How to Hold Down Specialist Costs

Your health care provider can provide most of the care you and your family need. You may be advised to see a specialist, however, if you have a condition your health care provider can’t treat, such as heart disease or cancer.

Your health care provider will usually refer you to the specialist he or she thinks would be best for you. In fact, many specialists don’t accept patients who haven’t first been examined and referred by a family doctor or internist. This helps ensure only those who really need medical specialists see them.

Even so, depending on the type of health insurance plan you have, you may be involved in the selection of a specialist. If you’re able to choose the doctor yourself, ask your health care provider to help you determine which specialist will be most appropriate, says the American Board of Medical Specialties.

Cost controllers

Fees for specialists are almost always higher than those charged by health care providers, even when the same procedure is performed. Knowing how to find a specialist and work with him or her properly can help control your costs.

Call the member service representative for your health insurance plan to determine if you must select a specialist from its list of in-network providers. Otherwise, it could cost you hundreds or thousands of dollars if you choose a specialist who’s not approved by your plan.

Ask your provider for a list of specialists who are in your area and covered by your plan.

Find out if you need pre-authorization for an office visit or any procedures.

Get organized  

Collect the following information before your visit. Take it with you to your appointment:

• Medical records. Include all medical records for previous treatment for the same or a similar problem. If you don’t have current test results with you, the specialist may require you to have important tests retaken, which could be costly.

• A list of all prescription and nonprescription medications you’re taking.

At the end of your appointment with a specialist, be sure you know when to return for another visit. Ask about any tests you must have and when results from any tests you have had will be available.

If the specialist recommends you have surgery or an expensive or high-risk treatment, get a second opinion before proceeding.