The state-of-healthcare is essentially a ubiquitous water cooler conversation these days. Often, the conversation surrounds policy and politics, be it the Affordable Care Act (‘Obamacare’) or health insurance issues.
But at the core, healthcare is an incredibly intimate proceeding that starts and ends in an exam room (literal or figurative, in the case of virtual/telemedicine programs). It is in this room where costs are born, with decisions made between individuals. And, given that most medical decisions are gray-area, it seems reasonable that cost-of-care be a real-time considered factor in which choice to make.
Increasingly, you should feel comfortable engaging your provider in cost-related questions, and demonstrating that cost can be/should be a factor in the decision-making process. To that end, consider asking these questions:
1. How much is that recommendation going to cost?
Seems simple, right? But many people don’t feel comfortable asking this question. Frequently, the provider will not know the answer—it can be complex, especially in the private insurance world where cost-to-consumer depends on many factors, including where you are in your deductible or what is your contracted co-pay—but putting in the time on the front end to figure the answer out could save you hundreds, if not thousands, of dollars.
2. What service code (CPT) will you be using for this visit?
Preventive care is a service that you pay with your premiums. And, the zero-cost is largely dependent on your provider using the proper codes that are submitted to the insurance company. Consider writing down what code they use—often referred to as an ‘E&M’ code (Evaluation & Management)—and comparing it online to established preventive care codes.
3. What diagnostic code(s) (ICD-10) will you be recording?
This code typically is complimentary to the CPT code and represents, as best the provider can assess, the diagnosis that was treated on a given visit. This code can drive whether an insurance company will pay fully for a preventive visit, or whether a visit is deemed ‘medical necessary.’
Part of the goal in asking questions—besides helping yourself—is to create a shift in societal expectations of their providers, and to reframe provider expectations regarding the patient-doctor relationship. While you may not get all the answers on your next visit, by continuing to represent cost-of-care as a consideration you will help build momentum to change ‘the system’ that we’re all in, and that we all largely are dissatisfied with.
About the Expert
Pediatrician Dr. Bryan Fine has been a physician for more than 15 years, and is the founder of Percentric, an innovative, physician-led health benefits optimizer. Visit Percentric.com to learn more.
