How much will that doctor's appointment cost?

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BY|Theo Gagen View Bio|6th Aug 2019

As I’ve gotten older, my fear of doctors has increased exponentially. It’s not because of blood, or shots, or anything that most people are fearful of when walking into a medical office. It’s because of the oh-so-unpredictable bill that I know I’ll receive in the mail three weeks later  when my insurance inevitably fails to cover as much of the cost as I anticipated. 

I’ve been thinking about this issue a lot lately, and frankly, I think it’s our right to have access to tools that help us predict medical costs. So that’s what I’m going to attempt to do. I’m about to get into the nitty gritty, and it may not be all that interesting, but I guarantee it’ll be informative! So stay with me. 

When you’re trying to predict your doctors bill, there are 2 key factors to consider:

  1. Your insurance policy
  2. The types of medical services you need

Let’s begin. 

Your Insurance Policy

Let’s assume you’re trying to find a dermatologist, and don’t have one yet. In this case, we’re starting from scratch. The first step in finding a cost-efficient dermatologist for you is taking a good look at your insurance policy to find out the following information:

  • Deductible 
  • Copay
  • Coinsurance

Deductible

If you take a look at your insurance card, somewhere on there you’ll see a Member ID number. Usually, you can go to your insurance company’s website and sign up for an account (using your Member ID) where you can see your insurance plan details. Once you find out what your deductible is, write it down. That will come in handy in a minute. 

Copay

Next, we need to figure out what your copay and coinsurance costs are. If you look on the front of your insurance card, you can probably see copay costs. For example, it may say “Primary Care: $25, Specialist Care: $50”, etc.  If it says a dollar amount and not a percentage, it’s a copay. Since you’re “looking for a dermatologist” in this example, that would be considered a specialist. Write that number down. 

Coinsurance

Coinsurance is usually found in the same portal where you found your deductible. Just in case you aren’t able to use an online portal to get access to your benefit information, let’s find your coinsurance a different way. Pull out your insurance card and find the name of your insurance plan. Now do a Google search for “[Your Insurance Plan Name Here] Summary of Benefits and Coverage”. You should be able to find a web page or PDF document with the details of your plan. (This also was probably mailed to you when you got your insurance card, so if you have the physical version that works as well.) Find your coinsurance amount. This will be a percentage, not a dollar amount. You guessed it, write that percentage down. 

Now you should have your deductible, copay, and coinsurance amounts written down. (If you are struggling to find any of this information, call the customer service number on the back of your insurance card to speak with a representative.)

 

The Medical Services You Need

This is where things get iffy. It can be really hard to predict the medical services you’re going to need when you’re going to the doctor, because well, you’re not a doctor. 

However, there are a couple things you can do to make sure a doctor appointment is cost-efficient. The first is to make sure your going to a doctor who is in-network. To find a doctor in-network, visit your insurance company’s website and log into your portal. There is usually a “Find a Doctor” feature that will ensure you find one in-network. There is a risk that your in-network doctor uses an out-of-network laboratory, which can make your bill skyrocket. To make sure the lab is in-network as well, ask your doctor or call the lab directly. 

Second, do your best to shop around to find out the lowest cost for the service you need. If we go back to the dermatologist example, let’s say you need a basic exam. Call a couple different offices and see what their basic exam normally costs. This will help you narrow down your choices, especially if you have a lot of in-network dermatologists. 

Once you’ve picked your doctor, here’s how to calculate an *estimate of how much your visit will cost. 

Example:

Deductible: $500

Coinsurance: 20%

Copay: $25

Cost of Appointment: $1000

In this case, you would pay $25 (copay) at the time of service. After your doctor submits your claim to insurance, you would owe $500 for your deductible, plus $100 as your coinsurance (20% of the remaining 500). In total, you would pay $625. 

The good news is, once you meet your deductible, your insurance company will cover future costs and you’ll just owe a copay and coinsurance. This means if you went to the doctor again and it cost the same amount, you would pay $25 (copay), plus a $200 coinsurance (20% of 1000), making your bill $225. 

Always remember that medical bills are somewhat unpredictable, and don’t kick yourself if you miscalculated. Everyone has times where they get a bill that is higher than they expected, medical or otherwise. The best you can do is to educate yourself on your insurance plan, but be aware that medical insurance is a complicated subject that will take time to master. 

For more resources on insurance-based info, check out https://sondermind.com/resource-library/blog