11 Tips to Avoid Overpaying for Healthcare

Healthcare comes with a hefty price tag

but knowing your rights and being proactive can go a long way to protecting your wallet.

Whether you’ve personally experienced it, heard from a friend or family member, or read an article in the NYT, exorbitant medical bills have become far too common. But that doesn’t mean you don’t have any recourse or can’t take steps to get a fair estimate of the costs ahead of time. 

Particularly with the passage of the “No Surprises Act,” patients have more rights and there is somewhat more transparency in pricing of common medical procedures and services. 

Read on to learn how you can better protect your wallet, no matter where you are in the process. 

Prefer this in video format? Watch on YouTube. 

Before the appointment

In-Network

First, always choose “in-network” providers. This seems obvious but medical practice groups can change which insurance they support without notice; and in fact, they may have changed to being out-of-network (OON) since your last visit, so double confirm when making an appointment. 

With hospitals, some types of procedures or providers can be out-of-network (OON) even when the hospital is in network. This happened to a friend of mine: she was at a hospital that was in-network, and working with a doctor that was also in-network. That doctor referred her to the hospital acupuncturist. She had the acupuncture treatment, and eventually got out of the hospital. A few weeks later she got a huge bill for the acupuncturist who was out-of-network with her insurance.  

This can happen with hospital anesthesiologists and radiologists, as well. While to some extent this should be a thing of the past with the “No Surprises Act,” that still doesn’t guarantee some facilities won’t try to issue an out-of-network bill. 

Therefore, you can’t assume that a provider, procedure, test, etc will be in network. Always double check. Unless, of course, it’s an emergency, then just get the help you need.

Cash Pay or use Insurance?

Always ask: Is it cheaper with insurance or to cash pay?

You can definitely ask how much the procedure or test will cost if you go through insurance versus if you were to cash pay. You may find significant cost savings to pay by cash if you haven’t yet met your insurance deductible & aren’t close to meeting it. 

Many times opting for cash pay could save you 10-20%, or more. 

I’ve definitely found this to be true, especially for many types of medical imaging and tests such as bloodwork outside of the annual physical.

The reason is because the provider or facility saves money and time by not applying for reimbursement through insurance, waiting to get paid, and ultimately maybe not receiving much. When you cash pay, they get the money right away, so that’s money in the bank for them. 

No Surprises Act

Make sure you’re taking advantage of the No Surprises Act & the Transparency in Coverage Rule, both of which went into effect in 2022 with additional transparency efforts being rolled out in ‘23 and ‘24. Here’s how you may benefit: Because each hospital operating in the US is required to provide clear, accessible pricing information online about their services, that means you can price shop across hospitals and estimate the cost of care before choosing a hospital. Basically the same way you price shop on Amazon or Google Shopping, you can increasingly do so with medical procedures, tests and imaging, and hospital visits. Besides checking the hospital’s own website or calling their billing department, these tools may help:

• Lookup the average price of procedures near your zip code at FairHealthConsumer by clicking on the shopping cart.

• See prices at HealthcarePriceTool.

• Compare hospital vs. urgent care visits at SolvHealth.

• Check if your employer has paid for employee access to HealthcareBluebook.

During the appt

Annual Physical

During your annual physical or well check-up, say to the doctor, “Can we keep the conversation limited to what the billing department would consider a preventative visit?” That way you won’t get hit with an office visit charge when you thought you were going for your free annual exam. 

If the doctor finds something that needs to be discussed or you want to talk about a specific complaint, schedule that for another visit. 

Annual Bloodwork

Always get all the bloodwork done that’s included as part of the annual physical. It’s great to have that data and to track your biomarkers overtime. It may also save you from paying for them yourself later in the year, if you find later that you need those tests. 

I like to track all of my bloodwork and biomarkers overtime using Inside Tracker — it’s great to reference if a question comes up about how cholesterol or HbA1c have been trending over the years, regardless of where the tests were done. With Inside Tracker, I also get personalized recommendations on what to eat, how to move, and lifestyle habits to adopt based on my blood markers. 

If optimizing your health or biohacking is of interest to you, Inside Tracker is definitely worth checking out. You can buy tests from them, or you can manually input the blood tests results from your annual physicals.

No to Balance Billing

Don’t agree to balance billing with an out of network provider, especially if you weren’t provided an estimate 72 hours in advance; and always read the forms before signing. This is one of your rights with the No Surprises Act.

Balance billing is where the provider bills you, the patient, for the remainder of the fees that weren’t covered by your insurance.

If you do get a bill under these circumstances, you’ll have to appeal with your insurer and may even need to take it up with a regulatory authority. You can also call the No Surprises Help Desk for assistance: 800-985-3059.

Afterwards

Get the EOB & the Itemized Bill

Don’t pay a provider’s bill until you get the Explanation of Benefit (EOB) from your insurance carrier—you may need to login to your insurance carrier’s portal to see this. Also, request an itemized bill from the provider, imaging center, or hospital. Once you have both, here’s what you need to look for:

• Are you being billed only for services rendered? Watch out for double billing or billing for services that weren’t provided.

• Confirm the provider is charging you what your insurance has decided you owe based on what they paid, any discounts, and then what’s leftover. 

• Looking at the EOB will also help you determine if you need to or should appeal any billing for OON procedures based on the No Surprises Act. 

Check the Statute of Limitations

If it’s been many months since your procedure, you may not owe anything. Sometimes called a “timely billing” law, the statute of limitations for issuing medical bills in your state may require that medical bills be sent to patients at most 6 months or 1 year after treatment. 

A few years ago I broke my foot and I had to have an MRI. Thirteen (13) months later they called me and told me I had only paid for half of the MRI; however, I had never received a bill for the second half. So, I told them the statute of limitations had passed and they couldn’t collect. And it’s never been an issue again.

Take Initiative & Don’t be Afraid to Negotiate

Don’t let a bill just sit and ignore it, even if you can’t pay it. Take the initiative and call the billing department - don’t wait for them to call you. Explain to them you can’t pay and figure out what your options are.

If it’s a non-profit hospital and they verify your inability to pay, the bill may be waived in part or in full.

In other cases, they may work with you to set up a low- or no-interest payment plan. 

In another example, I have a friend who called the billing department at a hospital where she had emergency surgery and told them in her lifetime she’d never be able to pay the full bill they’d sent her. But, instead she offered to pay them a certain amount immediately whether they could accept that as her total payment. They accepted her proposal and her bill was settled for far less than the original amount. 

In summary, if you’re facing a hefty medical bill, don’t ignore it. Take initiative, call and negotiate with the billing department. If that doesn’t achieve what you need, you can find patient advocates online to work towards a solution. 

Other Ideas

Here are some key questions to ask before committing to healthcare services or products:

• How much will this cost?

• Do I really need this test, procedure, or medication?

• Is there a cheaper medication or generic?

Medical Tourism / Cheaper locations for Healthcare Services

If you’re a citizen of another country, and are already planning to travel there to visit friends or family, it is likely more affordable to have tests and procedure done in that country, which are almost always cheaper than in the US.

Likewise, if you’re planning to travel somewhere, and whatever procedure or test you need isn’t too involved or require too much follow-up care, it may be worth inquiring about the cost. Mexico and all of Latin America are popular medical tourism destinations, for plastic surgery, dental work, Lyme treatment, and more. For example, my husband got lasik eye surgery in Colombia for about one-fifth the costs of doing it in the US. His doctor was trained in Europe and had the latest top of the line equipment. 

Definitely worth considering if you have the time and means, and are still healthy enough to travel for cheaper health services. 

As the price of healthcare and health services continues to rise in the US, you can be a smart and informed consumer. Advocate for yourself, know your rights, get expert assistance when needed, and protect your wallet and your health.