Talking to Your Doctor About Health Costs

In a new brochure developed for patients, medical student Jessica Jou writes, "Most people can find an estimate to hire a babysitter or fix a car. But what about a chest x-ray? Even in the age of Google, you may be surprised by how difficult it is to learn the cost of your health care."

This has become increasingly important as more patients find themselves with health plans that require the first several thousand dollars of expenses to be paid out of pocket. It doesn't help that talking to your doctor about health costs can be uncomfortable.

Using insights from hundreds of patient anecdotes that Costs of Care received during our last two essay contests, Jessica lists lessons learned and helpful tips, including answers to questions such as "What if my physician refers me to the billing department?" and "What kinds of cost-aware decisions can my physician make for me?

Download Jessica's brochure directly from the Costs of Care website.

Jessica Jou is currently a second year medical student at the Tufts University School of Medicine. She grew up in Taiwan where medical insurance is universally provided by the government. While in college, she lead a team of physicians and students to provide healthcare to rural villages in Nepal. They are now in their fifth year of service. And after working with the uninsured population in Boston at the Sharewood Project, she is inspired to empower patients and physicians alike to start the conversation about healthcare costs

Savvy patient finds hidden discounts just by asking

The following anecdote was written by Suzanne Nesmith, a patient from Arkansas who was a finalist in the 2011 Costs of Care Essay Contest.

My husband and I have been self-employed for many years, and though our income is quite limited, we have always been careful with our finances,  have always managed to live within our means, and have always paid our bills without assistance.  We had private health insurance coverage and saw premium increases each year. Then to avoid further increases, coverage of office visits outside of deductible was dropped, and our deductible was raised to $4500.  Finally, about seven years ago, the cost became prohibitive for us; when yet one more increase was announced, our monthly premium payment would amount to approximately 30% of our monthly income.  We were in relatively good health and, in fact, in 10 years we had only one health insurance claim-- an emergency room visit when our  daughter fractured her arm in a roller skating accident. 

We did not do it lightly, but we made the decision to drop the health insurance coverage we could no longer afford. We started to research alternatives and found Samaritan Ministries International, a Christian need sharing group. It was through SMI we were first made aware of how prices for medical charges could vary, that discounts were often made to self-pay patients, and what a difference simply asking about prices could make. What valuable information—for anyone, but especially for the self-paying!

Recently, I required more than routine health care and my doctor ordered a CT scan.  I called three facilities to ask what the cost of the ordered CT scan would be, understanding that it would not include the physician’s reading fee only and that it would be only an estimate.  The first things that was obvious was that hospitals are unfamiliar (and it appears to me uncomfortable) with being asked this question.   I was often transferred from one department to another, usually ending up in billing or finance, and more than once, was told,  “I’ve never been asked  that before.”   When finally connected with the person who could give me that information, I also asked if any discount was available for self-pay patients, and for cash payment.  The results were so interesting  that I put them in the form of a chart to show to my doctor.  

Facility	estimate	discounts	estimated result
XXX	$2921	20% discount if contacted within 10 days of billing, and paid with first billing	$2441
XXX	$5459	20% discount for self-pay 20% discount if balance paid within 1 month	$3276
XXX	$3849	58% discount if  ½ paid in advance and balance paid in next billing cycle.	$1616

Not only did we have the benefit of cost savings by comparing prices, we had additional cost savings through discounts by  simply asking—these might have otherwise been missed.  My doctor has since ordered a colonoscopy.  So, I called different facilities and was quoted prices of anywhere from $1288 to $1500; and in each instance it was not until I simply asked about any discounts was I told that I could arrange for a 50% discount if I would simply ask to pay (even as little as 1/4^th payment) at the time of service.  Simply asking about price and discounts will now be an essential part of my personal responsibility and proactive attitude concerning  my own health care.