This is a picture of Mike Bertaut with text that reads: "How Can I Find Out What I'll Pay for Care? Straight Talk."
Category: Cost of Healthcare, Health Insurance

How Can I Find Out What I’ll Pay For Care?

These days, we’re used to shopping around and getting price information for just about anything within a few clicks! But, it’s not that easy with healthcare. Unlike shopping for clothes, food and most other professional services, it can be tricky to figure out how much different healthcare services cost, or which part of those costs you’ll have to cover out of pocket.

Price transparency in healthcare is still developing, but there is progress. A federal law that took effect this year requires hospitals nationwide to post their gross charges for all procedures, drugs and supplies, to give consumers more information. And, there are tools that Louisianians with health insurance can use to get a better idea of what they’ll pay for healthcare.

Mike gives the Straight Talk on what you can do to find out what your care will cost you.

4 comments on “How Can I Find Out What I’ll Pay For Care?

  1. Brendan McAdams

    Hi Michael. Great informative site!
    I’ve been surprised recently by balance billing charges for in-network care after I thought all charges were covered by my insurance. In one instance, even after I was told by a physical therapist that my insurance would cover my services, I received bills for the balance not covered by my insurance. I was told by the medical group’s billing department that there’s no way a doctor could know what the charges will be ahead of time.

    Something I’ve been trying to understand is whether balance billing protection applies BEFORE you’ve paid your deductible? Or is a patient responsible for paying all balance billing charged to them until they’ve met their deductible? (My current health plan is the Pelican HSA 775 high deductible health plan with Blue Cross and Blue Shield of Louisiana if that makes any difference.)

    Thanks again for the great work here making clear sense of a complex subject!

    Reply
    • Michael Bertaut

      Brendan, This is a great question!

      I’ve noticed a trend lately of medical providers saying to people “Oh yes, we take Blue Cross” but not actually being in-network providers. What they mean is, “We’ll take what BCBSLA will pay, but then bill you the difference up to any price we decide to set.”
      A provider that is legitimately IN NETWORK is FORBIDDEN from billing you 1 penny over the amount BCBSLA has agreed with them they can charge for any covered service..

      EVERYONE PAY ATTENTION: IF that provider is not listed on OUR WEBSITE as IN YOUR PARTICULAR NETWORK (there are more than 1 of them) then it’s likely they are out of network providers trying to get you to use their services anyway. ASK specifically “ARE YOU IN BLUE CROSS’s XXX NETWORK?” and if they hem and haw, move on.

      So, let’s say a therapist is in-network with BCBSLA (since you used that example) charges $200 for a service, and has an agreement to bill BCBSLA network customers $100. Once he has received his $100, either from you or from us, he CANNOT under his contract bill you any more for that covered service. To do otherwise would violate the contract with us, and we take a very dim view of that.

      You are responsible for the BCBSLA agreed upon charge (you can see it on your EOB under “allowable”) in full, whether as part of your deductible or co-insurance. But if you get billed MORE than the BCBSLA allowable charge, then the provider is either
      1. Billing you for an uncovered service; or
      2. Violating their contract; or
      3. Not in your network.

      Hope this helps!…mrb

      Reply

Leave a Reply

Your email address will not be published.