Ask:
How will this procedure (blood test, x-ray, surgery, exam) change my treatment or improve my outcome?

There is widespread agreement among researchers and doctors that many common procedures are unnecessary, including services that lack evidence that they produce better health outcomes compared to less-expensive alternatives. In fact, spending on unnecessary procedures has been estimated at 15 percent of total healthcare spending.

Resources:

• 5 Questions to Ask Your Doctor Before Any Test, Treatment, or Procedure (wallet card)
• Choosing Wisely – Consumer Reports materials describing some of these unnecessary procedures. There’s even an App! 

Ask:
How much will this procedure cost?

Unwarranted price variation for medical services is well documented. Chances are the doctor will not know how much a recommended procedure will cost.  But it is important for your doctor to know about cost constraints you may face. There is growing recognition that doctors should be more aware of patient costs.

Resources:

• Tips for talking to your doctor about costs

• If you’re insured, check your plan’s website for pricing tools. If you can’t find helpful resources, let the plan know!

• These sites show “typical” pricing and they’re available to anyone: FAIR Health, Healthcare Blue Book. A few states, like Minnesota and New Hampshire, have pricing tools available to general public.

• If you’re uninsured or face a large deductible before your insurance kicks in, tell the provider offering the service.  They are often willing to negotiate a discount off their usual rates. Even hospitals will do this!

Ask:
Where will the procedure be performed?

The fees you face may be very different depending on whether it isat the hospital, at a surgery center or the office. And some offices are actually part of the local hospital leading to surprise and expensive “facility fees”!

Resources:

• It’s hard for patients to research which offices charge facility fees (Better see public actions below)

• (Unless you live in Connecticut which requires all hospitals and their physician groups to notify patients about facility fee charges.)

 At the Pharmacy or Lab 

Ask:
Are there cheaper alternatives that are equally good, or nearly so?

Surprisingly, you may have a brand drug prescribed when an equally good and cheaper generic is available.  Also, pharmacists are sometimes prevented from volunteering these options. Be sure to ask!

Resources:

• Five Hacks to Lower Rx Costs from Consumer Reports

• GoodRx.com to compare prices

If you are referred to other doctors or the hospital 

Ask:
Who else will be involved in my treatment? 

Will I be getting a separate bill from another provider? Can you recommend someone in my insurance network?

Surprise medical bills from providers who aren’t part of your insurance network are astonishingly prevalent…and expensive.

Resources:

• How to Beat a Surprise Medical Bill by Consumer Reports

• On Medical Financial Consent Forms: indicate that you are willing to consent to the financial cost so long as providers are in network

During a hospital stay 

• Decline a private a room

• Keep a log of what happens and identify and write down the people who come by your bedside, or ask a family member to do so.

• Hospital Safety: Hospitals sometimes fail to take basic precautions to keep patients safe during their stay.

• Hospital Safety: Use this checklist from the Johns Hopkins Armstrong Institute for Patient Safety and Quality to help keep yourself safe in the hospital.

When you get your bill

• Get an itemization to see if what they say was done really was done to you. Bills often contain errors or improper “up coding.”

• Appeal coverage denials. You have a right of appeal coverage denials that don’t comport with your understanding of how your health plan works. 

• Negotiate. Providers will often negotiate or may offer discounts to low-income patients. Even hospitals will do this. Ask! And if your bill contains charges from a surprise out-of-network provider, fight back and complain to your insurance regulator.

• Find a medical billing patient advocate if you need help.

Resources:

• Some states, including Connecticut, Rhode Island and California, have offices staffed by healthcare advocates.

• The nonprofit group, National Patient Advocate Foundation, provides case management free of charge. 

Surprise Medical Bills

Background on this issue:

Surprise medical bills occur when patients cannot avoid being treated by providers outside their health plan's contracted network. For example, the hospital is in-network but the anesthesiologist or emergency department doctor is out of network.

• Definition and resources

• Video spoof using pizza analogy

Take Action:

Consumer Reports’ Campaign on Surprise Medical Bills (share your story and find out what’s happening in your state)

Vox's Sarah Kliff launched The Problem is the Prices project, which seeks consumer stories about hidden ER facility fees

Patient Safety in the Hospital

Background on this issue:

While many hospitals are good at keeping their patients safe, some hospitals aren’t. As many as 440,000 people die every year from preventable errors in hospitals.

• Hub taxonomy of Medical Harm

• Hub Medical Harm Infographic

Take Action:

Consumer Reports’ Safe Patient Project (share your story take and action, and find out what’s happening in your state)

Affordability of Drugs

Background on this issue:

prescription drug costs have been rising faster than inflation for years—especially brand-name and specialty drugs. Patients suffer from poor outcomes when they can’t comply with their doctor’s recommendations due to concerns about costs.

• Hub Primer on Drug Cost Drivers

Take Action:

Patients for Affordable Drugs is an independent group where you can share your story and see proposed solutions.

You can also share your drug price story at Consumer Reports. 

Hospital Not Meeting the Needs of Local Community

Background on this issue:

The majority of hospitals in the U.S. are nonprofit or tax-exempt. To keep this status the facilities must demonstrate their benefit to the communities they serve.

• Community Benefit and Community Engagement: Basic Facts and Terms

Take Action:

The Hospital Accountability Project is a project of the independent consumer group Community Catalyst. Here you can learn how to get involved with local hospital to address unmet community needs. 

Lack of Price Transparency 

Background on this issue:

Many consumers face high deductibles or are uninsured, thus facing the full price of the medical service. It is critical yet very difficult to learn the cost of care before it is delivered. 

Take Action:

Crowd source the prices you encountered at ClearHealthCosts.com