My thoughts on some of the six excellent questions Elizabeth Rosenthal, author of “An American Sickness,” suggests you should ask at every doctor’s appointment to make sure your medical bills are what you expect.
Question #1. How much will this cost? Your provider’s office staff will know the fee a procedure, or series of procedures are billed at. And they will be able to tell you if your health plan has negotiated a different fee schedule including your flat copay or co-insurance percentage. To be forewarned is forearmed.
Question #4: Are there cheaper alternatives that are equally good, or nearly so? One example I see is a medication that is a combination of two, or more, off-patent generics. Check your health plan’s drug formulary and compare the co-pays. If the new combination pill is high priced ask your prescribing doctor why the one pill is recommended over taking two; sometimes the only benefit is convenience.
Question #5. Where will this procedure take place and how does that selection affect my cost? Your health plan may have a preferred pricing arrangement (called “in network”, “participating” or “contracted”) with other facilities. Ask your doctor about performing the procedure at one of those.
One more suggestion. Contact your health plan agent or member services representative when planning an appointment with a new provider or facility. Your plan may have preferred providers, usage limitations and pre authorization requirements.