Zurik: 10 questions to ask before your next pricey medical procedure
NEW ORLEANS (WVUE) - "It's outrageous," Glenn, a North Shore resident, tells us. "The rates that they're charging: they're beyond reasonable and fair."
Glenn unknowingly learned a vital lesson - one that can save you money.
Two years ago, Glenn's doctor prescribed physical therapy for a painful shoulder at a North Shore clinic.
"They billed my insurance company $190 per physical therapy session," he says. "And I had to pay a $35 copay. That's what I call reasonable."
Last year, Glenn's injured shoulder needed more work. His doctor sent him to a different therapist, connected to a hospital on the North Shore.
"Instead of $35 per session out of my pocket, it's a $120 per session out of my pocket," Glenn tells us.
He doesn't want to name the hospital or his health insurer, but he says each hour-long physical therapy session cost his insurance company nearly $500, and cost Glenn an additional $120 out of pocket.
"I was told that it's because they are certified," he recalls. "They're a licensed hospital, and therefore we have an agreement with them that they have to pay their hospital rates. But there was no such hospital engaged in this process, there was no hospital associated with it. It was a clinic in a building."
They even charged him $27 to apply an ice pack. Glenn says they never told him the cost ahead of time; if they had, he says, he would not have taken that cold pack.
Glenn's insurance company made him pay a total of $1,500. But he could have had that same procedure, paying cash, for $900.
The lesson Glenn learned, and one we discovered in our Cracking the Code series, is that routine procedures - even something like physical therapy - can be cheaper when performed outside of a hospital group.
"The patient is the one that pays that large difference when they are guided to the hospital for MRI scans," says Shea Soll, who owns and manages Doctor's Imaging Services in Metairie.
That disparity can be seen in MRI's - the cash price for a lower back MRI at Ochsner is $1,055. At the Doctor's Imaging clinic, it's $695.
"The patient should always be interested in the advice of their physicians," Soll says. "But when it comes to where do they go for various services, whether it's imaging or labs or other services that are provided outside a hospital environment, they should look into the pricing - because the doctors are typically either too busy to be very aware of those pricing differences, or sometimes it's just not their priority."
FOX 8 News and our partners at NOLA.com | The Times-Picayune and ClearHealthCosts.com have compiled pricing information throughout the New Orleans metro area, developing a first-of-its-kind database of costs.
As we analyze the numbers many of you have submitted to us, we've created 10 easy questions to ask - questions that may help you reduce your healthcare costs.
"For you as a consumer, the most important thing is to negotiate early, before you get the procedure," says Robert Field, a nationally-recognized authority on healthcare policy. "That's when you have the leverage. If you go to the provider, whether it's a hospital or a clinic or a doctor, and you say 'I need an MRI, what's it going to cost me,' they're in a position to bargain with you and try to give you a reasonable price. If you've had the procedure and then you come back and you say, 'This bill is outrageous,' well, what's their incentive to be nice?"
- Each procedure comes with a code, a CPT code. Your first question should be to get that code number. For a lower back MRI, it's 72148.
- Next, ask if you're dealing with a provider who is in your insurance plan's network.
- And then, specifically ask the cost: make sure you ask how much it will cost me.
- If you're insured, they should have just quoted you the insurance price - but also ask the cash price. We've found examples where that is cheaper.
- We recommend pricing your procedure. Log on to our interactive tool to find other prices around the metro area.
- Call two or three other providers, so you know a range of options.
- Make sure to ask if you could incur additional charges. For example, we've seen a colonoscopy come with separate prices for the doctor, the anesthesiologist, a lab fee, and even a facility fee for the place where it's performed.
- Call your insurer directly; ask what it will cost you.
- Make sure to get those cost estimates in writing.
- And if you choose the cash rate, ask your insurer how that could impact your deductible.
"Do your shopping," Field says. "Treat it like you're buying a car. Go from one dealer to the next and say, 'This guy will sell the car for $25,000, will you match that? This guy will do the MRI for $500; will you match that?' You've got to be an active consumer."
"We've had the game of hide the ball," Field tells us. "And now it's important to us individually to find that ball, because if we're uninsured or paying everything and if we have a deductible of $6t,000, that's a big chunk of change that we deal with. So now we have to look for the ball. And the system didn't develop in a way that we could find it easily."
We've heard from hundreds of FOX 8 viewers who asked questions too late.
"If you go in and just say, 'I'll find out the price when I get the bill,' you're going to get sticker shock," Field warns.
Glenn still sounds shocked. A handful of physical therapy sessions have left him with an unpaid bill, almost $1,700. In comparison, the same group of sessions at his old clinic would have cost $490.
"It's ridiculous that the two could be so far apart," he says. "The disparity is so great between the two."
Glenn says, lesson learned, he'll be asking questions like this before he makes another trip to the doctor.
"Not only is it frustrating, it angers me because - had they told me in advance anything, anything about these charges, what they might be - I would have not have gone there," Glenn tells us. "I would have gone someplace else, I would have gone to the place I went the year before."
Remember: we want you to join our investigation. Please contribute your prices, your stories to our database.
We want to see the prices you have to pay on any procedure.
Copyright 2017 WVUE. All rights reserved.