It’s happened to just about everyone: You open the mail to find a massive bill for a medical procedure, and you are left with massive sticker shock. You may be asking yourself why the bill is so high, and why you are still paying hefty insurance premiums that are draining your bank account. Although you may be feeling overwhelmed, there are many practical steps you can take to decide if full insurance is for you, or if you can save more money over the year by using price comparisons and a higher deductible plan.

How does billing at my provider with insurance work?

  • Some insurances are branches off of other companies and can vary from state to state. 
  • One example is Blue Cross Blue Shield; they have various branches based in different states, and each has completely different policies and pricing than the others. 
  • Although some are under the same “umbrella”, you need to figure out which one is applicable to you and your policy before requesting pricing. 

It’s really helpful to know how the insurance system works before you go digging around for information. Many people have misconceptions about what their insurance includes, and what the premium they pay each month even goes to. It’s time to dig up that big packet of paperwork that you were given when you signed up for your employee-provided or self-purchased insurance program.      

  • Some insurances are branches off of other companies and can vary from state to state. 
  • One example is Blue Cross Blue Shield; they have various branches based in different states, and each has completely different policies and pricing than the others. 
  • Although some are under the same “umbrella”, you need to figure out which one is applicable to you and your policy before requesting pricing.

It’s also helpful to know that the same procedure can have multiple price points at your provider. That’s because insurance companies can negotiate the rate of payment in their contracts with the provider’s office. And while you’d assume you’d be receiving the best deal, that simply isn’t always the case. There is a standard price (sometimes called a sticker rate or rack rate) that many insured people are being charged instead of the negotiated rate, and you may have no idea that you’re not receiving the best deal.

When is it beneficial to choose a higher deductible plan?

It sounds strange to suggest you don’t use an insurer that you are paying a monthly premium for, but the reality is that insurance companies don’t always go to bat for you. Of course, this isn’t always the case, but the assumption that your insurance is getting you the best rate is something that can cost you more than you realize. With so many people now paying into high-deductible plans, many providers and hospitals are actually offering significant discounts for those who pay their balance upfront or in full, which can save you thousands of dollars. 

This doesn’t mean that everyone should forego health insurance, as that is dependent on your family situation and medical needs (and preparation for a large medical crisis such as injury in a car accident or a lengthy hospital stay). Choosing a higher deductible plan can save you money in monthly premiums that you can set aside for lower-priced cash pay rates on the medical care you may need. 

What could I be saving money on?

It’s not just the large procedures like knee surgery or an ICU stay that you could be saving on! Price comparisons can save you on:

  • Prescription drugs 
  • Diagnostic scans such as MRI’s
  • Physical therapy. 

How much money could you really be saving? A procedure such as a brain MRI could have a “sticker price” of $600-$900, but a negotiated rate could put you at $500. That’s a huge saving, especially if you’re on a tight budget.

What Should I do?

If you’re reading this, you likely are in one of two scenarios:  

  • You have already had a procedure or scan done, and you’re stunned by the huge bill you received.
  • You are preparing for a medical procedure or scan, and wondering how to afford it. 

If you’ve already had your visit or appointment, there are still steps you can take to secure a lower rate. First, you can call your provider and ask if you can see a “superbill”, detailed analysis and listing of each and every charge that is being billed to you. This is a simple way to see what you’re being charged for, and why. Sometimes, there are even incorrect charges on a bill, and this is a great way to catch any of those right away before you pay. 

 If you’ve already received a bill, make sure that it is an actual Estimation of Benefits (EOB) from your insurance program, and read it carefully. You should then receive a second bill from your actual provider, showing what you truly owe. Retain all documents received and make it a practice to keep detailed healthcare records. If you haven’t yet had your medical procedure or appointment, you’re in the best position to benefit from a cash payment or negotiation. Start by price comparing! Just like many other industries, did you know that medical care can be price compared?   Many patients don’t realize they have the buying power when it comes to their own care, and they can shop around, just like they would for car insurance or a better rate on a mortgage. Sites like ZeaMed make price comparisons easy and painless, showing you the estimated rates for things like an MRI, a CT scan, or a doctor’s visit.  

There will be instances when using your full insurance is the best thing for you to do, like if you’re close to reaching your deductible, or if you anticipate that you will have numerous health concerns within a calendar year. There will also be instances when cash pay (choosing a higher deductible plan and price comparing) will be completely in your favor, such as receiving a discount to pay in full or receiving a negotiated price due to cutting out the middleman (insurance). As always, do your research, and don’t forget that you, the patient, have the true buying power to get a better rate depending on how you pay. All you need to do is ask for it. 

If you want to see the price comparison of healthcare in your area, check out zeamed.com to price compare now.

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