Ask a nurse

The five most common health care cost questions people ask Carolyn Espinoza, RN, a nurse case manager for Regence BlueCross BlueShield of Oregon:

1. Why is what I’m being charged this time for a procedure, medication, or other service, different than what I was charged at another time for the same thing? Health care costs, in general, have been steadily increasing for years, so if you are comparing current bills with bills from several years ago, inflation could be a factor.Changes in coverage, especially if you changed plans altogether can also influence what you are charged. Deductibles and co-insurance amounts usually start over every year, so if the last time you were charged you were at a different point in meeting those amounts, what you owe now would be different.

   Lastly, sometimes providers will send a bill even if your insurance hasn’t yet processed a claim; usually these include a note that they are waiting for insurance.  So it’s possible that the next month they will send a bill that shows you owe a very different amount.

2. How can I make my medication regimen less costly for myself?A good place to start is talking with your prescribing physician. Providers may not always take pricing into consideration as the write a prescription, especially since they may not have access to specific information about how your insurance plan is structured. It may be possible to find a medication that works exactly the same as the one your provider initially prescribed.Having that conversation with your provider will let you make an informed decision about what treatments will be best for you.

   Reviewing your insurance coverage may also be helpful, since some plans are written in such a way that the first fill or two of a medication may be at a higher cost compared to later in the year when you start to meet deductibles and other out-of-pocket amounts.

3.  Will it really cost me significantly more to use an out-of-network provider instead of a provider who is in-network?It depends. Some insurance plans have no coverage at all for out-of-network providers, so the entire bill will then be your responsibility.Even with plans that pay a portion of charges for out-of-network providers, without a contract setting limits on what a member can be charged, an out-of-network provider can bill any amount they choose. They can also bill their patients for anything that the insurance doesn’t pay. These charges can be thousands of dollars more than a person’s out-of-pocket maximum on their insurance plan, might be difficult to predict, and sometimes are nearly impossible to negotiate downward after services have already been provided.
4. What can I do if I receive a medical bill I can’t immediately afford to pay?First check to make sure your insurance plan has paid their portion. Sometimes providers will send out a monthly bill to all their patients, even when they know that the insurance plan needs to pay first.If your insurance has paid, or if it seems like they should have paid, it’s best to start making some phone calls. You might need to talk with your insurance company to see whether there’s anything you need to do, such as submit information to them about other coverages or lack thereof, so that your claims can finish processing. You might also consider calling the provider sending the bill to discuss making partial payments or to see whether they have financial assistance programs you can apply for.

   Sometimes there aren’t financial assistance programs available for health care. But there might be other community resource programs, such as utility bill assistance, that a person might be able to access that would free up some of their money to pay off medical bills.

5. How can I make sure I’m using my available medical benefits efficiently, especially if I’m expecting a complicated treatment course in the near future, or if my treatment team is telling me that there is more than one type of benefit I could be accessing and that it’s up to me which one I’d like to use?This is a tough question because every situation is as unique as the individual involved. If you’re feeling overwhelmed by health care choices or feel like you need to talk through your options with someone experienced in navigating the health care system, this is a great time to call your health insurance company to ask what resources they offer. Case management may be exactly what you need.