This is a situation that one of our employees is currently experiencing here at Medical Billing Advocates of America. Even with health insurance, many Americans are facing a difficult problem when it comes to healthcare: choosing between care and commodities.
I recently starting having unusual symptoms that sent me to my general practitioner. After answering a multitude of questions and a thorough exam, it was determined that I might be having some difficulties with my heart. But to get to the bottom of the problem and to give me a proper diagnosis, I would need to have several tests done and I would need to wear a holter monitor, which is a device that a patient wears for a day or more that monitors and records your heart activity. The doctor was adamant about having all tests done in a timely manner to rule out any potentially dangerous conditions that might require immediate attention. But when I called the facility about the price of each test and looked at my individual health insurance policy, I began to get nervous.
Like many Americans, I have a very strict budget that I must abide by in order to make it from paycheck to paycheck. A mortgage, student loans, credit cards, car payment, insurances, utilities, groceries and fuel are the most important things to take care of on my list of bills. After these items are paid, there isn’t a whole lot left over. So when I called my health insurance company to inquire about my out-of-pocket responsibility for tests and items that my doctor felt were necessary to diagnose my condition, I felt uneasy when I learned that I would be responsible for 20% of the total cost. 20% might not sound like a whole lot, but when I dug a little deeper and learned that just one of these necessary items could cost nearly $3,000, I felt sick.
And so I am where many Americans find themselves – choosing between getting to the bottom of my symptoms and paying for the items necessary to live my life. It’s a bit ironic though that many of us feel forced to forego services that could prolong our life so that we can just live month to month.
The wisest decision is to do as the doctor instructs, but when the patient has the opportunity to discuss their financial situation and options with the doctor, it can be very helpful. In my case, I will start by doing the least expensive test first. If this test is inconclusive, then we will move on to the next test. In my mind, and the doctor agreed, this was the best route for me to take. If the doctor is able to see what he needs from one test, then the other tests might not be necessary. This might end up saving me some money. It will also space the tests out a bit, so that I’m not hit with a large bill all at once. But please remember, every patient’s situation is different and you must, above all else, do what is best for your health as suggested by your doctor.
I can still negotiate the cost of the tests, too. I can ask for a prompt-pay discount, in which I can pay the balance in full within a certain time period and save a percentage off the balance I’m responsible for. Talk to your facility about any discounts and savings you might be eligible for.
Many Americans are feeling the pain associated with rising premiums, rising deductibles and dwindling coverage. If you need to have necessary healthcare services performed but are concerned about the cost, make sure to do your research ahead of time so that you can weigh your options and make it as affordable as possible.