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02


Nov
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How Much Will Healthcare Cost Me?

Why is healthcare pricing so confusing?

With all the layers of complexity in the healthcare market, trying to estimate the cost of a simple doctor's visit can be overwhelming. As physician and behavioral scientist Dr. Peter Ubel notes, "sometimes the economics of the U.S. healthcare system are so maddeningly confusing, it is impossible to know [whom] to be angry at." All of the major players—from health insurance companies to hospitals to pharmaceutical drug companies to the government—seem to be playing the "blame game," while healthcare consumers are the ones saddled with ever-rising costs. 

One reason for the confusing state of medical pricing in the U.S. is that providers cannot always predict in advance how long a visit with a particular patient will take, nor what further tests or procedures (if any) will be medically necessary.

Also, with the variety of different third-party medical payors, providers may have separate agreements and negotiated prices with each payor. The vast majority of patients have some type of private health insurance or are on Medicare, and providers may not be incentivized to go out of their way to create smooth, transparent processes for the occasional patient who pays in cash.

 

What do health care services really cost?

The Healthcare Financial Management Association has done a good job of breaking down the meaning of some confusing healthcare jargon. However, even healthcare experts can still get confused when they try to identify the true costs of health care. What then? There are many variables to consider, so nailing down a price requires a lot of effort in narrowing down the question. For example, if a doctor performs two procedures with separate CPT codes, the patient may be charged for each procedure as a separate line item. If an identical procedure is performed on two patients—one in the hospital and one in an outpatient clinic—the hospital patient will receive a much larger bill including a hospital facility fee that may exceed $1,000. Anesthesia, lab work, immunizations, prescriptions, and any services not explicitly included in a doctor's visit will probably result in extra charges.


If you're looking for the starting price on a first-time office visit with a new primary care physician, you've come to the right place! SAMI-Aid can help you make an apples-to-apples comparison without all the tedious guesswork. Our Physician Price Search tool is the first of its kind to provide you with this information. At SAMI-Aid, we believe that everyone should have access to medical information that allows them to meaningfully compare prices on all healthcare services before purchasing them.

 

How can I be a smart healthcare consumer?

If you'd like a more coherent and logical process for making health-related decisions, here are a few tips we recommend following.

  1. Be proactive and prepare for the unexpected. A little work in the present can go a long way towards alleviating the stress of addressing an unexpected medical problem in the future. If possible, set aside $1000 for unexpected medical emergencies. We also recommend doing research on the costs of emergency medical services. If you have a high-deductible health plan, you may even be eligible to set aside money in a tax-free (including interest) health savings account, which you can then draw upon for legitimate medical expenditures in the future. 
  2. Be selective in choosing a primary care provider. If you don't have a primary care physician, spend a little time searching for one who truly fits your needs. Some important factors to consider are location, cost, language, and whether a particular doctor is someone whom you can trust and personally get along with. If you have health insurance, you'll probably want to find a doctor in your network. 
  3. Practive preventative care. Whenever possible, obtain the appropriate tests, screenings, immunizations, and other services recommended by your primary care provider. Also, as a rule of thumb, it's a good idea to check in with a doctor at least once a year even if you feel perfectly well. Preventative care visits are relatively inexpensive compared to the possibly far higher costs of treating preventable medical conditions that become worse later due to lack of proper care. Constantly educating yourself on healthcare-related issues can help you stay ahead of the game, as can practicing a healthy lifestyle.
  4. Have a holistic mindset. Holistic health means taking a "bird's-eye view" and looking at the big picture of your health. Sometimes this mindset involves finding entirely new or even seemingly counter-intuitive approaches to a problem. For example, if you're focused on saving money, you might compare health insurance plans and find that all of them are too expensive to account for the value they provide to you personally. You might then opt out of health insurance entirely, put money into savings instead of premiums, and seek out a-la-carte self-pay medical services like SAMI-Aid. If you're focused on dieting, you might find that qualitative changes such as eating more fresh food and cutting out junk food are more effective than quantitative changes such as counting calories. At SAMI-Aid, we're here to help you develop a personalized strategy that encompasses all of your healthcare.
  5. Request price estimates. Before visiting your doctor or clinic, and before agreeing to pay for any additional medical services when at a doctor's office, ask for an estimate of the price. If you have insurance, the estimate may involve careful examination of your health coverage including deductibles and co-pays or coinsurance. If you are paying out-of-pocket, SAMI-Aid has the research on pricing for you already. Simply log in to your SAMI-Aid account—or sign up if you're not a member already—visit your member portal, open the Physician Price Search tool, and easily compare estimated prices on office visits with primary care physicians, commonly prescribed lab tests, and other procedures.
  6. Consult with a medical professional. While you can find plenty of free medical information—including right here at SAMI-Aid!—you should always consult with a physician for qualified medical advice before making any significant decisions that will affect your health. You can consult with a SAMI-Aid physician from your computer or mobile phone anywhere in the United States, within minutes, for only $54.99 per appointment. Book a consultation today! If you're looking for pricing estimates on more complex scenarios, give us a call at 1-844-SAMI-AID we will help identify providers that can best meet your needs.

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