Let’s just see if my health insurance will cover it…wrong!

cost of healthcare
cost of healthcare
Courtesy of mgma.com

When it comes to getting outpatient treatment of any type – colonoscopy, sending a biopsy to the lab – consumers hope their health insurance will cover it. They think, even if my health insurance doesn’t cover it, there’s no harm in trying, right? Wrong!


It’s no big deal if my health insurance doesn’t cover this

This is the deal that patients don’t understand. If my office submits a biopsy specimen to the lab on the patient’s behalf and they pay out of pocket, it may cost $70. But if they submit it through their insurance, then the negotiated rate applies. Let’s say the insurance company’s negotiated rate is $150 (this is an example but it’s always more than the self-pay cost). What happens then?


When the insurance company doesn’t pay because the patient hasn’t met their deductible, that $150 bill will be forwarded to the patient. If they would just pay out of pocket in the first place, knowing full well they haven’t met their deductible, they would save money.


That’s the problem – patients don’t think there’s any harm in trying to go through insurance first. They figure, let’s try and if it doesn’t work, I’ll pay it. But they’ll pay more! So doctors should use a Price Estimator on their website (including cosmetic and medically necessary services) that gives patients a good out-of-pocket estimate. Even if the estimate isn’t exact, it will help patients make better decisions.


Better decisions such as, it will be less expensive just to pay out of pocket and not worry about a bigger bill coming in three months. Also, that money paid out of pocket doesn’t have to be a “waste.” The receipt for the out-of-pocket payment can be forwarded to the insurance company and count towards your deductible for the year.


To check pricing on out of pocket services – cosmetic or medically necessary before the deductible is met – click here.



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