A Doctor Referral May Cost You More

When a Doctor Referral is Not in Your Best Interest

If you are like most people, you follow your doctor’s recommendations when it comes to referrals. Your doctor hands you a card with the contact information of the specialist and suggests you make an appointment. In most cases, you view this referral as a courtesy because it saves you time.

Think again. The healthcare industry is a $3.5 trillion business, and that convenient doctor referral may be contributing to the healthcare cost burden. It’s time to start asking questions about why your doctor is referring you to a specific physician or facility.

According to The Wall Street Journal article, “The Hidden System That Explains How Your Doctor Makes Referrals,” many doctors employed by hospital systems feel pressured to refer patients to other physicians in their hospital system, even if the patient may benefit more from a physician outside the system.

Because many primary care physicians work at hospital-owned practices, they are expected to refer patients to physicians within their hospital group. These in-house doctor referrals often mean patients will be scheduling their procedures at hospitals or hospital outpatient departments (HOPD), which may be much more expensive than independent ambulatory surgery centers (ASC).

How to Shop For Healthcare

You can shop for affordable, quality healthcare in the same way you shop for an appliance or car. When your doctor refers you to a specialist for a procedure like a colonoscopy or an upper endoscopy, ask why he or she recommends that physician or facility and request an estimate of costs. Before you leave the doctor’s office, get the procedure code for the procedure or screening so you can begin your own research.

Websites like HealthcareBluebook.com and Medicare.gov Procedure Price Lookup Tool (for Medicare patients) provide helpful information like the national average cost for common procedures, often comparing hospital rates against independent facilities like ambulatory surgery centers (ASCs). You can also ask friends and family members for recommendations or read online reviews and testimonials.

Location, Location, Location

You can save as much 40 percent on a procedure at an independent ASC compared to hospital rates for the same procedure. Preventive procedures are often covered at 100 percent for insured, eligible patients at most independent ASCs, and diagnostic procedures are a fraction of the cost charged by hospitals.

For example, the nationwide, average cost of a colonoscopy is $1,711 at an independent ASC compared to $2,750 at a hospital.*

Besides being more affordable, ASCs offer advantages including:

  • Transparent pricing
  • Curbside drop off and pick up
  • Convenient parking
  • Shorter wait time
  • Top-ranked industry accreditations and certifications for safety and quality

Save on Your Next GI Procedure

A 2015 study found 80 percent of patients want to talk to their physicians about healthcare costs, but 72 percent say they have never broached the subject. The next time your doctor refers you to a physician or a facility, don’t be afraid to ask, “Why?” A doctor referral is just that – a referral, not a requirement.

*National average from HealthcareBluebook 2018. Rates vary by geography and procedure code.