With high-ticket tests like MRIs and CT-scans, costs can vary wildly from facility to facility. “The rule of thumb is a free-standing diagnostic center will be cheaper than a hospital,” Shaffer said.
For example, if you have a high deductible plan, an MRI might cost you $1,500 at a hospital, or $800 at a free-standing testing facility, said Martin Rosen, co-founder of Health Advocate, a Pennsylvania-based company that helps patients around the United States navigate the healthcare system. “Americans will drive around to save a nickel on a gallon of milk or a penny on a gallon of gas,” Rosen said. They need to employ the same mindset when it comes to healthcare.
When Kaskel, who has osteoporosis, needed a bone density scan, her internist suggested an imaging center, rather than the hospital.
“That saved me about $200,” she said.
If you need surgery, and your doctor practices at more than once facility, costs can vary whether it’s performed at a small community hospital or a large teaching facility, Rosen said. “Know the questions to ask. Be an educated and informed consumer,” he said.
With an HMO, the advantage is once you’re in an HMO-approved facility, everything is settled through the HMO, Leon said. With a PPO, there can be “lots of snouts in the trough,” he said, so the best advice is to call the facility before a procedure and make sure everyone is in network.
“It doesn’t always work, because sometimes an out-of-network anesthesiologist or specialist may need to be called in, but you can try to eliminate possible problems,” Leon said.
Of course, if there is an acute need, such as an emergency, you don’t have the luxury of shopping around, Rosen said.
Ask about it upfront, and be confident, especially if you don’t have insurance, Rosen said. “Ask ‘What’s the cost? Can I get a discount for paying cash? Can I arrange for a payment plan?’” he said. “Especially if you have been seeing a provider for a long time.” They’re running a practice and trying to make a living, too, but sometimes they will work with you.
Rosen said once he negotiated a $2,400 cash price for dental work down to the insurance company’s negotiated rate, which was $1,000.
“I had been a patient for a long time, and I asked in a nice, professional way,” he said. “The average consumer doesn’t realize that insurance companies are buying wholesale, and we are paying retail. You are never going to get those wholesale prices unless you ask.”
Remember this is a process best tackled in advance, Leon said. “It’s better to try and make a deal up front. It can be done, now more than ever, because so many middle class people are experiencing layoffs” and losing their insurance, Leon said. If you have been with a provider for a while, use that as a base for conversation. “Say ‘I no longer have this insurance, but I would like to continue with you,’” Leon said.
If you need a test and are uninsured, look up negotiated rates on your insurer’s website for a procedure and call the testing facility. The online tools typically require a logon and password, so if you aren’t insured, ask a friend who does have insurance to look up costs for you, Leon suggests. “You can call and try to cut a deal, but look for a locally-owned place,” Leon said. You will have less luck at larger companies like Quest or Lab Corp, as opposed to a locally-owned facility where you can talk to someone with the authority to negotiate, Leon said.