Before Your Visit 

Believe it or not, the process to ensure that your healthcare visits do not overwhelm you with costs start even before you pick a healthcare provider or facility.

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If it is Not an Emergency...

The first thing you want to do is find the correct healthcare facility for you

 

Step 1: Primary Care or Urgent Care?

• Typically many go to urgent care because making appointments at primary care facilities is less convenient.

• However, Urgent Care is more expensive no matter if you are insured or uninsured; there is a higher copay!

  • Therefore, the best option is to find a reliable primary care physician that knows your history and you can turn to, especially for long-term health conditions and maintaining your health.

• That being said, you should still choose urgent care if you need immediate attention for a cold or injuries and your primary care physician is entirely unavailable.

• Only decide to go to the emergency room (ER) if you are experiencing chest pain, loss of consciousness, severe breathing, stroke symptoms, and other similar symptoms. The emergency room cost will be significantly higher than Urgent Care, and you may not receive as much attention if your symptoms are not dire.

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Step 2: Always Check If Everything Fits Your Financial Situation

• If you are insured, always check if the healthcare facility and your doctor is in your plan. 

  • One way to check specifically what your insurance plan supports, log into your insurance website 

    • Find sections titled with either "Benefits," "Coverage," or "Cost Estimator,” where you can find what your insurance covers for

    • You can also see your deductible, copays, and coinsurance for specific services. 

  • Another way to check if the service you are looking for is in your insurance plan, you can use the "Find a Doctor" or "Find Care" tool on your plan's website 

    • This allows you to find care that is near your location

  • The most detailed way that you can find a healthcare facility or doctor that is your fit is by calling the number on your insurance card

    • By reaching out to a person within your insurance agency, you can engage in a one-on-one call with a professional that can walk you through the best path for you

    • Ask questions such as

      • "Is [specific service/procedure] covered?"

      • "Do I need a referral?"

      • "Is prior authorization required?"

      • "What are my costs (copay, deductible, coinsurance)?"

      • "Is the provider in-network?". 

  • Lastly, you can always go directly to the doctor’s office or the health care facility you are interested in and ask them to verify your coverage

 

• If you or the person you are seeking medical treatment for are on Medicare, check out this website offered by Medicare itself that allows you to compare services near you that accept this insurance plan:

  • Click here to access the website

 

• If you are uninsured, check out this website

  • This is a government-run website that helps you locate Federally Qualified Health Centers (FQHCs) near you. FQHCs are clinics that offer primary, dental, and mental care for anyone regardless if they have insurance or not, and they are typically located in underserved areas. 

  • When you are brought to this website, enter in your zip code and the distance you are able to travel to find a clinic that is nearest to you.

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Step 3: Coding and Good Faith Estimates​​

• Once you’ve found a healthcare facility in your plan, call the number they have provided for customers and ask how they code their services.

  • Essentially, coding is how healthcare facilities ensure consistent communication and concise documentation of what procedures have been done, what supplies were used, and more.

  • When you call and ask for how these facilities code certain services and different patient scenarios, you can get a good idea of how much you will be charged with each procedure or medical equipment used.

    • Codes may vary depending on how they are used by either physicians or facilities, so it is safe to check.

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• • Specifically, you should ask for each procedure’s CPT (Current Procedural Terminology) code, which are five-digit codes used in medical billing that stands for certain services and procedures done by healthcare professionals.

  • • For example, the code 93010 can be for an EKG

    • And when you call the hospital or healthcare facility you are seeking help from, you should ask “What are the CPT codes for [your planned procedure or service]?”

    • Be sure to write down and remember these CPT codes when you ask!

    • Even if you do not have insurance, checking CPT before your visit allows you to see what you will be paying for in the future.

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• • If you have insurance, after you have your CPT codes, call the number on your insurance card and tell them your CPT codes and ask about your remaining deductible, your coinsurance percentage, and what the estimated out-of-pocket cost will turn out to be.

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• • You can also ask for a “Good Faith Estimate” from the hospital or healthcare provider.

  • • The Good Faith Estimate will detail the expected costs for your visit even if you are not insured.

    • Please note that for unexpected treatments and emergencies you may not receive a proper estimate.

    • Find out more about how to ask for a Good Faith Estimate here