By Elizabeth O'Brien
May 3, 2017

There’s plenty of uncertainty in health care these days as Congress wrestles with Obamacare’s fate. But there’s one thing we know for sure: The price we pay for health care keeps going up.

Even setting aside the winners and losers under the GOP proposal to replace Obamacare, the underlying bill for medical goods and services—everything from MRI scans to joint replacements to prescription drugs—continues to climb. According to the Centers for Medicare & Medicaid Services, national health spending is projected to grow at an average rate of 5.6% per year for 2016-2025, driven by projected growth in medical prices.

And that ultimately increases out-of-pocket costs for everyone, explains Elisabeth Rosenthal, editor-in-chief of Kaiser Health News. “The reasons premiums, deductibles and copayments are going up is because prices are going up,” she says.

A former practicing physician and New York Times health care correspondent, as well as author of the recent book, An American Sickness: How Healthcare Became Big Business and How You Can Take It Back, Rosenthal says in an interview with MONEY that medical prices defy normal market forces. In medicine, for example, competition often drives prices up, not down.

But to some extent, you can control how much you pay for your health care. Here are three strategies Rosenthal recommends for lowering your medical bills:

1. Choose the Right Doctor

courtesy of Penguin Books

Most consumers know to ask whether their doctor takes their insurance or not. But you should also ask whether the practice is owned by a hospital or licensed as a surgery center, Rosenthal says. If the answer is yes, you or your insurer may find yourself on the hook for high “facility fees.” (Even if your insurer picks up the tab, the carrier will eventually pass those increased costs on to you in the form of higher premiums, deductibles, and co-pays.)

Other questions to ask: If you need a referral, would the doctor only refer you to a specialist within your insurance network? Where does the office send blood work or radiology testing? (The prices for blood processing at a hospital can be 100 times more than at a commercial lab, Rosenthal writes, while a bill from an out-of-network radiologist you never met—but who read your scan—can come as a shock.)

2. Question Treatment Decisions

If you have chest pain, shortness of breath, a bad allergic reaction or other urgent symptoms, seek medical care right away, Rosenthal says. But for less pressing ailments, it pays to wait a few days to see if the problem gets better on its own. “Cars don’t get better by themselves, but people do,” she says.

Once you have an appointment, you need to realize that, for medical practices, there’s no money in waiting. For the most part, doctors make money by performing procedures, not by counseling patients to give it a little time. When your doctor does recommend a test or procedure, ask questions.

  • Ask how much it will cost—and don’t accept “it depends on your insurance” for an answer, Rosenthal says. The doctor—or the office’s billing specialist— should be able to give you a price range for your insurer; at minimum, you should be able to get them to tell you the cash price charged by the testing location.
  • Ask how the test/surgery/exam/x-ray would change your course of treatment. If the answer is it probably won’t, then press for why the procedure is needed—and consider skipping if you don’t get a good answer.
  • Ask where any proposed treatment will take place. Doctors often do procedures at different locations on different days of the week. Avoiding your doctor’s days at the hospital could save you big.
  • And ask upfront if anyone else will be involved in your care, in order to avoid surprise medical bills from doctors or other medical providers—some of whom you might never actually meet, particularly if they end up treating you when you’re under anesthesia.

3. Challenge Your Bills

Rosenthal recommends taking one extra step when you’re hospitalized: In the pages of the admitting documents you have to sign, there will be an item on your willingness to accept financial responsibility for charges not covered by your insurer. Before you sign, write next to it, “as long as the providers are in my insurance network.” This will give you a basis for challenging unexpected charges later.

Despite your best efforts, however, you may still receive some outrageous bills. “Prices are so inflated that often even low-level clerks are authorized to approve major discounts,” Rosenthal writes. If you haven’t met your plan’s deductible and are paying out of pocket, make the doctor an offer, she recommends—noting she’s heard from patients who have had bills more than halved on the spot.

Always ask for itemized hospital bills, she notes. Many hospitals group charges under categories like “pharmaceuticals,” when in reality every single pill and piece of surgical equipment carries an individual price. While hospitals sometimes balk at the request, it’s your right to see all of them, Rosenthal says.

Check your bill for errors—which are more common than you’d think—and protest any mistakes or outrageous charges in writing, says Rosenthal. (She includes sample letters in her book.) If you’re disputing a surprise out-of-network bill, check what protections your state offers against them. New York is among handful of states with laws on the books to protect consumers from surprise bills from out-of-network providers. But even if your state doesn’t have one—or you’re in a large-group plan that isn’t covered by your state’s law—you can still reference those laws in your protest letter, Rosenthal says. Consumers Union has an online tool that can be used to find contact information for the insurance department in your state.

The dispute process can take time, Rosenthal cautions. To preserve your credit, let the doctor or hospital know that you’re disputing their bill, and ask that they not send the bill into collections.

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