Procedures You Should Never Have at a Hospital

If you’ve ever skipped a test your doctor recommended because it was too pricey, you’re not alone. A Gallup survey found that 30% of Americans did just that in 2021.

No wonder. Costs for routine procedures such as blood tests, X-rays and outpatient surgeries are skyrocketing at hospitals. Yes, insurance covers it, but you still have copays and a deductible if it’s not covered completely.

You can get many of these procedures done at a diagnostic testing facility, clinic, or surgical center. And you’ll save big. “You can save anywhere between 45% and 60% on average,” says Deborah M. Bain, R.N. She’s the managing director of Prism Health Advocates, a health care advocacy company in Kent, Connecticut.

Hospitals have massive overhead, she explains, including administrative and infrastructure costs. They can charge you for everything, even the pain relievers they give you. “When you go to the outpatient clinics and surgical centers, they tend to have many more fixed costs. There’s a huge saving there because they don’t have the overhead [that hospitals do],” says Bain.

The trick is to know where to go. “The doctor says, ‘Get this done,’ and you go and get it. Most people don’t ever look into what things cost because that information is not easy to get,” says Anne Llewellyn, R.N. She’s a nurse advocate in the Fort Lauderdale, Florida, area.

She’s right. It’s not easy. But you can shop around so that you get the best price without sacrificing quality. Here’s how.

There are tools to help you compare costs of medical procedures in your area. Go to Clear Health Costs and start price shopping.

Look it up

Look on your insurance provider’s site or in your member handbook for outpatient labs, surgery centers, or clinics that are in network, suggests Llewellyn. Going there first guarantees that you’ll stay in network so that your insurance can cover at least part of the cost.

Plus, “your insurance company has already vetted these providers for you,” says Llewellyn. So you know that they’re board-certified and have licensed technicians and other providers.

Call your insurance provider

If you can’t find what you’re looking for or you don’t understand something, call the insurance company and ask for help. “And don’t just stop at the customer service representative — ask for supervisors,” Llewellyn recommends.

This is especially important if you have a complex procedure or condition, says Llewellyn. If dialysis at the hospital is proving too expensive, call and ask if there are other in-network places that do it.

Ask for recommendations

Reach out to friends, family, or your doctor. Check to see which clinics they’ve visited or think are excellent, suggests Bain. (Then make sure they’re in network.)

Be honest with your provider

If your doctor suggests you get an MRI, be your own advocate, says Bain. “Say, ‘I will absolutely get that MRI, but I’m going to shop around a little bit for a less expensive MRI. Can you help? Do you know of a place that’s quality?’”

Take the time to make calls

After you’ve found a couple of places, do a cost comparison by calling and asking for prices. You also want to check for board certifications, says Bain. For example, if you’re having a surgical procedure, the clinic needs to be certified by the American Association for Accreditation of Ambulatory Surgery Facilities. The doctors and technicians should also have the appropriate licensing. Yes, it’s time-consuming. But as Bain says, “You have to take the time.”

What to know about individual tests

Lab work

• Complete blood count (CBC), which checks all the components in your blood, including red and white blood cells
• Metabolic panels (checks kidney and liver function)
• A1C tests (looks at blood sugars)
• Lipid tests (checks cholesterol and triglycerides)

Where to go: You can go to freestanding diagnostic testing sites, or urgent care clinics.

How much you’ll save on average: Hospitals charge two to three times more for these tests, according to the National Institute for Health Care Reform (NIHCR).

What to know: Getting blood drawn can seem easy, but the techs doing it (aka phlebotomists) have to be organized and able to multitask as they draw blood and label it correctly. “Make sure [the lab] is [a national chain] like Quest that is completely aboveboard — they’re certified and have actual phlebotomists working there and know what they’re doing,” says Bain.

Imaging tests

• Ultrasounds
• CT scans
• MRIs
• X-rays
• Mammograms

Where to go: Look for imaging clinics. Many urgent care clinics offer X-rays, and some even have CT scan machines.

How much you’ll save on average: According to the NIHCR, prices are 52% higher, on average, in hospitals for MRIs of the knee, the most common procedure.

What to know: “You just want to be incredibly careful to make sure you’re going to a place that’s legitimate,” says Bain, especially if the test is being done to rule out something serious, such as cancer.

The center should be accredited by the American College of Radiology and staffed with certified technicians and board-certified radiologists. Depending on your health needs, you may want to find a center with a radiologist who subspecializes in a particular area, such as breast health, cardiology, or musculoskeletal health.

Surgical and other outpatient procedures

• Cataract surgery
• Endoscopies
• Colonoscopies
• Minor knee repair
• Procedures to treat bursitis
• Shoulder surgery

Where to go: Freestanding surgical centers or ambulatory clinics are good options. (Turquoise Health can help you locate clinics and compare prices.)

How much you’ll save on average (below costs from Medicare.gov price look-up tool):

• Basic cataract surgery: It costs about $1,606 at an ambulatory surgical center vs. $2,664 at a hospital.
• GI endoscopy: It’s about $557 at ambulatory clinics vs. $965 at hospitals.
• Colonoscopy: You’ll pay twice as much at a hospital vs. a clinic, according to the NIHCR. It’s $625 in community settings vs. $1,383 at a hospital outpatient department.
• Procedures to treat bursitis: You’ll pay about $80 at a clinic vs. $312 at a hospital.
• Minor knee repair: It’ll cost $1,917 at a clinic vs. $3,449 at a hospital.
• Shoulder or rotator cuff surgery: The cost is $4,095 at ambulatory surgical centers vs. $7,494 in hospital outpatient departments.

What to know: If you have a major health condition such as heart disease or diabetes, you may be safer doing these invasive procedures in a hospital, even if it’s routine cataract surgery, says Bain.

“If something goes wrong, they’re going to have to put you in an ambulance and get you to the hospital. And that just wastes time,” says Bain. “It’s not that they can’t handle an emergency at some of these places incredibly well, but the time frame can sometimes really matter.”

Yes, the clinic will screen you to make sure you’re healthy enough to go through the surgery or the anesthesia. But if you have any doubts, discuss it with your doctor.

The bottom line: Don’t automatically go to the hospital for standard tests and procedures — have an honest conversation with your doctor about costs. Going to a freestanding facility or clinic for these services could save you out-of-pocket expenses.

Additional sources
How the cost of health care impacts consumers: Gallup (2021). “West Health-Gallup 2021: Healthcare in America Report”
Price variations for procedures: National Institute for Health Care Reform
Procedure price lookup tool: Medicare.gov