Most people accustomed to working within a managed care or preferred provider (PPO) network don't question the quality of their care or the cost of that care. Often they don't know what providers charge until after a surgery when they get the bill.But as healthcare costs skyrocket and layoffs continue, consumer directed health plans (CDHP) and high deductible plans (HDHP) with health savings accounts (HSA) are growing in popularity. You pay less on your premiums, but more when you receive care. More than half of U.S. companies now offer them and that number will grow by eight percent this year, according to Watson Wyatt. Like it or not, at least part of the payment for surgery will be out of your pocket. So you must research cost and care options before they are provided, says Dr. Jeffrey Rice of www.healthcarebluebook.com, a free service that helps people determine fair prices for healthcare in their area. Dr. Rice suggests you follow these five steps to obtain high quality care at a price you can afford. 1. Discuss the cost of care with your doctor. Discuss what you can afford with your doctor. Make sure you tell your doctor if cost is an important consideration for you. This will allow the doctor to help you make good choices that aren't too expensive. Doctors know that treatments won't work if patients can't afford them. Before you agree to have any surgery or procedure you should understand the reasons for it, what will be done, its risks and benefits. Research-based web sites such as the Mayo Clinic, Web MD and Health A to Z offer detailed information on healthcare services explaining the problem, procedure, symptoms, diagnosis, tests, treatments and support resources. Learn as much as you can about your condition so that you can have an informed discussion with your doctor. 2. Be careful of costs leading up to surgery. Make sure you don't receive duplicative or redundant tests. If your primary care doctor refers you to a surgeon, you will need to take copies of your medical records, lab results and imaging studies to the surgeon. If you think you are getting duplicate tests or images, speak up and make sure your surgeon knows about the previous tests. There are often many, many tests that can be performed to diagnose a condition, but don't assume you need to have all of them. Don't be afraid to ask if a test is necessary or if it will make a difference in your diagnosis or treatment decision. For example, there are several different imaging studies to diagnose gall bladder stones. An ultrasound test is typically the single best test to diagnose this condition and usually the least expensive imaging study. 3. Make sure surgery is the best option for you. You should always discuss available treatment options with your doctor. In most cases, you will have several options to consider that may make a big difference in how much your care will cost. Your options for treatment will depend on your situation. Ask your doctor if you need a particular treatment right away or if there are less intense therapies that can be tried first. Sometimes there are low risk alternatives that can be tried before choosing intense medical interventions, such as surgery. For example, there are many different treatments for low back pain, only some of which require surgery. You may want to try rest, medications or physical therapy first. 4. Make sure you get the best type of surgery for your situation and that it's done in the right place. There are often different types of surgery that can be performed for a particular condition. Selecting the best option for you can be better for your care and save you money. For example, if you need a hip replacement, you might get a different procedure or prosthesis depending on your age and your activity level. If you can have laparoscopic surgery instead of a traditional or open surgery, this will often allow you to save money on your procedure. With this option, you will often stay in the hospital for a shorter time and recover and return to work sooner. Selecting the best place for your surgery can save you money. Usually surgery performed at a hospital with an overnight stay will be the most expensive option, followed by out-patient surgery at the hospital and then out-patient surgery at an Ambulatory Surgery Center (ASC). You can ask your doctor what options are available and how they may change the cost of your care. 5. Find a fair price for your surgery. Always ask about the cost of surgery before you get the procedure. The administrative or billing office can let you know what your provider will charge for your treatment. The main parts of your total costs will be from the surgeon, facility and anesthesia fees, so make sure to ask about all three. Web-based resources such as www.healthcarebluebook.com provide pricing information about what a fair price should be for surgery and other healthcare services. The Healthcare Blue Book prices are based upon what insurance companies typically pay doctors, hospitals and others. You may not end up paying the Blue Book price, but if your provider charges a lot more it gives you a starting point for negotiation. You should also call more than one provider to compare prices because they often vary a lot, even among in-network providers. If you don't have insurance, ask if you can get a fixed fee for the procedure (called a case rate). And don't forget to ask for the prices in writing. Then you can compare the prices you agreed upon, with what you are billed. Dr. Jeffrey Rice is CEO of CareOperative, the parent company of HealthcareBlueBook.com. He has over 20 years of clinical, information technology and executive management experience within academic medical institutions, national health plans, disease management organizations and healthcare IT firms. ********** Published: February 27, 2009 - Volume 7 - Issue 45