Over the last few weeks, we’ve talked about how to read your medical bills, insurance explanation of benefits, and how to cross-check the two to make sure they are correct and ready to make payment. Today is all about how to talk to our doctors about our doctor bills.
What to Know About Doctor Bills:
It’s important to know most doctors and healthcare providers do not have an active role in the medical billing process. As a result, they are not aware of the prices attached to their services. In addition, doctors and other healthcare providers play a minor role in determining which charge is attached to their service. With the advent of electronic medical records (EMR) their participation in the billing process boils down to a click of the mouse. Doctors and providers typically choose the diagnosis and the procedure they performed during your visit. That information populates the superbill. The superbill generates a claim. The claim is sent to your insurance carrier. Upon review of the claim, your insurance carrier processes it and provides the explanation of benefits along with payment or denial to your doctor/provider.
Doctors Are Surprised Too:
Many times doctors are surprised when they hear how much things cost in healthcare. I recently spoke with a friend who was avoiding some tests because of the cost. She had a follow-up appointment with her doctor last week. During the appointment, he asked why she did not have the tests yet. She explained she was concerned about the cost. He was not only surprised by the price but he provided her with alternative options to obtain the tests that might provide better pricing.
When to Talk to the Doctor About Bills:
My friend only talked to her doctor about the price of those tests because he asked. I encourage everyone to open the financial conversation in the exam room as the doctor is suggesting treatment and treatment options.
My Experience With Doctor Bills:
Last winter I went to the doctor. She prescribed a steroid and wanted to give me a shot to jump-start the effects. I asked how much the shot would cost. Of course, she didn’t know. She left the room to find out. Upon her return, she announced the shot would cost me an additional $15. I promptly consented. Upon checking out, my bill was almost $100 more than I expected! The shot was $15, and the administration fee was $85. I advised them I was not paying the $85 administration fee. I was quoted $115 and $15 is all I was willing to pay. It took time but ultimately they removed the charge. So, here are the questions to ask while in the exam room with the doctor.
What to Ask:
- How much does this item/shot/service/procedure cost?
- What CPT codes are associated with this item/shot/service/procedure? (more on CPT codes in another post)
- Are there any additional charges that accompany the item/shot/service/procedure?
- Are there other locations where I can receive this item/shot/service/procedure?
In Conclusion:
In conclusion, talking to your doctor about the cost of your healthcare is important. Hopefully, these questions will help you start the conversation with your doctor.
Don’t forget to pick up the Medical Bill Checklist I use to review my own medical bills!
As always, if you find yourself needing more assistance, please reach out to me directly at NBroadhurst@TennesseeHealthAdvocates.com