Tuesday, April 3, 2012

Negotiating medical costs

So now that Peanut and I are on a high-deductible health care plan, we are facing something of a crossroads - what do you do when the cost of the care makes you wince?

I have a cyst in my breast. I had an ultrasound done on it five years ago when it was discovered to make sure it wasn't anything more serious, and it was basically no big deal. It doesn't bother me and it doesn't appear to have changed in the time since a previous doctor found it. My new doctor wants me to get another ultrasound to confirm that it hasn't grown or changed in five years, as a benchmark. She noted that the location is exactly the same as last time, and the size is exactly the same, but an ultrasound would provide a second data point in case I had future issues. I see the logic in that, so I agreed to have it done.


An ultrasound is really freaking expensive! The place she referred me to costs $600 for the facility fee, plus there's a radiologist fee that I haven't been able to determine yet. That's totally out of pocket for a scan of something that doesn't bother me and isn't likely to determine anything new and really wouldn't even help diagnose anything in the long run in the future. Ouch!

My insurance company's website indicates that there's a different facility with a significantly cheaper negotiated cost, so I'm going to call the doctor back and explain that $600+ is just too steep for a basically unnecessary procedure, but I'm happy to get it done if she'd like to refer me to the other location. I feel a little weird about this - I've never discussed financials with my care providers, because I've always had insurance that had a $20 or so co-pay and then I'd go on my merry way. And it kind of feels like arguing with doctor's orders, but I just can't stomach paying close to $1,000 for something that really doesn't seem necessary to me at all.

What would you do? Have you faced something like this before?


  1. I would go to the other location. The doctor probably assumes that your insurance will just cover everything except a $45 co-pay, so she just referred you to a friend of hers.

  2. I say talk to your doctor about the costs openly. I actually work in the health insurance world and we talk to doctors a lot about how they have no idea what is going on with their patient's insurance. If you talk to her about the particulars of your situation and your feelings on the necessity of the ultrasound (I agree with you, by the way) you might be able to come up with a better plan.
    The other alternative is to try to bargain with the first place you were referred to. Since you are responsible for the entire cost, the facility may be willing to drop the price if you pay in full on the day of service. High deductible plans make doctors nervous because there is a smaller chance of recovering money from patients than from insurance companies.

  3. Referrals should be for a test, which you absolutely can take wherever you want. It is like a prescription: your doctor can't order you to go to Walgreen vs CVS. Just call the office and ask for a paper requisition form and go wherever, then ask that they send the report back to your GP (have her office info on hand).

  4. Agree with all those above.

    I had high-deductible insurance when I had to see a cardiologist for some tests. I asked her how much they cost and she had no idea. To her credit, she took me seriously and found out while I was in her office what the price of each test would be, so I could make my decisions.

    Most doctors, I would wager, don't know what their procedures, tests, Rxs, etc., cost, because they don't have to, because most patients don't ask, because "insurance will pay for it."

    I'd openly explain to the doctor that the costs matter to you, and go to the cheaper place. (As someone else said, a referral should be for the test, not the place.)

    In Europe, you probably wouldn't be having this test done at all.

  5. I think in this situation, what you are doing is cool. So long as you don't choose to not have the test whatsoever, I'm cool with trying to get it done for cheaper. Even if the cyst doesn't bother you and the ultrasound may not provide any new and important information, I still don't think you should risk not getting any sort of medical check, no matter what the cost. Do try to do it for as little as possible though if it is just stuff like x-rays.

  6. I am an RN and I KNOW physicians often order tests as a "cover the ass" protection. Ask your doctor frankly how the results will affect her treatment recommendations. If she needs the results to determine the best treatment for you then get it done. If there is no clear benefit then you can weigh how important the additional information is to you. Unless you have a positive family history of breast cancer then statistically you are at low risk just because of your age.


Thanks for commenting!