The charge may be a good deal less than you were charged.
If you received or used a product, find out what it cost the doctor. For example, if the doctor administered drugs i.v., how much did they cost the doctor? The charge may be a good deal less than you were charged. (You can ask the doctor or a member of his/her staff, a doctor that is not involved with the particular situation, or search on line.)
NOTE: If you ask a doctor what she or he charges for a particular service, you are likely to find that there are several prices. For example, there is likely to be a price for uninsured patients and a different price for patients who are insured. There may even be different prices for different insurers. The cheapest prices are generally reserved for people with Medicaid or a health insurance with an insurer that has a relationship with the provider. Highest prices are generally charged to uninsured patients. Ask the doctor or other service provider to give you the lowest insurance company rate. If the provider will not agree to the lowest rate, perhaps there will be agreement to at least give you a discount of some type.
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