Frequently Asked Questions

I am switching doctors. What questions should I ask when finding a new doctor?
  •  Is the practice owned by hospital or licensed as a surgery center? If the answer is yes, you or your insurer may find yourself paying outrageously high facility fees.
  • Will you refer me only to other physicians in my insurance network, or explain in advance why you can’t? A doctor may have extreme pressure on them to refer patients to a particular hospital or medical group. A doctor should take the time to look at your insurance network’s list and pick someone he or she trusts within it.
  • Will there be charges for phone advice or filling out forms? Is there an annual practice fee? It is good to know in advance how your doctor views his commitment to medicine and his patients.
  • If I am hospitalized, will you be seeing me in the hospital? What is your coverage on weekends? These services are an essential part of being a great doctor and most patients around the world expect to receive them. In the United States, despite physicians’ high salaries, many practices have outsourced them. You DO NOT want a doctor whose off-hour backup advice is to go to your local urgent care center or a hospital emergency room with which he has no contract.
What questions should I ask when at the doctor’s office?
  • How much will this text/surgery/exam cost? “I don’t know” or “It depends on your insurance” in not an acceptable answer. The doctor should give you a ballpark range or the cash price at the center where he or she refers. Many things that sound like simple little tests are now priced at many thousands of dollars.
  • How will this test/surgery/exam change my treatment? If the answer is “It won’t, but it might be good to know,” take a pass. Doctors likely feel the need to do something or order something if you have a complaint.
  • Which blood test are you ordering? What X-ray? Why? When doctors order blood work, they are frequently just ticking off boxes on a long electronic checklist, with no awareness of how much they might cost. Your questions alone will make them more discerning.
  • Are there cheaper alternatives that are equally good or nearly so? If you go to a pharmacy or a lab and encounter a high price, call your doctor’s office and tell them or her about it. Force your doctor to learn. He or she likely didn’t know.
  • Where will this test/surgery/exam be performed – at the hospital or surgery center, or in the office – and how does this place impact the price? Doctors often practice and do procedures in different places on different days of the week. If you go on a Thursday and that happens to be your doctor’s day at the hospital, it could double the price of your biopsy or colonoscopy. If he or she refers you to an ambulatory surgery center ask, “Are you the owner?” A little shaming might encourage better behavior.
  • Who else will be involved in my treatment? Will I be getting a separate bill from another provider? Can you recommend someone in my insurance network? Avoid a lot of unexpected charges up front by making sure that whoever is involved in your care – doctor, physician assistant, pathologist, anesthesiologist – is in your insurer’s network.

What do I do if myself or a loved one gets hospitalized?
  • In the pages of admitting documents you’ll have to sign, there will be inevitably one concerning your willingness to accept financial responsibility for charges not covered by your insurer. Before you sign, write in “as long as the providers are in my insurance network.” At the very least this annotation will give you a basis for arguing later.
  • Hospitals have built a huge oversupply of private rooms, though insurers frequently won’t cover their costs. If you are assigned to a private room, make it clear that you did not request it and would be happy to occupy a room with another patient. Otherwise, you might be hit up to pay the “private room supplement” by your insurer.
  • Be clear on the terms of your stay in the hospital: Are you being admitted or held under “observation status”? Ask point blank. The answer will have big implications for your wallet. Typically for most insurance policies it is best to be fully admitted. If you are on observation status, ask why you cannot be fully admitted.
  • If you are feeling well enough, ask to know the identity of every unfamiliar person who appears at your bedside, what he or she is doing, and who sent him or her. If you are too ill, ask a companion to serve as your gatekeeper and guard. Write it all down. Beware the nice doctor who stands at the foot of your bed each day and asks if everything’s OK. That interaction may constitute a $700 consultation.
  • If the hospital tries to send you home with equipment you don’t need, refuse it, even if it’s “covered by your insurance.” This is a particular concern if you have had an orthopedic procedure. Avoid $300 bills for slings you could buy for $10 at a pharmacy or $1,000 knee braces.

I received large medical bills. What do I do?
  • If you receive an outrageous bill from a hospital, a testing center, or a medical office don’t wait – negotiate! Get someone on the phone that has the authority to negotiate the bill. Prices are so inflated that even low level clerks are often authorized to approve major discounts. If you need you can always request to speak with the hospital’s CFO. If he or she resists, state that you intend to litigate the bill and the reasonableness of the charges.
  • Before you call to negotiate request a complete itemization (request form UB-04): Many hospitals will use umbrella headings like “surgical supplies” on their bills to ty to fudge full disclosure of costs. The hospital may resist. Don’t let them. An itemized bill is your right!
  • Arm yourself with embarrassing statistics: Look up Medicare payment rate for your procedure to determine a reasonable offer. Medicare pays out according to each hospital’s own calculated cost for delivering care, plus a small profit.
  • Use Online Pricing Tools: Healthcare Bluebook, Pratter, ClearHealthCosts, and Fair Health, are available to determine and compare costs for outpatient hospital procedure in your zip code.
  • Check the bill against the notes you made while you were in the hospital: Make sure you received the services for which you are being charged.
  • Argue against surprise out-of-network bills: Florida protects consumers from this. Everyone has grounds not to pay. Informed consent is a bedrock legal and medical principle. The doctor and the insurer will have to work out a fair price themselves.