Thursday

SOS Mom Saver: Saving Money On Health Costs

Sometimes, we cannot avoid expensive medical procedures.  If you have a low or no deductible, then there's likely no stress when this happens.  If, however, you have a higher deductible, the cost of these procedures matters greatly.

Did you know that you can negotiate health care costs?  Before you start attempting to do so, though, you'll need to know a few things.  Most of them can be found out by calling your insurance company.
  • Is there a co-pay for the procedure you're needing to have done.  You may find that for some procedures that there is a co-pay.  If, for example, the co-pay for an MRI is $100, then you likely can just stop here.  You're not going to get an MRI for cheaper than that.
  • What is your deductible & how much of it have you met to date?
  • After you have paid your deductible, what is your co-insurance amount?  (In other words, what percentage of the cost do you have to pay after you have met your deductible.  This is typically 10%, 20%, or 30%.)  
  • What, if any, is your total out-of-pocket max for the year?  (For example, a person might have a $1,000 deductible and a co-insurance after of 20%, but they don't have to pay more than $5,000 total out-of-pocket every year.)  Usually, this number does not take into account co-pays which aren't included in your out-of-pocket maximum.
  • Is there a facility you must use for the ordered procedure?
Once you know these questions, you can then call the facility you must use for your insurance and ask them the last question:
  • What is the contracted amount with your insurance for the procedure?  
  • They may try to tell you that this will depend on your benefits, etc.  The contracted amount is a pre-determined amount that they have agreed they will charge.  This doesn't change according to your benefits.  The only thing your benefits determine is how much of that contracted amount YOU will pay.  Tell them that you know your insurance benefits & just need to know their contracted amount.  If they won't give it to you, go in & request it.  (Although I have always gotten the information over the phone.)
Once you are armed with this information, then you can know...UP FRONT...how much you will be required to pay.  Here's how you figure that out:
  • You have a $1,000 deductible and 20% co-insurance.  The contracted amount for the procedure is $1200.  You have not yet met any of your deductible for the year.  You will be required to pay $1040.  (Your $1,000 deductible and 20% of the remaining $200.)  Here's another example:
  • You have a $1,000 deductible and 20% co-insurance.  The contracted amount for the procedure is $1200.  You have met $600 of your deductible for the year.  You will be required to pay $560.  (The remaining $400 of your deductible and 20% of the remaining $800 charge.)
If you are not comfortable with what you will be required to pay, then you can proceed from there to find a cheaper rate elsewhere.  It is vital to know what you will actually pay before continuing, though.  Attempting to find a cheaper rate is simple:
  • Call providers in your area who provide the procedure you have been asked to have. (Don't forget to also call the place that is contracted through your insurance.)
  • Ask them what their cash price is.  It really is that simple.
  • Don't forget to ask if the price they give you includes contrast if that will be required (such as for an MRI).
If you find someone with a cheaper cash price than what you'll be required to pay using your insurance, you just take the order your doctor gave you to that facility and pay cash instead.  Don't even mention to them that you have insurance.

The only bad I have ever seen to doing things this way is that the cash you pay won't go towards your deductible or yearly out-of-pocket max.  We've had some plans with deductibles as high as $8,000 so for us...it just wasn't necessary to worry about a particular procedure's cost going towards that deductible. 

Disclaimer:  I am not suggesting that you do this without fully understanding the risks involved (that the money you pay won't go towards your deductible &/or yearly out-of-pocket max).  "They" always suggest that you consult with your doctor, insurance provider, &/or financial provider before deciding to move forward with anything like this.  We decided that moving forward with this was beneficial to us and our situation.  As I cannot look at everyone's situations, you must decide for yourself whether this is a good idea for your family or not.

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