High deductible plan member — figuring out how much care will cost

As someone with a high deductible healthcare plan, how can I best estimate my out-of-pocket cost for a medical procedure prior to incurring the expense?

My insurer does not make this information available.  All I want to know is, what the negotiated rate in-network is for a particular procedure.  In my experience, providers can tell me the “list” price, but that usually bears little resemblance to the actual amount I have to pay.

Trying to Be Savvy

Dear Trying to Be Savvy,

Insurers consider their in-network fee schedule to be top secret. And many hospitals and doctors are not equipped or informed themselves.  You are finding the limits of consumer driven health care decisions.  You are expected to make good decisions and take costs into account as a medical care consumer, yet no one can tell you what you will be paying.

There are various credible sources for national average costs for certain common surgeries or other procedures.  Try the CDC’s FASTSTATS   for some useful data.  Your state may also have data; do a web search with your state’s name and “all payer claims data base”.  This should lead you in the right direction.

At worst, you can plan to pay your maximum out-of-pocket. This is your deductible plus your “coinsurance”, which is a percentage of your bills that you pay after you have paid your up front deductible. If it comes in lower, you can celebrate.

Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.