How to Predict the Size of Your Next Major Medical Bill

People avoid going to the doctor for many reasons, but cost is a huge deterrent. According to a 2014 report from the Kaiser Family Foundation, 26% of women and 20% of men delayed or went without health care because of the cost.

Medical debt is no joke: For years, it has been the leading cause of personal bankruptcy in the U.S., and unpaid medical bills can trash your credit standing, though newer credit scoring models are starting to weigh medical debt differently. (You can see if medical debts or collections are hurting your credit scores for free on

Most people know health care can get expensive, but part of the problem is unpredictability. Even if you have health insurance, understand your deductible and memorize your co-pay amounts, it sometimes seems like there’s no way to know exactly what your bills will amount to.

Estimating your medical bills before you receive treatment isn’t easy, but it’s getting better. Marty Rosen, a vice president at Health Advocate, a health care advocacy and patient assistance company, said cost transparency has improved significantly in the past three to five years, allowing people to shop around for affordable treatment options.

“Is it perfect? No. Is it improving? Yes, and if you gauge it against a bigger time horizon, the changes are profound,” Rosen said. The hope is that improving transparency in health care pricing will not only help people save money but also make better decisions about their health care.

Trying to save money while seeking medical treatment can be as frustrating as having medical problems in the first place. Pricing on the same services varies wildly among providers in the same area, and if you don’t ask ahead of time, you’re unlikely to have any idea how much a health care provider will charge you.

Unfortunately, along with cost, finding the time to go to the doctor is among the top reasons people avoid getting medical care, according to that Kaiser Family Foundation report. In order to get somewhat affordable health care, you need to spend some time comparing prices, and you probably feel like you don’t have that time.

Of course, if you need emergency treatment, you’re not going to have time to crunch numbers, leaving you few options beyond hoping your insurance covers a lot of it and negotiating the costs once you get the bills. Emergencies aside, the cost of health care can devastate your finances, which is why you should try to figure out your expenses in advance. You have much more leverage in negotiations before you receive treatment, so when you can, shop around for the best deals in health care. That starts with understanding your insurance.

Know the Basics

You can’t expect to be able to estimate your medical bills if you don’t understand your insurance. Given the increasing number of insured Americans, there are a lot of online resources available to help explain things like deductibles and co-pays, which will help you determine your out-of-pocket costs on various treatments.

The first thing you do is shop around for an insurance plan you think will suit your needs. Once you have insurance and need medical care, you’ll want to know if your provider is in your insurance network.

That’s often a more complicated question than it seems.

“Call the insurer to make sure you have all the precertifications in place, then call the provider and say, ‘I want your guarantee that everyone who touches my case is in my network,'” said Sarah O’Leary, CEO and founder of ExHale Healthcare Advocates, a consumer health care company.

O’Leary said it’s common for consumers to go to a hospital that’s in their network and a doctor that’s in their network, but then the radiologist who reviews their MRI (for example) isn’t in network, and the consumer gets a huge bill for dealing with an out-of-network provider. To protect yourself from something like that, you need to ask about every worker with whom you’ll interact.

Research Prices, Then Negotiate

There are dozens of online tools for estimating the cost of health care, and many insurers have cost estimators on their own websites. A few minutes of online research should help you get an idea of what your treatment should cost in your area, and then you can use those figures to negotiate pricing when you ask specific providers for their estimates.

You can negotiate on either end of the process, but you have more leverage before you receive the treatment — when a doctor gives you a quote that’s twice as much as the price you found in your research, you have the ability to say you’ll go somewhere else for your care. If you can pay upfront or have a relationship with the doctor, leverage that to get a better deal, Rosen said.

You also need to consider that certain providers cost more.

“If you broke your arm, you don’t have to go to a trauma center,” Rosen said. “If you go to a trauma center for a lower-level emergency, it’s going to cost you more money.” In essence, you’re paying for the sophisticated capabilities of that trauma center, which you may not benefit from in the case of a simple broken arm.

Ask a Lot of Questions (& Get the Answers in Writing)

Part of what makes health care more confusing than other purchases we make is how many variables it involves. You’re not just getting a hip replacement, you’re paying for the specialists who perform the procedure, the anesthesiologist who keeps you under, the drugs that the medical team administers throughout the process and the socks they put on your feet to keep your toes warm in recovery, and so on. You need to know all the details that go into your procedure (and whether they’re covered by insurance) in order to know what you’re going to pay.

“I always tell people to ask the providers to respond, in writing, what the procedures and charges will be and what the patient will be responsible for,” said Adria Goldman Gross, owner of MedWise Insurance Advocacy. “As long as it is a planned procedure, the providers should be able to provide you with this information.”

Then, of course, there’s the possibility of errors. Request an itemized invoice of your treatment so you can review it for mistakes and contest them.

Various studies have found the error rate in medical bills to be between 30% and 90%, which is where having all those estimates in writing can come in handy. That also means the legwork doesn’t end after you’ve spent hours of your life researching medical procedures and talking to your insurer and health care providers. But if you really want to avoid overpaying for medical care (or worse, dealing with massive medical bills that put you into debt and trash your credit), it’s something you probably have to do.

“It’s certainly not fun for people to do, it’s not pleasant, but if your goal is to protect your fiscal health, you have to work at it,” O’Leary said.

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Image: iStock

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