How to Not Go Broke at the Doctor's Office
When you walk into a juice shop, you know exactly how much you’ll pay for a green smoothie. That’s true for almost everywhere you spend money—except your doctor’s office. You trust your doctor to run a test, and then you find out it wasn’t covered by insurance. You go in for what seems like a routine procedure, then get a bill (after insurance pays its share) for more than your monthly rent. Health care is a killer combo for anyone’s budget: unpredictable and expensive. As a result, as many as 56 percent of young women skip seeing the doctor because of the cost, according to a Glamour survey. But you do have some control over your medical bills. Here’s how to rein in those expenses, without putting your well-being at risk.
First, Se t Yourself Up for Savings
A little prep can prevent surprises later. Most doctors’ offices will ask for your insurance information and can tell you standard office fees when you make an appointment. Next, contact your insurance to confirm your copay. That’s the bare minimum you can expect to shell out. You can also ask whether a treatment you think you need is covered. Travel vaccinations? Likely not. Flu shot? Probably.
Your insurance deductible is one of the biggest indicators of out-of-pocket costs, so know if you’ve met it and try to time visits accordingly. “I had a client whose surgeon scheduled a biopsy at the end of December, but the lab had a backlog, and the slides weren’t reviewed until the new year,” says R. Ruth Linden, Ph.D., founder and president of Tree of Life Health Advocates in San Francisco, which helps clients navigate the health care system. That meant a new deductible, and a $1,200 outlay that otherwise would have been covered by insurance. Of course, no one plans a health scare, but you can ask if it’s possible to process your claim before your deductible resets. The folks in billing are likely familiar with the pinch patients feel when a new plan year kicks in.
Another hack? An app called Ada—think Siri or Alexa with a nursing degree—can help you decide if you even need to see a doctor. By asking simple questions about your health and symptoms, it recommends cost-effective next steps, whether that’s a visit to your doc or just the cold and flu aisle at CVS.
Take Action in The Room
If your doctor is recommending anything beyond a basic blood draw or urine sample, know that those specialized tests or procedures may cost you—and you may have other options. Nita Landry, M.D., an ob-gyn and cohost of The Doctors, suggests asking, “I’m concerned about my out-of-pocket costs. Tell me what tests or procedures you want to order today, and why. Is it an option to ‘wait and see’?” It’s often perfectly safe to delay, but you and your doctor can decide how urgent your situation is. Remember, a doctor’s primary focus is understanding your symptoms, determining what tests are needed, and prescribing treatments to help, but you can still ask about prices. Your doctor should know general fees and recognize what care tends to be above and beyond the basics, says Amita Kundra, M.D., a cardiothoracic anesthesiologist with NYU Winthrop Hospital in Mineola, New York. The front office may also be able to check with your insurance.
As your doctor explains the next steps, listen up: Certain words should send up “This will be pricey!” flares. Insurance generally covers most preventive care, such as vaccines and screenings for diabetes, blood pressure, cholesterol, and colon and breast cancer, including your office visit and lab work (assuming you stay in network). But Dr. Kundra says there are some gray areas. For example, if your doctor recommends a “second look” or a repeat test, that may not be covered. When care switches from prevention to actual treatment, know that you may be in more expensive terrain. When in doubt, ask.
Also your prerogative: waiting to get a test or procedure until you have a clearer picture of the cost. Consider kindly asking your doc to take a beat and then call your insurance right then and there. A representative should be able to estimate what’s covered and how much you’ll have to pay.If there’s no way around a pricey procedure, or if you don’t have insurance, you may want to ask about payment plans or financial assistance. “Be prepared to counteroffer,” says Dr. Linden. “Ask whether a 50 percent reduction would be considered if you paid in cash”—that could save them hours of insurance paperwork—“and keep negotiating until you reach an agreement that you can meet.”
If you want easy access to your doctor without costly copays adding up, a Direct Primary Care practice might be an option to explore. For a monthly fee—sort of like a gym membership—DPCs give you unlimited visits and the ability to text with providers. Insurance may cover tests or treatment, but membership’s on you. Google “concierge doctor” to find one nearby.
Scrutinize the Bill
It sounds silly, but when you get a bill, first verify that it’s actually yours. Mistakes happen, and someone else’s throat culture is truly the last place you should be spending your money. Also check that there are no duplicate charges or services you didn’t receive. In hospital settings sometimes tests or meds are ordered that don’t get administered—and only you will know to cry foul. If anything seems amiss, call your insurance, stat. It could be their error or a slipup in your doctor’s billing office, but just because you’ve been billed doesn’t mean the cost is set in stone.
If the facts do check out but you’re concerned about your ability to pay, it’s always worth simply asking what can be done. “I genuinely want my patients to live healthy, happy lives, and I want them to feel empowered and well-informed,” Dr. Landry says. “Remember, as a patient, you are in control of your health.”