Life Hack for Affordable Healthcare

Okay, this may not actually be considered a “life hack,” but I want to provide some useful tips that may help you gain access to more affordable healthcare. By way of background, I have been in the outpatient healthcare ecosystem for more than a decade. I started in healthcare consulting, then revenue cycle management (medical billing services), and eventually as a co-founder and executive of an independent multi-specialty healthcare system. Through my years of experience and education I have learned some very helpful ways to navigate healthcare costs and ensure necessary precautions are taken to avoid large, and sometimes unnecessary, medical bills. As a disclaimer, this is not medical, legal, or financial advice, rather I am providing some helpful information that may provide you ways to access more affordable healthcare.

First and foremost, the simplest and best advice I can give is to ask questions. If you have been prescribed a medication, a diagnostic test has been ordered, you have been referred to a specialist, or you have been recommended for a surgery or procedure, ask questions. I know, it can be scary when you are not in healthcare, but I promise, if you don’t ask questions, you will have no idea if there are more affordable options for the care you need. To help, here are a list of very helpful questions you can ask of your healthcare provider in any of the above situations:

1. Do you know how much this service/procedure/surgery will cost?

2. Is it possible to have my tests, labs, or recommended services completed at an outpatient or independent facility?

3. Are there any generic medications available in lieu of name brand medications?

4. Do I have to see someone within the hospital system or can I go to an outside or independent provider?

5. Can my procedure or surgery be conducted in the office or at an ambulatory surgery center instead of at the hospital?

6. Can you tell me the brand and type of brace or medical equipment you plan on prescribing so I can search for it online?

7. Are you referring me to a hospital-based physician/practice or can I be referred to an independent group?

8. Can you tell me what it would cost to pay cash for this service?

This list of questions is not meant to be exhaustive but provides a good starting place to get to the root answer - i.e. is there a more affordable option for your needed healthcare?

To better explain and expand on the above questions, it makes sense to look at some factors that create the need to dive deeper before making healthcare decisions. For instance, a major driving factor for increased costs to the patient for co-insurance, co-pays, and patient responsibility stems from the site of service where care is received. A study from Blue Cross and Blue Shield, published in September of 2023, found that routine medical care can be up to 58% more expensive at a hospital than at a doctor’s office. An expanded review of the financial implications of this report were later published in December of 2023 and found that hospital outpatient department procedure prices were substantially higher — in some cases, five times more expensive — than when performed in an ASC or office setting.

Although it is becoming more public knowledge that services, procedures, and surgeries are more expensive in hospital settings than at independent facilities and offices, not many people realize the difference when it comes to laboratory services, radiology services, surgeries, and hospital-owned practices. A major component to consider when going to a hospital-owned practice (even if outpatient) is having to pay facility fees. These facility fees are charged by hospital systems for outpatient services in addition to professional fees.

Typically, insurance companies and patients receive two separate types of bills for care provided in hospitals. One type, (the professional bill) covers the care provided by physicians and other medical professionals (for example, nurse practitioners, physical therapists). The second type, (the facility fee) covers the additional costs of providing that care in the hospital (beyond professionals’ care). However, when independent healthcare professionals provide services outside of hospital, insurers typically require the professional to charge for both their time and for other practice expenses, such as rent and equipment, on the same bill. In that way, insurance companies negotiate with physicians for a single combined price for the total scope of the outpatient care provided. In sum, if you receive care at a hospital-owned facility, even if outpatient, you are subject to higher charges, regardless of your insurance status.

Next, it is important to know that you have the power to decide where you go for the majority of your care. Of course, if you are admitted to the hospital for inpatient care it has been determined that you need a higher level of care and picking an outside facility may not be possible. However, if you have been recommended for an outpatient test, procedure, or imaging study, you can request to go to an independent provider to avoid higher costs associated with hospital-based services. An MRI for instance, performed at a hospital can cost 4 to 10 times more than what it would cost at an independent imaging center.

Another valuable lesson is that more and more healthcare products and medications are becoming available in the general market outside the typical healthcare ecosystem. For instance, Mark Cuban founded Cost Plus Drug Company where they offer a litany of prescription medications at cost, plus 15%, plus the pharmacy fee, if any. This venture allows patients to directly search for medications to determine whether utilizing their health insurance is actually the most affordable route to purchase their prescriptions. Similarly, Amazon now offers a wide range of durable medical equipment (DME), bracing, and other medical equipment that is often far less in cost than the same items if purchased from a healthcare provider, even if utilizing health insurance.

Finally, many healthcare providers, especially independent practices, now offer affordable options for self-pay or cash-pay patients. If a patient is without insurance, has a high deductible plan, or wants to self-pay for a non-covered service, many practices will provide significant discounts to patients for same-day payment. These discounts are available to patients because the provider avoids the bulk of costs associated with coding, billing, follow-up, and a variety of other administrative fees.

So what is the common theme here? You have to ask questions! You can’t just expect that you are going to walk into a healthcare provider, hand them your insurance card, and get the most affordable care available. You have to take the initiative to ask questions, do research, and make fiscally responsible decisions with your health just like you should in every other aspect of your life. If you implement this life hack you will put yourself in the best position to obtain more affordable healthcare.