How to Have 'The Talk' With Your Doctor

On TV, people seem to speak comfortably about sexual dysfunction and incontinence products during ads that run during the news hour. But you get in the doctor’s office and get tongue-tied because you need to ask about something really embarrassing: what your health care is going to cost. (And often we don’t. We get our first clue when we see the explanation of benefits from our insurance companies.)

There’s a better way, says Jeanne Pinder, founder and CEO of ClearHealthCosts and a Credit.com contributor. Here’s what you can do: Take a deep breath and say something like, “I’m going to ask you about money, and I know you hate it as much as I do.” Not every provider actually knows what things cost, she said. But increasingly, they do. “Providers got into business to help people,” she said. “They’re often willing to have the conversation or to refer you to someone who can.”

So when’s the best time to ask? During your appointment is a good time to start, but health should be your first priority. “We don’t recommend shopping for care when it’s an emergency,” Pinder said. “In that case, you might ask, ‘Are you in network?'”

But if you have a chronic condition or a disease that will require ongoing supervision and treatment, you can count on a continuing expense. And in that case, it can make sense to shop around, particularly because there is a big disconnect between what you pay and what you get. (Pinder recalled a time when, in her family, there were three surgical procedures in 14 months. The bills for anesthesia were $2,000, $2,000 and $6,000 for seemingly identical service.) So first, know that more expensive does not mean better and that in some cases less treatment can yield better results.

She gives as an example an MRI. If a doctor orders an MRI, check to see what’s in network and what prices are before you schedule it. It’s perfectly acceptable to tell your doctor that one place would charge $500 and another $6,000 and to ask if the less expensive option is acceptable. (Or, put another way, you could pay hundreds or thousands more for identical services or procedures because you did not ask or investigate.) If a procedure isn’t covered by your insurance, you may be able to get a discount with the provider by asking for a cash or self-pay price as well.

How Involved Should You Be?

As a patient, you have the most at stake, with both your physical and financial health. It’s smart to educate yourself — familiarizing yourself with your condition and its available treatments as well as your insurance coverage, co-pays and needed authorizations and pre-approvals. Learn about Current Procedural Terminology (CPT) codes and Medicare reimbursement rates, so that you can better compare prices. Here are some websites that help you compare prices (also check with your insurer; it may have more specific information):

ClearHealthCosts.com – This site uses crowdsourcing and research to compile data on how much certain health care procedures cost, and, when available, how much insurers are paying.
Healthcare Bluebook – Type a procedure into this search engine and you’ll get an estimate of what that procedure should cost.
NewChoiceHealth – You’ll have to sign up for a free membership to use this site. By entering your ZIP code, you’ll automatically see a range of prices for procedures in your area.

Pinder suggests keeping your own health records. Among the advantages: You can keep your records together (if you have specialists, there may not be a single, cohesive record). Records generally are better for supporting the billing process than they are for tracking a person’s health history, she said. Another advantage is that a health record you maintain yourself will not be mingled with someone else’s, resulting in an inaccurate history and possibly inappropriate treatment, potentially due to medical identity theft. Keeping your own records can also help you protect yourself from medical bills going to collections, a costly billing error that can do serious credit damage. (You can see if a collection account is hurting your credit scores for free on Credit.com.)

And finally, get active online. There was a time when doctors discouraged patients from online searches of their condition, but those days are over. Patient communities can give you tips on everything from dealing with side effects of medications, navigating insurance and billing, to what the latest treatments are and where to get them. Don’t sell yourself short as an advocate. Make sure you are part of the team of people who are helping you.