Medical Expenses are Not Created Equal

Jun 26th, 2011 by Ziva Beck in Medical Expenses

What a difference a few miles can make! In my case, the surgical facility fee for the same medical procedure performed by the same doctor was 68% higher in one location than the other.

This year, I had to undergo a medical procedure that was done in same day surgical facility on an outpatient basis. My doctor mentioned that they perform the procedure in several locations and suggested the one that was closer to my home. That sounded like a good idea until I spoke to the procedure coordinator. I have mentioned that cost is a concern and she kindly suggested that I speak to the billing manager and check the cost of the procedure in their second location as it might be lower. To my big surprise, it was lower. Indeed, the facility fee in Paramus was 68% higher than in Emerson.

This discrepancy in cost is possible because each facility negotiates the fee with the insurance company separately and there can be a big difference as I have discovered.

Another important question to ask is if the outpatient facility is in-network provider for your insurance. Just because your doctor is in-network provider doesn’t mean that the facility they use is in network. Out-of-network providers don’t have negotiated fees with the insurance company and therefore can charge higher fees that can be 2 or 3 times higher and sometimes up to 10 times higher. If you find that the facility is not in-network, you have to negotiate up front that you should not pay more than what you would normally pay for an in-network provider.

To be on a safe side, whenever I need to have a procedure done, I follow the 3 steps below:

1)      Ask if the outpatient facility is in-network provider

2)      Ask for all costs, including physician fee, facility fee and anesthesiologist fee. Sometimes there are Lab fees as well.

3)      Ask if there is more than one location and the cost for each location.

If your doctor does the procedure in several locations it is a good idea to compare which one has a lower contracted fee with your insurance. Different doctors will have different contracted fees and will use different facilities to perform the same procedure. It pays to shop and compare!

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