Tips to save money on specialist visits

…or mistakes I wish I hadn’t made

We are entering a new era in health insurance coverage and paying for health care. Kind of.

More people will have an opportunity to buy insurance through the new exchanges. However, we will also be expected to pay much more towards our care through considerably higher deductibles and co-pays.

And I suspect this is a trend that will spread to more and more insurance plans in the near future.

My family’s new deductible will be about $10,000, so I will be more motivated than ever to limit my health care expenses. But we’ve always had a high-deductible plan (just not this high), and I’m always learning from my past mistakes in paying for unnecessary care.

Most recently, those lessons learned came from a trip to a specialist’s office.

Insurance companies will discourage specialist visits

Insurance companies use co-pays, or cash payments at the time of service, to try to keep us from visiting our doctors too frequently, especially the specialists. A typical co-pay for a primary care doctor is about $10-30; for a specialist, $45-60.

Some new insurance plans will also demand prior authorization or pre-approval before you can see a specialist.

Insurance companies tried this in the late 1980s and early 1990s. As a nurse, I spent a lot of time on the phone trying to get approvals for various visits, tests and surgeries. Patients hated it, doctors hated it (I hated it), and eventually most insurance companies went back to allowing patients to see whoever they wanted, whenever they wanted.

I think this time around the reality of high health care costs will trump what the patient wants.

And that’s actually OK with me. Specialist visits are expensive, and to save money I would rather not see one if I didn’t absolutely have to.

Which leads me back to my last expensive (and ultimately unnecessary) trip to see a specialist.

What I would do differently to save money

Several months earlier, I had noticed a small nodule on the back of my throat. It first appeared after a nasty sore throat and sinus infection, so I assumed it was related.

After three months, when it was still there, I decided I should be prudent and get it checked out by my doctor. She looked at my throat and nose and ears, and said although she didn’t think it was anything to worry about, she wanted me to make an appointment with an Ear, Nose and Throat, or ENT, doctor.

First Mistake: I should have asked, “Is that really necessary? I have a huge deductible. What about my coming back in another three months?” Chances are good she would have gone along with that plan. Often doctors recommend a specialist because they think it is what the patient wants.

But I didn’t question her, and I called the ENT’s office to make an appointment.

I was told I would need to schedule a hearing test with the audiologist prior to the exam with the doctor. This was how his office worked, and he would need this information for a complete exam. It was in my best interest, the receptionist explained, because then I wouldn’t need to come back on another day.

Second Mistake: I should have questioned the necessity of the test. I wasn’t being seen for a hearing problem. I should have asked that an exception be made, said that I was willing to come back another day if the doctor convinced me a hearing test was necessary.

I did push back a little, but the receptionist stood firm. So I went ahead and scheduled the hearing test. “Fine,” I thought. “At least I will get a thorough check up of my ears, sinuses and throat.”

Third mistake: I should have called my doctor back and asked for a referral to another specialist, one who didn’t insist on extra tests of questionable necessity before my exam.

Instead, I kept my appointments with both the audiologist and the ENT.

Not surprisingly, my hearing was perfect.

Then I saw the ENT.

“You’re here about your left ear?” he asked.

“No,” I said, slightly confused. “I have a small nodule at the back of my throat.”

“Hmm, the note I got from your doctor mentioned the throat nodule, but she was more concerned about how your ear drum looked.”

Really? She hadn’t mentioned this to me.

Fourth mistake: Before making the appointment, I should have questioned my doctor more closely about the reason for my referral. Obviously, she left me out of the loop. But at least that explained the audiologist.

The ENT looked briefly at the nodule in my throat and told me it was just lymphatic tissue and nothing to be concerned about. He also looked in my ears and said they looked just fine.

He took less than five minutes to tell me I had nothing wrong–with my throat or ears.

Total cost? $614.00. Initial doctor visit $128.00; hearing test $161.00; ENT $325.00.

Frugal Nurse tips to save money

  • See your primary care provider (PCP) first.
  • Don’t insist on a specialist. (If you don’t trust your PCP, find another one.)
  • Ask about options, such as watchful waiting, rather than seeing a specialist.
  • Let your PCP know if a co-pay and/or high deductible is involved. Everyone’s insurance is different, and your PCP might not realize your out-of-pocket costs are high.
  • When scheduling an appointment with a specialist, be very clear about the reason. If there seems to be some confusion (like scheduling a hearing test when you don’t have a hearing problem!), call your PCP back for clarification.
  • Your PCP knows more than one specialist. If you feel the specialist’s office is being unreasonable about scheduling you for extra tests, ask your PCP for another name. Different offices do things differently, and some doctors are more sensitive to patients’ concerns about costs.
  • Specialists in large clinics with their own labs and x-ray departments tend to order more tests.  When you schedule an appointment, let them know if you have your own recent test results. Don’t be pushed into repeating tests just because the doctor wants to use his or her own equipment and staff. (Yes, that happens! Labs and x-ray departments are expensive and need to be kept busy.)

Most specialists’ offices are set up to maximize their convenience and profit. Fair enough, medicine (unfortunately) is a business. But don’t let their office procedures maximize your inconvenience and costs.


Frugal Nurse

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Tips to save money on specialist visits — 8 Comments

  1. Thanks for this! Wish I had read it 3 months ago before I got slapped for a bill of $436 for a consultation with an ENT. Thank goodness I wised up and cancelled a separate hearing test and cancelled a CT scan, b/c I couldn’t get the imaging center to give me a straight answer on the cost of that… it could have been worse, but also could have been better if I had read these good tips ahead of time. Thanks for sharing!

    • Hi, Anna! Live and learn, right? Too bad these kinds of mistakes are so costly. Keep pushing back against needless testing and non-transparent costs–eventually they will have to listen to us consumers, I hope. Cheers, FN

  2. I really like the advice, especially the recommendation to cross check diagnosis before deciding on expensive tests. Sometimes these tests are necessary, however, you don’t want to pay the money if you don’t have to. I also have a lump on the back of my throat I need to get checked out and will be sure to see multiple professionals.

    • Hi Esther, thanks for the nice comment. Take care and I hope you get the answers you need at a reasonable price! FN

  3. Greed is the root of all evil. Sickens me knowing the way our health system has evolved, into a greedy profit mongering business! Government feeds us poison through food and vaccines which in turn sends us to the doctor so they can take our dollar and convince everyone that we cant live without them. This world needs a makeover and fast!