Saving money on healthcare is more than just possible — with the right tools and knowledge, it can be easy. Award-winning investigative journalist Marshall Allen shares his tricks of the trade on how to lower your medical costs, unpacking everything from insurance plan mark-ups, to itemized healthcare bills, to disputing unnecessary claims. Business leaders and HR community, share this with your employees to help them become more informed in navigating healthcare costs.
In the American healthcare system, there are countless incredible carriers and providers looking out for their patients’ best interests.
But there are also a lot of shady players looking to make a quick buck. And because they’re the keepers of the care and services we need to stay healthy, most of us don’t question it.
Well it’s time to start asking questions. Because we can’t afford not to.
We mean that literally. The U.S. healthcare system is extremely expensive, and only getting worse. We’ve seen a 200% increase in healthcare costs vs wages since 2010. Even with insurance, people are hit with life-altering bills every day.
The good news? You can fight back against these predatory players. And it’s easier than you may think.
We called in the expert to share his cost-saving secrets. Award-winning former ProPublica journalist and author of “Never Pay the First Bill”, Marshall Allen joined us to offer a peek into his cost-saving playbook.
Read on for your step-by-step guide to reducing your healthcare costs before, during, and after your appointment.
Shop around before you make that appointment
Some folks might assume that the U.S. healthcare system is kind of like a restaurant chain, with the same prices on the menu at every doctor’s office. You go get a physical in California, and you’ll be charged the same as if you were in Florida. The price is the price.
But we’ll let you in on a little secret: there is no nationwide “menu” of healthcare prices.
Instead, there can be a huge variation in pricing for the exact same services, even in the same geographic areas.
As explained by Marshall, “People don’t realize that you can get the same MRI or CT scan, or blood work, or even knee replacement, in the same town for exponentially different prices. You might get a CT scan at a hospital. They might charge you $2,000 for that scan. You could go to an independent imaging center that’s within a mile of that same hospital and pay $300.”
So it’s in your best interest to check out the prices first. And thanks to a recent law, hospitals are now required to share their prices publicly.
Here are two Marshall-approved sources where you can find local care prices:
Some employers also offer price comparison tools as a benefit to their employees. Using these tools, you can compare pricing before choosing a provider. (Yep, healthcare is finally catching up with modern online shopping era.)
Check out the prices both with and without insurance
We know what you’re thinking: Insurance makes healthcare costs lower. It would be nuts to not use insurance for any kind of treatment, especially big-ticket procedures… right?
Well, that may be true. But in some situations, using your insurance may end up costing you more.
Sometimes it’s much cheaper to pay for care without running it through your plans first. That’s because the price with insurance depends on what the carrier negotiated. And let’s just say they’re not always the best negotiators.
“The insurance companies and the hospitals say, ‘oh, well, we negotiated this price,’” Marshall explained. “And so you have to pay it… I’ve seen cases where [under their medical insurance plan], an emergency room visit was charged at 22 and a half times the cash price. The cash price was $256 for a level three emergency room visit. Through [their insurance], the discounted rate was $5,800. That’s not fair.”
This tactic may be especially helpful if you have a high deductible. Why pay out the nose on something that you could have gotten for much less?
Always ask for an itemized bill
If you look at a lump sum, you may be missing the trees through the forest.
In other words, some providers will price gouge for certain services (say, charging $629 for a bandage) and then hide it in the lump sum bill. Or they may “accidentally” tack on costs for services you didn’t have, and then assume you won’t ask any questions.
With an itemized bill, you’ll have the full view into all the details. And that’s your starting place to begin disputing any charges.
But here’s the key: make sure your itemized bill includes the billing codes for each charge. Why?
“Now I know nobody’s thinking, oh, I wanna learn about billing codes. Right? It sounds so boring. But with each billing code, let’s just say, it’s an emergency room visit. And let’s say it’s for something extremely simple. Like you cut your finger or something.
That should be like a level one or a level two emergency room visit. And if you can get the codes, the 99281 is the CPT code for a level one emergency room visit. Well, they should have bill you at a 99281, but if they bill you at a 99285, that’s a level five emergency room visit. That’s the most complicated kind of emergency room visit.
And so whether it’s because of a mistake in the billing, or because of something, maybe more unethical, which is that they’re upcoding you, because they’re trying to make more money. You can end up spending way more money on your emergency room visit than you should be paying.”
And don’t worry — you’re not going to have to become fluent in billing codes. This is all on Google. It’s one quick extra step that could save you a lot of cash.
Once you have the bill in hand, confirm that the services you were billed for were actually the services you received
Yes, really. This problem is more common than you think. It’s also called fraud.
“When those bills get sent to the insurance plan, that insurance plan isn’t checking to make sure that those services were actually provided at the level that the medical provider is claiming. Nobody is checking that. So the patient needs to check that.”
About the Author
Brandon is the Co-Founder and CEO at Nava Benefits, a modern benefits brokerage on a mission to provide high-quality, affordable access to healthcare to all Americans. Prior to Nava, he co-founded VTS, a company that transformed the commercial real estate marketplace, and is now used in over 50% of all office buildings in the United States. Outside of work, he enjoys getting into nature, and is passionate about backcountry skiing, mountaineering, and trail running.