If you’ve ever been hit with a surprise medical bill, you know all about the unexpected costs of health care. Often, the invoices arrive in your mailbox piecemeal, over a span of months. First you get one for $500, then $1,000, then $1,500. The price keeps climbing and you worry that it will never stop.
That’s why it’s important to have an open conversation about pricing with your doctor. You should have an idea of how much you’re going to spend and whether there’s a way to bring the cost down.
“Patients are shy about doing so, but even if we don’t know all the exact nuts and bolts, we can work with you to figure something out,” says Jordan Frey, MD. He’s a plastic surgeon in Buffalo, New York, who runs a financial wellness blog called The Prudent Plastic Surgeon.
To help you save money, we spoke to doctors and found 7 questions that can help reduce your out-of-pocket expenses. Why? Because Optum Perks is dedicated to your financial health. If you download our mobile app, you can use it to search for coupons on prescription medication.
Now, here are the questions to ask your doctor.
Is there an alternative facility where I can have my imaging done?
The cost of basic services can vary wildly from one medical center to the next. In a study of providers in Iowa, the cost of magnetic resonance imaging (MRI) on a hip varied from $485 to $4,463. That’s nearly a tenfold difference. And hospital prices are often the highest. According to a report from National Nurses United, they mark up the cost of services by an average of 417%.
So if your doctor recommends a routine service such as an x-ray or MRI, ask how much it costs. Then ask if you might be able to get it cheaper at another facility, says Mahek Shah, MD. He’s a managing partner at WTM Advisors and an associate faculty member at Brigham Health and the Harvard T.H. Chan School of Public Health in Boston. He advises that you ask which ones are in your insurance’s network, especially if the doctor you’re seeing is also in network.
“At the outpatient centers, you don’t know what anything costs and may get caught off guard,” says Dr. Shah. In many cases, you can save thousands of dollars by driving to a nearby independent lab that specializes in the scan you need.
Can you refer me to a specialist?
Say your joints are aching and you think you need to see a rheumatologist. You still want to start with your primary care doctor. Otherwise, your insurer may not cover the visit.
“Too often, patients will go directly to a specialist without checking with their primary care physician first,” says Andrea Paul, MD. She’s the medical adviser for Illuminate Labs and is based in Sarasota, Florida.
That could lead to hundreds or even thousands of dollars in out-of-pocket charges. “Even if you’re certain as a patient that you know what specialist you need to see, it can be the right financial decision to see your primary care doctor first,” says Dr. Paul. “Getting the referral will often allow the specialist visit to be covered by insurance.”
Is all my care in network?
Just because your doctor is in network doesn’t mean you won’t get hit with an out-of-network bill, says Dr. Frey. “People don’t realize that if a doctor orders bloodwork or refers them to a radiology center for an x-ray, it may not always be in network,” he says.
It doesn’t seem fair, does it? But many doctors use other medical centers for routine services. That means you can sometimes get bills from companies you’ve never even heard of, and they may not work with your insurer.
So when your doctor orders tests, ask who they contract with. Then ask whether those companies are in your network, says Dr. Frey. Your doctor can check, and if you don’t get a clear answer, you can call your insurer to find out.
This is also important if you plan to have a medical procedure. “The surgery itself may be covered by insurance, but the hospital where it’s being done could be considered out of network,” says Dr. Frey. In some cases, your doctor may be able to move to an in-network hospital or medical facility to perform the procedure.
Oh, and while you’re scheduling that surgery, ask your provider if you can have it done at an outpatient clinic. That’s often cheaper than having it done in a hospital.
Is there a cheaper medication option available?
If you’re facing a pricey prescription, ask your doctor if there’s a less expensive medication that can treat the same condition — or if you can switch to a generic version, which has the same active ingredients but costs less.
You can also find lower prices on medications in other places. Dr. Shah recommends going to the manufacturer’s website, especially for brand-name medications. “They often have patient assistance programs, or you can sometimes buy direct for less than your copay,” he says.
You could also use a medication discount service such as Optum Perks. Click here to see how prescription discount services work.
Are my medical expenses HSA-eligible?
If you’re on a high-deductible health plan (HDHP), you can put pretax money into a Health Savings Account (HSA), explains Dr. Paul. This leads to what’s known as a triple tax break: You contribute pretax money, which grows tax-deferred and can be used tax-free for medical expenses.
You can use that money for out-of-pocket medical expenses such as deductibles, copayments, prescription medication, and vision and dental care. But always ask your doctors if any additional out-of-pocket expenses are HSA-eligible, advises Dr. Paul. If your doctor deems them necessary, things such as massages, yoga, personal trainers and other health-related costs could be HSA-eligible.
For 2022, if you have an HDHP, you can contribute up to $3,650 for individual coverage and up to $7,300 for family coverage into an HSA. And there’s no risk of losing that money: If you don’t spend it, it rolls over to the next year.
Can I get a discount for paying in cash?
If it’s late in the year and you’re pretty sure you won’t hit your deductible, ask your provider about a discount for paying in cash. “It could be cheaper than your copay and whatever you owe out of pocket after insurance,” says Dr. Shah.
You probably don’t want to ask this question in January or February, however, since you don’t know what other medical expenses you’ll rack up throughout the year. But it could make sense if November or December rolls around and you’re still thousands of dollars away from meeting your deductible.
Related reading: What’s left in my deductible? (And other common insurance questions).
Do I need to head to the emergency room?
The emergency room is expensive, so many people try to avoid it. Instead, they schedule an appointment at urgent care or book the earliest open slot with their primary care doctor. In many situations, that makes sense. But if you really do have an emergency, you should treat it as such, says Dr. Frey.
For starters, the emergency room allows you to get help quickly. But as far as money goes, if you’re going to end up in the emergency room anyway, you might as well make it your first stop. That way you won’t end up paying for the original doctor’s appointment as well. “If it turns out that it’s something more serious that needs to be seen in the emergency room anyway, your costs will have doubled,” says Dr. Frey.
If you’re not sure where to go, contact your primary care provider to find out. A sore throat, possible urinary tract infection or dog bite can generally be handled at urgent care, for example. But chest pain or trouble breathing usually requires a visit to the emergency room.
Remember: Nobody can manage your health care better than you. By asking smart questions, you’ll be an informed consumer. And you’ll probably spend less in the long run.
For another way to possibly lower your costs, download the Optum Perks discount card. Just present it to the pharmacist at checkout to see if a lower price is available.
Dr. Frey’s medical finance blog: The Prudent Plastic Surgeon
Hospitals hike prices by 417%: National Nurses United
Variation of MRI costs in Iowa: Iowa Orthopedic Journal (2020). “Obtaining Imaging Cost and Quality Information in Femoroacetabular Impingement: The Patient Experience”
HSA overview: Healthcare.gov