Whether you are going to a hospital emergency room, a doctor’s office, or a medical imaging facility for x-rays or scans, you will first be presented with  an all in one  form for your signature , often on an electronic pad,   that solicits all at once both your consent to  treatment and more importantly your consent to pay all costs associated with the treatment   which are not covered by your insurer, or if you are uninsured, to be paid by you alone. Do not sign this form. Instead, bring with you, or write out any available sheet of paper, the following one sentence  statement: “I consent to appropriate treatment and (including applicable insurance payments if any) to be responsible for reasonable charges  up to  but not more than  two times the Medicare rate .” This language is recommended by  Quizzify, a health care literacy/education  company (www.quizzify.com), for all patients outside of Medicare or  Medicaid  who must  navigate the private sector healthcare market.  Take a picture of this  statement after signing it and before handing it over to the clerk at the reception desk. If the hospital personnel balk at your form, then remind them that federal law requires hospitals to provide emergency care to patients who need it whether or not they sign the hospital ‘s financial consent form, which hospitals try as explained above to bundle in with that   consent form. All that you are required to consent to is appropriate treatment, and you are doing that with your own form without agreeing to take responsibility for any and all charges you might receive which might expose  your wallet to unlimited plunder .By using your own form as recommended here, you are, in legal terms, entering into an open ended contract in which no price has been  agreed upon before treatment . Your ER medical  provider and/or the  clerk at the ER reception desk  would be unable in any event  to tell you before examination and diagnosis what those costs are . In the case of open ended contracts such as you have, which are agreements that do not specify an exact price, the Uniform Commercial Code dictates that costs when articulated after contract signing  must meet the standard of being  “fair and reasonable”. Medicare payment schedules constitute the gold standard for fair pricing.  If the ER bill that you later receive comes in at an exorbitant  price which you dispute, you will be able to show in court or to an arbitrator or to any debt collector who pursues you  that you made a  reasonable offer of payment at the very beginning  of your interaction with your provider via  this customized  “homemade” authorization .    Even if you are forced to sign the hospital form before ER treatment, in the remote possibility that ignorant hospital personnel threaten to withhold treatment unless you sign their form, you preserve your right to  argue later than you signed it unwillingly, under duress when you were too ill to do otherwise . Any contract that you are thus forced to sign is called a contract of adhesion and if you raise that adhesion  issue defensively  against any subsequent medical bill collectors,  no court will award judgment for that  debt collection, provided you observe all the bill collection dispute deadlines detailed elsewhere on this website.   

What is a fair price for the medical services you received?

Medicare Pricing   

Medicare, the government’s insurance plan for people disabled or 65 or older, sets prices for the services it funds. These  prices are typically much lower than what either an uninsured person is charged, or what a commercial health insurance company negotiates in the private sector of the economy. Medicare prices create a clear benchmark for a fair price we should be willing to pay. Even if you agree to pay up to twice the Medicare rate it’s a good deal compared with how much hospitals and doctors would otherwise charge. The commercial health plans that cover most Americans below the age of Medicare eligibility unfortunately allow hospitals, doctors and other medical industry vendors to charge their insureds anywhere from two  to ten times more than Medicare prices.  

We discourage other forms of age discrimination in this country but regrettably this form of discrimination has become  the norm  in the private sector health care market which covers most Americans of working age and their families. It would be as if McDonalds sold Big Mac’s for $4 to anyone over age  65 but from $8 to $45 for everyone else.

There is no reason why  you should have to pay more than Medicare would pay for the same service just because of your age. Discrimination is wrong, and you should challenge it in health care pricing as in other venues where it might appear. You can do this by finding what Medicare pays for the particular service you received. When you have the Medicare price in hand you acquire leverage to ask for a better deal and this could be essential if you are uninsured or have a high deductible insurance plan.

How do you get the Medicare price? It is easy if your servicing hospital posts on its website the prices it receives from Medicare  for  your particular procedure. If not, you can go to the official Medicare website and download the Procedure Price Lookup Comparison File. That is an Excel spreadsheet that provides the national average total payment that Medicare makes for almost four thousand services and procedures in ambulatory surgical centers and hospital outpatient departments. The prices would be an estimate of what Medicare would pay in your area because the actual Medicare payments are adjusted for labor costs and other region specific factors in your part of the country.

You can also use the Medicare outpatient procedure cost lookup tool. Type in the name of the procedure or its billing code to see the total cost paid by Medicare. For example, a colonoscopy price is listed at $715 at an ambulatory surgical center and at $1212 at a hospital outpatient department. Again, these are national averages so the Medicare price may be higher or lower in your region.

Since the Medicare rates obtained through its website only provide an approximation of what the federal government health plan would pay for a particular service at your local facility in your region of the country, you should ask your hospital or outpatient facility to tell you as they are legally obliged to do exactly what price  they get from Medicare for your procedure. Then tell them you want to pay the same price unless you have a lower copay or deductible under your particular insurance plan .     

Additional Fair Price Guidelines  

Here are some additional tools to help you find the best available prices for medical services and procedures. The websites FairHealthConsumer.org and HealthcareBluebook.com give price estimates for a test or procedure in the non Medicare healthcare market in your region. Your doctor should be able to give you a clear description of what they are ordering, and their billing department should be able to give you the billing code associated with it so you can make an accurate price comparison among whatever facilities in your area offer that test or procedure. If it is a service by a doctor or an outpatient facility, such as a walk in clinic or a surgery center, you should receive a CPT code that describes what you need. If it is a hospital procedure that requires an overnight stay , you might receive a ICD to PCS code.

FairHealth Consumer (www.fairhealthconsumer.org)  gives an estimated price based on the negotiated and out of network rates of insurers that cover that area. If you are uninsured, you should expect the initial asking price to be the out of network estimate. However it is important to remember that all prices are negotiable.  Again, the cash paying patient can often get a better deal than an insured patient because doctors and hospitals do not have to bill and wait for an insurance company to process and send a check.    

Healthcare Bluebook (www.healthcarebluebook.com)  price estimates are based on what others outside the Medicare sector have actually paid for these services , so it is a good benchmark for what would you might expect to pay.     

Neither website might list the precise procedure you are looking for or be available in your location, but they should cumulatively give you an approximate  estimate of what a fair price should be.

We should  be able to get many price estimates from hospital websites. Hospitals and insurance plans are now legally required to provide prices and cost sharing information to patients for common procedures but due to the insignificant  financial penalty compliance has been uneven.  However you have a  legal right to demand the price information even if it is not conveniently posted online by your provider. Compare all the nearby hospitals in your area because one or more  may offer cheaper prices for the same types of treatment than the hospital  to whom you have been referred.