If you have been a Liberty HealthShare member for any length of time, you know that we ask our members to be actively engaged with the cost of their care so that, as a community, we can wisely steward and preserve the financial resources we all share in times of unexpected and unaffordable medical need.
Any time we interact with the healthcare industry as patients, from a yearly check-up to an unforeseen surgical intervention, we alone have the power to compare prices and choose how and where we will access healthcare. In our interactions with medical providers, we not only have the right to transparency in pricing but also the responsibility to ask questions and accept only the care that is absolutely necessary and reasonably priced.
The reality is, we can promote wise healthcare consumerism until we are blue in the proverbial faces, but none of this counsel is worth anything if members don't understand how to "shop around" when they are about to undergo treatment or a procedure. For many of us, years of participation in a third party-payer system (in which the bills are sent to a distant bureaucracy) means we have little to no prior experience "shopping" for healthcare. So where should we begin?
For starters, it's not as complicated as it seems. Think about the last large purchase you made: your home, a car, even a furniture set. You didn't just tell the real estate agent or salesman to decide what was best for you without having a chance to research what they were selling and how much it was going to cost. No, you did your own research, setting how well the item fit your needs against cost considerations. Healthcare is no different. You can and should apply the same shopping principles to your interaction with your physician and the care he or she recommends for you.
What this looks like in practice requires a paradigm shift; one in which you and your physician decide together what the necessary next steps are when you have a diagnosis and require treatment. For instance, if your physician prescribes a battery of blood tests, an imaging study, or a procedure for some symptom you have shared with them, you can and should ask questions such as, "Are all of these tests, etc. required at this point or is there a more conservative route we can take?"
You should make sure your physician knows you are a self-pay patient who is concerned with the cost of your care, and that you only wish to undergo the testing and treatments that are truly needed. Unfortunately, in our litigious society, many physicians practice what is known as "defensive medicine", ordering tests that have little or nothing to do with your symptoms purely to show they discharged their due diligence in case of a lawsuit. Make it clear to your doctor that you are most concerned with good financial stewardship and that you only wish to undergo the interventions that are absolutely necessary.
The same paradigm shift applies where prescription drugs are concerned. Unfortunately, some physicians prescribe medications based on which pharmaceutical representative has most recently visited their office to push new therapies. What people don't realize is that many older drugs are still just as effective as they always have been and they come in at a fraction of the cost of newer drugs. Your agenda is not the same as that of a pharmaceutical company, which has no incentive to promote the use of well-established, cheaper drugs if they can get doctors to prescribe something new and more expensive for the same illness. As patients, we have the right to ask questions and request effective therapies that are more affordable.
If you are given a prescription or an order for a test, imaging study, or procedure that is truly necessary, your next step is to research the cost. You may have read this on our blog before, but it bears repeating: the cost of certain tests and procedures can vary from facility to facility, sometimes by up to ten-fold! Believe it or not, hospitals and other providers are able to arbitrarily set their pricing (in other words, there is no standard for pricing within the healthcare industry). Add to this the fact that most patients and doctors are not engaged in weighing cost while considering interventions, and prices commonly far exceed the actual costs of care.
Researching cost is probably the most time-consuming step of shopping for healthcare, but for members of a healthcare sharing ministry, it is an absolute must. We must always remember that the money being spent to share in our eligible medical costs is coming from a fellow member's pocket, not the coffers of a distant monolith. The truth is, if more Americans cared about keeping their healthcare costs down, it could create some accountability within the healthcare industry and drive prices down. The breakdown of the connection between patient and cost is exactly what has created the skyrocketing prices we now experience in this realm!
The first way to shop prices is to call various providers in your area and asking them to give you the cost for your prescribed test or procedure. A couple things to be prepared for: you will likely be put on hold, the call probably will not be short, and you may need to be persistent/firm with whoever you encounter. Because of the nature of healthcare pricing, many representatives don't even know the answer to your question. After all, why would they need to have this information if neither the patient (nor the physician) typically asks about the price?
For self-pay patients (that's you), there are some online tools available to help you navigate costs in your area. One such site is called MD Save, and it allows you to research pricing for a wide range of tests and procedures among participating providers in your area. Once you have selected the location at which you want to undergo your testing or procedure, you prepay for it on the site. You are then provided with a voucher showing you have paid for your procedure along with instructions for scheduling your visit. That's it - no further costs at the provider's office. This may be a great option for some of our members!
As always, the ideas we have shared are just some of the many ways you can go about shopping and determining where to undergo treatment or testing. No matter what, the Sharing Guidelines still apply to any bills you submit for sharing. Keep in mind that, for certain tests and procedures, pre-notification is required in order to ensure members are only undergoing necessary care at the lowest cost possible. Here are two helpful blog posts about pre-notification, known as our Member Stewardship Advisory Program:
The assistance offered through this program is not limited to those procedures that require pre-notification. Representatives are also available to offer assistance for other testing and procedures. You can and should get in touch whenever you are unsure about the cost of your care!
We recognize that what is being asked of you through the shopping and pre-notification process is a massive change from what you might be used to. Whereas you likely used to take your physicians recommendations without any questions, accessing care wherever they directed you, we ask you to actively engage as healthcare consumers and steward the funds of this community as you do. We believe our members are smart and capable of doing this. Even more, we are seeking to live up to our name by giving you the Liberty to decide what is best for you and your families.
We are more than happy to provide the tools for you to exercise true freedom while you pursue health. Please feel free to contact a Member Stewardship Advisory Program representative at 888-604-4337. They will be happy to answer questions and help you find the lowest cost for the care you truly need.