Do you remember the last time you bought a car? Maybe you wanted a convertible, so you went from dealer to dealer test driving for important features like trunk space and speed of transformation (maybe you looked at the Camaro first) before settling on a model, and then checked Kelley Blue Book, called a few dealers, and settled quickly on a fair price. Healthcare is nothing like that. For obvious reasons, test driving isn’t the best idea, and without transparency, it’s hard to identify what model of healthcare providers you want, and even harder to find information about the features affecting their price and quality. So here is another step-by-step guide through the labyrinth of this one small corner of the healthcare industry to help you find the care that’s right for you. Here we go.
- Find your CPT code. So your doctor says you need imaging. Don’t panic. Calmly look at the order form the nice person at the front desk has handed you. It should say something like “Requisition for Imaging” or “Radiology Imaging Order”, and have a description of procedures requested, often with check boxes down the side with the one or two marked for your procedure. What you’re looking for is your procedure’s current procedural terminology (CPT) code. These are specific numbers and letters that identify each procedure. CPT codes are standardized so that no matter which insurance and healthcare provider you use, you have the same CPT code. If you can’t find it on the form, you can easily learn the CPT code for your procedure by asking your doctor, looking it up online, or calling DIS. Note that location on the body and whether or not the procedure comes with ‘contrast’ all affect the code.
- Know your insurance network. f you don’t have insurance, then you can go to any provider and pay the cash rate (but be sure you ask for their discount cash rate first—we’ll have another article out on this topic soon). But if you’re insured, you’ll need to find out whether a provider you’re considering is in-network or out-of-network. Your insurance will pay a larger percentage of in-network care than it will for out-of-network care, and sometimes out-of-network care won’t be covered at all. So if you can, you should choose an in-network provider. Be sure that both the facility (which could be a hospital or an independent center) as well as the radiologist (one of the facility’s doctors who is an expert in medical imaging) are in-network for your insurance plan. You can call DIS to check that both our facility and our radiologists are in-network. Be sure to use the word “in-network” and not “covered,” because some facilities can be deliberately misleading and say that you are “covered” when they are out-of-network, because your plan includes both in-network and out-of-network benefit. If a facility can’t or won’t answer the question of whether they and their radiologists are in-network for you, go somewhere else.If you’re based on the exchange, you might see a benefit that distinguishes between ‘freestanding’ and ‘outpatient hospital’ centers. Unfortunately, neither your insurance, that center, or anyone else actually knows what type of center your insurance will definitively assign to which category, but you can take a guess and google the imaging center. If it seems to be affiliated with a hospital or medical group that sounds familiar and does more than just imaging, it’s probably not freestanding.
- Understand your radiology benefit. If you’re insured, your imaging benefits will determine how much you end up paying out-of-pocket. Some imaging benefits require just a copay, or a flat rate regardless of what the insurance company ends up paying. Others require a coinsurance, in which case you have to pay the full amount of the final price up to your deductible, at which point you and your insurance split the difference based on your coinsurance. Deductibles can vary from nothing to several thousand dollars, and often for high-deductible plans, you personally—not your insurance company—will be responsible for paying the full amount of the exam. You can confirm your current deductible status by calling your insurance company or logging onto their website. Check on your imaging benefits by looking for a document called “Summary of Benefits” and searching for the right benefit for your procedure, usually ‘MRI/CT’, ‘Mammogram’, ‘General Diagnostic’, or ‘Xray’.
- Estimate cost of care. When you’ve found some providers that seem promising, you have a few ways to research cost. One is to call the provider and ask about their cash price for your CPT code. You can also do some research on your insurance company’s website, but even within one insurer, individual people’s plans differ, so you might not be able to factor in your own plan’s radiology benefit. The DIS patient relations and communications department does everything we can with the information you provide to us to give you a good faith, if not exact, dollar amount that you may owe for your exam if there are financial obligations that are your responsibility. No matter your insurance, hospitals are usually much more expensive than independent imaging centers, potentially several times more expensive. By charging more for outpatient procedures, hospitals can offset some of their other high costs. Independent imaging centers such as Diagnostic Imaging Services tend to be smaller, more efficient and have lower overhead, so we can offer patients lower list prices and subsequent fees.Especially if you’re not currently hospitalized, you can find equally high-quality but much more affordable care by choosing an independent facility instead of a hospital.
- Make your decision. If your doctor just handed you a list of providers and left you to your own devices to find an imaging center, you can just go ahead and contact the center and ask for an appointment. If the referral is to a hospital or hospital-based imaging center, STOP! Because of the important point made above about hospitals being much more expensive, and if you have coinsurance, copays or an insurance deductible, this is where Diagnostic Imaging Services can really step in and help you save money. By being an independent entity with lower list prices (hospitals usually refer to them as “charge master” rates), after insurance discounting, DIS will be hundreds, sometimes thousands, of dollars less expensive.And that is for the same test. Same technology (sometimes better). Lower costs. Great care and service.
Sound too good to be true? It’s not.
One healthcare financial advising organization made this claim: If every doctor recommended non-hospital based care, we’d save the United States about $700 billion dollars each year. That’s a lot.
If true, become someone who saves on healthcare.
Say YES and spend LESS at DIS.