By Dr. Michael Jacobson, D.O., M.P.H., CHM Medical Director
*Editor’s note: This information was published in the April 2023 issue of Heartfelt Magazine, CHM’s monthly magazine that provides CHM membership-related tips and tricks, medical advice from doctors, testimonies from CHM members, and more. Please refer to the CHM Guidelines and applicable web pages for the most up-to-date information regarding CHM membership, sharing eligibility, and ministry news.*
For most Americans, healthcare costs are rising progressively faster than inflation and even faster than an increase in earnings. This means it’s taking a larger portion of dollars and leaves average Americans with less financial flexibility.
I recently had the privilege to speak with Kevin Summers, a Provider Relations specialist at CHM, to discuss how we can combat these issues and save money on healthcare.
Medical bills
Dr. Jacobson: Today's topic is extremely timely considering what many of our members are experiencing in the marketplace. Kevin, how do you know if you’re getting fair pricing on your medical bill?
Kevin: Comparing CPT codes (or descriptions of service) helps you know that you’re getting fair pricing. The CPT code provides transparency, since it displays what providers are charging for their services. Here are some great resources for comparing services:
Dr. Jacobson: What tools are available to us to help us get the best healthcare prices?
Kevin: The most important tool is the CPT code. By using CPT codes, you and CHM can know exactly what procedure was done, even if it’s an office visit. The code tells what rate is charged, which is why it’s important to get those codes!
Dr. Jacobson: Is there a national standard or benchmark for a fair price?
Kevin: Yes, there is! That’s set up by the CMS and it’s the Medicare baseline you can view online. All you’ll need to do is enter the CPT code for the procedure. It’s a tool that gives you the opportunity to price check and compare offerings across your area or across multiple providers.
Cost cutting
Dr. Jacobson: Since we’re talking about cost cutting, what three tips would you recommend for reducing healthcare costs?
Kevin: Great question! First, understand the cost in advance by getting the CPT codes, as well as a price estimate from the provider before the services have been performed. Next, do research and shop around to compare those prices with different providers in your area. Lastly, consider asking your doctor if they have privileges at an ambulatory surgery center. Often, those facilities not only have better quality, but they’re typically a lower price.
Dr. Jacobson: What if my provider doesn’t offer discounts?
Kevin: Many providers should at least offer a self-pay discount. If your provider doesn’t offer a discount, I’d be concerned about that because it’s routine for them to reduce and discount charges. Call us and we’ll be happy to talk through that situation with you.
Dr. Jacobson: One last question: How do you know if you’re getting high-quality care?
Kevin: First of all, I wouldn’t base the quality strictly on price itself, because a high price doesn’t equal high quality. Neither does low cost mean low quality. That’s actually a huge misconception in the healthcare arena.
There are innovators in the marketplace equipping people with the ability to search prices on their websites, and they often include bundled prices for surgical procedures that can be done at a particular facility. This allows you to see upfront what the cost will be, which will help you avoid all of the after-billing that often takes place.
Dr. Jacobson: I affirm that as well! Higher price doesn’t automatically mean you’ll be getting higher quality care. One of the best resources members can have is a well-connected family physician in their community who they can consult with as to what facilities get the best outcomes.
There’s also a new concept in the marketplace called nurse navigation. These navigators have access to those quality outcomes and can tell who’s actually getting the best care based upon the available data. That’s exactly how our new maternity education equips members here at CHM.
Thanks for your time Kevin!
