Medical costs can be confusing because one procedure may involve several separate bills. You may receive bills from the doctor, facility, lab, anesthesiologist, radiology group, pharmacy, or other providers.
You may not be able to know the exact final cost in advance, but you can often reduce surprises by asking the right questions before non-emergency care.
Start with your insurance company
- Is this provider in-network?
- Is this facility in-network?
- Is the procedure, test, or service covered?
- Do I need prior authorization?
- Do I need a referral?
- What is my deductible?
- How much of my deductible have I met?
- What is my coinsurance or copay?
- What is my out-of-pocket maximum?
Write down the date, time, representative name, and reference number for the call.
Ask the provider’s office
The medical office may be able to provide procedure codes, diagnosis codes, and estimate contacts.
- What billing codes will likely be used?
- Where will the service be performed?
- Will any outside providers be involved?
- Is prior authorization required?
- Who handles insurance verification?
- Can I get an estimate in writing?
Ask the facility
If the service happens at a hospital, surgery center, imaging center, or outpatient facility, ask about facility fees and whether separate bills may be involved.
Watch for separate bills
For some procedures, the person performing the service may be in-network, but other professionals involved may bill separately.
- Anesthesia
- Radiology
- Pathology
- Lab work
- Assistant surgeon
- Facility fee
- Durable medical equipment
- Medications given during the visit
Understand prior authorization
Prior authorization means your insurance company must approve the service before it happens. Ask whether it has been requested, approved, what dates it covers, and whether it covers the exact location and provider.
Ask about alternatives
Sometimes there may be more than one medically reasonable place or way to receive care. Ask whether the service can be done at a lower-cost outpatient location, whether another test could answer the same question, or whether monitoring is safe.
If you are uninsured or paying cash
- Is there a self-pay rate?
- Is financial assistance available?
- Is there a payment plan?
- Is there a discount for paying in advance?
- Can I get the estimate in writing?
You may not be able to predict every cost, but you can ask better questions before planned care.