If you’re like many Americans, you don’t know what an emergency department visit or operation costs until a bill from a healthcare provider or a letter from your health insurance plan comes in the mail. We realize this uncertainty can be stressful and can make it hard to plan your personal or household finances.
From the smallest purchases, like a package of gum, to the biggest ones, like a car or a house, you typically know what things cost before you buy them. But when it comes to healthcare, knowing your cost up front is not always easy. Estimating how much it will cost to “fix” a person will never be like estimating the cost of fixing a refrigerator. It’s not always easy to predict what is needed to treat an illness or restore a person’s health. But knowing the price you will be expected to pay for your care is more important today than ever.
what you need to know
First, if you have insurance, you and your health plan share your healthcare costs. The specifics of your health plan coverage, including your deductible, copayment, and coinsurance, determine how much of your healthcare costs you will pay, and how much your health plan pays.
choosing your doctor & hospital
Second, health plans have different networks of doctors, hospitals, and other healthcare professionals. When you choose a doctor or hospital, you will want to know if the providers you are considering are in your health plan’s network. And you’ll want to know how your out-of-pocket costs will be affected if you use an out-of-network provider. When you receive care from a network doctor or hospital, you typically pay a lower price. If you go out of network, you usually have to pay a higher price.
price information for providers
Finally, your health plan may have price information for many different providers in your network. A hospital can provide information about its own prices but it usually doesn’t have price information for other hospitals or the services of other providers who may be involved in your care.