Ask the Doctor: How Can I Lower My Medical Costs? 

One of the biggest challenges to saving money is a confusing system. Prices for the same service can be different depending on where you go. Say you sprained your ankle and need an X-ray in Memphis, Tennessee. You can pay anywhere from $72 to $740.

Doctor fees can vary too. Dr. A, who’s in your insurance network, might charge $100 for your annual checkup. But Dr. B — whose office is in the same building but isn’t part of your network— might charge $200. It can make your head spin.

Why is it all so complicated — and what can you do to save money? To find answers, we turned to Georganne Vartorella, M.D. She’s a board-certified primary care physician and President of Patient Advocacy MD. The organization helps patients and families navigate the confusing —and expensive — health care system.

“You have to learn to advocate for yourself,” Dr. Vartorella says. “I tell patients they need to have three essential skills. They need to communicate — with their doctors, nurses, everyone who’s involved in their care, including their insurance company. They need to educate themselves. And they need to participate in the process.”

For Dr. Vartorella, there’s no sitting on the sideline. Making your way through the health care system is an active sport, and Dr. Vartorella coaches you through it here.

There are tools that can help you compare prices of tests and procedures. Go to Guroo.com and start searching in your area.

Q: Can my doctor help me save money?

Dr. Vartorella: Yes. Speaking with your doctor, nurse practitioner, or whoever is your primary care provider can be your best place to start. But first, you have to educate yourself, prepare your questions, and then communicate them to your PCP.

Need a shingles vaccine? Ask the price of getting it in the office, then ask if there are cheaper alternatives, like a pharmacy. Or maybe the cost of Prolia® for your osteoporosis is too much for your budget going through a pharmacy. Your doctor may give you an order to go to an infusion center, which may be covered by your insurance.

Often, your PCP may not know the answer to your questions but should be able to refer you to the person on the team who can. It may be a direct member of the health care team, the office manager, or the billing department. Be proactive, but be kind and civil too. Remember, you’re looking out for your own health and wellness — and so is your doctor. You’re in this together.

Q: When is it appropriate to bring up the question of health care costs with your doctor?

Dr. Vartorella: Always. Even if this is your first visit, let your provider know what your concerns are. If you’re worried because you’re on a fixed income, or have two kids in college, or you’re pretty healthy now but you’re worried about medical expenses in the future, let them know you’re wondering how you can afford treatment and pay for the best, most effective care that will maximize your outcomes. If you want your health care team to document this information in your medical record, say so. As a health care consumer, it’s important to get over your fear of talking about money.

Q: I’ve heard I can save money by using non-hospital providers for tests and routine surgeries. But will I get the same quality of care as I’d get in the hospital?

Dr. Vartorella: If you’re looking to save money, or if your insurance company requires you to use a non-hospital facility, talk to your doctor about it first. Some procedures can be done at freestanding imaging clinics — or even ambulatory surgery centers — possibly for a lot less than at the hospital. Some of these facilities may be partnered with the hospital.

And just because a procedure is cheaper doesn’t mean it’s worse. It may or may not be exactly the same. You need to make sure you’re getting exactly what your doctor has ordered.

With an MRI, for example, your doctor may want to know the qualifications of the person who will read the image. Or they may be concerned that something serious could be missed. If your provider feels the hospital is a better choice, ask them to write an appeal letter to your insurance company. Or speak to the hospital and see if you can negotiate a better price. The most important thing is to make sure you get the best possible care.

Q: The idea of talking to my doctor about costs makes me feel uneasy. I’m not even sure which questions to ask.

Dr. Vartorella: You must be an active participant in your own health care — and talking about costs is a big part of that. So go in prepared. Know exactly what your insurance covers and doesn’t cover, as well as your out-of-pocket expenses. Be sure to read your policy carefully. If you don’t understand it, ask someone who does.

For example, if it’s an employee’s health benefits package, the HR benefits administrator may help, or speak with someone in the health care system’s financial department. If you’re researching your concerns, including your diagnosis and treatment options, choose credible sources, like the CDC or a teaching hospital. John’s Hopkins University, for example, has an excellent website with patient information, podcasts, and other valuable resources.

Go to your provider educated and prepared with a list of questions. Don’t leave until your provider answers them or sends you to someone who can. If you’re feeling intimidated, bring a friend or family member with you for support. Remember, you have the right to ask questions and the right to a mutually respectful partnership with your doctor. Always be polite, but never feel afraid to speak up.

Additional sources
Average annual health care costs: Centers for Medicare and Medicaid Services
Price comparison tool for procedures: Turquoise Health