Some doctors agree to keep insurance rates “confidential”, so who can tell you your cost of care?

Reporter: Lauren Sweeney
Published: Updated:

It’s a simple question.

“What is this going to cost?”

But a WINK News experiment found it’s really difficult to get the answer by calling a doctor’s office.

WINK News called five primary care and three specialty practices to try to find out what an office visit would cost based on the terms of specific insurance plans. We were attempting to compare the cost for a Blue cross customer, a Cigna customer, and a self-pay patient.

But only one office was able to quote these prices for the three.

All the others said we’d have to contact our insurance companies to get the information.

Tiffany Drake, a billing supervisor at a large orthopedic practice in Fort Myers, said doctors are not setting the price the patient will pay.

“The provider and the insurance companies negotiate a contract and a rate that they’ll agree on and that’s the max the provider is allowed to bill for the patient,” said Drake.

Confidentiality clauses are sometimes at play in those contracts.

Two large physician groups told WINK News that their contracts with insurance companies restrict the release of the negotiated rates to non-patients.

In fact, we were told several times during our experiment that we’d have to establish as a patient before we could actually get an idea of the cost based on our insurance plan.

Another problem at play could have been getting the right person on the phone to answer the question. We spent a lot of time on hold and being transferred around.

Drake said there is heavy turnover in the medical billing industry and finding the person who has all the information you need could be difficult.

She recommended to always ask for the central billing office.

But even when we did ask for billing, we were often told that they didn’t have a list of prices for insurance plans.

We found the same to be true when calling insurance companies to find the information. One company was able to provide pricing information for specific physicians over the phone.

But another said we’d been connected to a call center and she didn’t have the information.

A representative for that insurance company later said that we had selected the wrong number on the phone menu, and we should have been transferred to the appropriate department to answer our question.

So what did we learn?

Call your insurance company first and ask what specific physicians are allowed to charge for specific procedures. If you can’t seem to get the correct person on the phone through the insurance company, try your member portal or website. Both Blue Cross and Cigna recommend their members utilize these sites.

Doctors offices can give you the self-pay price and everyone we called was able to provide that with no problem.

Both Lee Health and Millennium Physician Group provided their direct central billing phone numbers for potential patients who want to get cost estimations upfront:

Lee Health: 239-424-1500

Millennium Physician Group: 1-877-856-3774

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