How to get upfront medical pricing

How to get upfront medical pricing

There's no need to be squeamish when it comes to asking about the price of a health care service. Avoid unpleasant surprises by following these tips:

  • Get ALL the details. If your treatment is a surgical procedure, make sure to ask about pricing for all aspects of the care, including the surgeon, hospital, anesthesiologist, pathologist, or any other related fees.
  • Know the specifics. Write down the name of the service and, if possible, ask your doctor for the billing, or CPT, codes. The more specific you are, the easier it is to get an accurate price.
  • Figure out the fair price. Before asking a provider, look up the medical service using the Healthcare Blue Book tool on and write down the price so you can compare.
  • Shop around. Call several highly rated providers and ask to speak with an employee who can discuss pricing.
  • Share your status. If you have insurance, tell your provider so you'll get the rate your insurance company has negotiated. If you're paying out-of-pocket, be sure to ask for the self-pay discount.

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Sadly, our experience has been that medical staff/adeministrative and insurance company phone contacts have little or no idea of what's going on. They are mostly functionary automatons who dare not commit to firm information. Fortunately, we have insurance, but that's no guarantee of anything except basic payments. We've had our disputes with providers, many of whom just rip off the system and their patients, sad to say. ===sigh===

Gina Warner


You can almost always count on your procedure cost being more than the estimate they give you because when you call for this estimate, the person answering the phone has no idea what is going to happen in the OR so, they can only give you a real estimate. If you are lucky enough to get a 'firm estimate' please get it in writing because it will probably be more once the procedure is done. I have had clients with estimates of $2000 and after the procedure, the bill is $6000. There is usually no way to get a 'firm and final' amount prior to the procedure.



This goes for Pharmacy's as well. Just because a Dr. Says Pill A, the Pharmacist may have an over the counter that is cheaper.



Wow, I've been seriously under-billing! Thanks for the info, now I can legitimately increase my prices! What's good for patients should be good for doctors as well.

v thompson


you must be aggressive! it took 6 phone calls and many days and I still couldn't get all the charges related to my upcoming knee surgery. Lots of evasive answers,and they do it on purpose! stick with it and be firm, write down everything and who told you what. get everything in writing when you can. my surgery was $2,000 over price, 'aftercare' was omitted as well!



all very good info. however if you call your insurance company for a dollar quote, you may be asked to supply the diagnosis code as well as the cpt code. your doctor's office should be able to supply that info.



This is a bunch of bologna. Prenegotiated rates from insurance companies vary widely. Plus, you need to factor in your deductible and excluded out of pocket expenses that you thought were covered but in the fine details it's actually not covered. It's the insurance companies that make things very shady and not the doctor. Also if you come in for one problem but then you start to rattle off a bunch of other ailments that you would like to include in your office visit, that will be a more expensive visit because it takes more time. Again, not the doctors fault.

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