The Fineprint
What Questions to Ask Before & During Your Visit
Before the Visit
Network and Billing Confirmation
Key details to confirm:
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Who will bill for the visit
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If each billing group is in-network
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If there were any outside groups involved
Location and Preventing Facility Fees
Key details to confirm:
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Where the service will be performed
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If a facility fee will be charged
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If one could receive medically equivalent care at a lower-cost facility
Prior Authorization and Referrals
Key details to confirm:
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If prior authorization is needed
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If a referral is needed
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Who submits the paperwork
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How could a person know if the approval was confirmed
Billing Codes
Key details to confirm:
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Expected CPT codes
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If the service is preventative or diagnostic
Cost Estimates
Key requests to include:
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Ask for a written estimate
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Ask that all expected services be included in the estimate
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If uninsured or self-pay:
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“I am uninsured/self-pay, could you provide me with a Good Faith Estimate in writing that includes all expected services before I schedule anything?”
During the Visit
Extra Services
Key details to include (when additional tests, imaging, or services or suggested):
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If these extra services are medically needed
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If there are alternatives that are less costly
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If it will raise the amount owed out-of-pocket
Medication
Key details to ask:
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Generic availability
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If location impacts the price of the drugs
