Find Out What Services Cost

You can ask your employer or your plan what your premiums and co-pays are. But what if you need a service that is not covered? Or you see a specialist outside your HMO, without your HMO’s approval, and you have to pay the entire cost? Try to find out costs before you get care. Remember, half of all bankruptcies in California are due to health care costs.

Cost transparency
Some hospitals and providers are making cost information available to the public. This is called cost transparency. However, in many cases, costs are still difficult to get.

Topics on this page

• Ask if the provider accepts your plan’s rates
• Outpatient costs
• Prescription drug costs
• Hospital charges

Ask if the provider accepts your plan’s rates

• Often a plan will set rates for specific services. The doctor or hospital may charge more, but the plan only pays the set rate.
• If you have to pay a percent of a bill, always ask if the provider accepts your health plan’s rates. Otherwise you may be charged even more than you expect.

Outpatient costs

If you are paying for the service, or are paying a percent of the costs, ask the provider’s billing staff what the service will cost. Ask for the cost in writing. Ask if you can save money by paying with cash.

Prescription drug costs

Costs can vary a lot. When a drug is new and is still copyrighted, or patented, the company that sells it can set the price. The company negotiates different prices for different purchasers. When a drug is no longer protected by a patent, other companies can make and sell generic versions of it at a much lower price. Different pharmacies may charge different prices for the same generic drug.

Learn what you can do to save money on prescription drug costs.

If you have prescription drug coverage, your doctor prescribes drugs from your plan’s formulary, a list of preferred drugs. To get a drug that is not on this list you need your plan’s approval. Otherwise you pay the entire cost of the drug.

Hospital charges

What you pay for hospital care depends on your health plan. If you need to pay a percent of the charge, ask your health plan or ask the hospital’s billing department what the charge is likely to be.

Hospitals are required by law to make the prices of common procedures available to the public. You can find some information on the website of a state agency called OSHPD  . You can see data for a particular hospital if you want.

Below are average 2005 charges in California for some common kinds of hospital care. However, the price you would be charged would vary, based on your insurance, the hospital you choose, and other factors:

• Vaginal delivery with no complications: $10,832
• Newborn infant care with no complications: $2,888
• Congestive heart failure $34,908
• Caesarian section with no complications: $20,724

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