SHOPPING AROUND for Health Care

Stop Letting Your Bank Account Dictate Your Wellbeing

BY STACY CUMMINGS

As budgets narrow, many people are struggling to find the means to make ends meet and keep food on the table. The thought of becoming ill, the cost of daily prescription medications, or needing a life-saving operation has become more defeating than ever before.

According to a recent poll released by CBS News, roughly 40 percent of Americans chose to forgo medical care in 2022 because of concerns about cost. Not only is this number alarming, it is also heartbreaking to think of people putting off potentially life-saving treatments, transplants, routine procedures, and annual appointments because of the price tag. While there aren’t necessarily “cheap” health care options available, there are definitely ways to make health care more affordable.

Price Compare

After your provider determines whether you need a certain procedure or treatment, if time allows, take the opportunity to shop around. Collect price estimates from different hospitals and facilities in your area. Many hospitals around the state actually allow you to get quotes online right through their websites for various procedures. Websites like comparemaine.org are available specifically for this purpose. Keep in mind that prices will vary depending on the circumstances, medications provided during and after the procedure, the length of stay, etc., but this link still does a great job showing you just how much the cost can fluctuate from facility to facility statewide.

To put this into perspective, I became curious and did some navigating myself. I found that the cost of a preventive-care colonoscopy in the state of Maine can range from less than $1,300 to more than $4,800. (It is also worth noting that, depending on your age, screening tests like this may be fully covered by your insurance.) Keep in mind, every situation and facility is different, but checking around online can give you a good place to start your comparison shopping.

DEDUCTIBLES & NETWORKS

Every plan is different, but thankfully having health care insurance can significantly cut out-of-pocket expenses for most medical care and procedures. According to healthcare.gov, most health plans must cover many preventive services, like immunizations and screening tests, at no cost to you. Depending on your age, colorectal cancer screenings, breast cancer mammography exams, cervical

VISIT COMPAREMAINE.ORG AND TALK TO YOUR DOCTOR

CHECK OUT YOUR PREFERRED HOSPITAL'S WEBSITE FOR AN ONLINE PRICING LIST

LOOK CAREFULLY AT YOUR INSURANCE PLAN cancer screenings, diabetes screenings, and many more preventative care tests are likely covered when delivered by a doctor or other provider in your plan’s network.

It is important to note that not every health care facility will accept every insurance. It is important to make sure you are choosing a location within your provider’s network. Often you can find this information right on your insurance provider’s website, with a quick facility search. When in doubt, call to ensure the provider and location are included in your insurance company’s coverage plan.

One important number to keep track of throughout the year is your deductible, which is the amount you are responsible to pay before your insurance plan kicks in. Once your annual deductible has been met, you’re often able to move forward with appointments and procedures with little to no out-of-pocket expense. Knowing what that number is and how close you are to it may allow you to better plan for procedures.

Once you have completed your homework and selected the most cost-effective option for you, let your referring physician know where you would like them to send the pre-authorization information. This is typically a very easy conversation that most medical professionals are very familiar with, and you will not be denied because it is within your rights as a consumer.

One more note to keep in mind if potential medical costs are making you hesitant to get the care you need: Know that most hospitals and medical care offices will allow you to set up a payment plan or use a sliding-fee scale, if your income qualifies. Make your concerns known, and a patient representative should be able to help you sort through options.

Knowing your rights and understanding your health insurance plan can make a big difference in both your physical and financial wellbeing. Be your own advocate and ask questions, request information, and call when something doesn’t seem right. The cost of getting treatment may be a temporary financial burden, but the consequences of not getting treatment can be longer lasting.