As you shop around for health care and dental services, you may notice that the cost for these services vary by zip code. What one dentist would charge in one area for the exact same services, may be more or less what a dentist would charge in another area. What one hospital charges for services may be charged differently by another hospital.
In this article, we explore why costs vary by zip code.
Demand and the Cost of Living
Location can mean everything. Many reasons can factor into why a residential area can be more expensive compared to others. Here are just a few:
The cost of living can be more expensive in certain cities compared to others (think Beverly Hills, California vs. San Antonio, Texas). Providing health or dental care may be more expensive because the property the office is built on is expensive, too. This can work the other way as well.
Population density: there may be more dentists/physicians per resident in well-populated areas, or just a few available in small towns. While health care providers may charge what is reasonable for their residents, they may charge slightly higher if there are too many patients that need their services.
Demand may be high: the health of a town’s population is a major factor. An unhealthy population would require more health care services, which could raise the costs of services for everyone. (Top 5 most expensive health care markets.)
The type of care available in your area. Hospitals and providers who specialize in a specific area of medicine or dentistry may require state-of-the-art technology, may be located in a more expensive area, or may just be high in demand. It all depends what is available in your area.
What’s your doctor’s specialty? Specialists are health care providers or dentists that focus on treating one specific disease, illness, or region of your body. Services by a specialist may cost more because the treatment that is required may be more involved. Your treatment may require the use of specialized software or technology, the use of an operating room, surgery, anesthesia, chemotherapy, etc.
General Dentists and General Physicians on the other hand focus on your whole being and on preventive care. This may work for your basic health needs, yet if your health changes, like expecting a baby, there may be a time when your health requires a specialist.
In most cases, your General Dentist or Physician will refer you to a specialist.
How can I save money?
There are several things you can do to save money:
If you can, use a PPO Network Provider. One easy way to save on your out-of-pocket costs is to select a provider in the BEST Life PPO network. Providers who participate in a BEST Life PPO network have agreed to accept a discounted rate for their services. Using a PPO Network Provider can save you anywhere from 5% up to 57%, depending on the service. Our networks include general practitioners and specialists.
If you are on a medical plan, BEST Life offers a regional network specializing in providing care in your area, and PHCS Healthy Directions for services outside your area.
Please note that the PHCS Healthy Directions secondary network is not available to PHCS members. These members already use one of the largest national networks in the country. PHCS Healthy Directions is available to Utah Beech Street members outside of Utah only.
Dental plan members have the option of using DenteMax (one of the largest national networks in the country) or, depending on their state and plan, a regional network. While BEST Life selects regional networks for the concentrated number of access points offered in a state, there may be situations where the DenteMax network can provide the needed extra access.
Some areas of a state may have more providers participating in DenteMax’s network; a member who is traveling may need emergency care; or a member’s child is going to college in another state where the regional network is not offered. In all these examples, members can select a DenteMax provider and still save on their out-of-pocket costs.
Regardless of which network you use, always call the network provider and confirm that he or she is in the network before setting up an appointment.
Always try to use your “In-Network Benefits”. If you are on a medical or dental PPO plan, going in-network will provide you with more coverage. Your plan may cover a percentage more, you may have a lower co-pay or lower deductible, and in some cases preventive care may be covered 100%.
Your Certificate of Insurance or Schedule of Benefits will provide you with the benefits and explain how your in-network benefits work. Or, if you need assistance, you may contact our Customer Service Department and they can explain how your plan works. Contact Customer Service at 1-800-433-0088 or at firstname.lastname@example.org.
Shop around. The great thing about PPO and Indemnity plans is the freedom they give you to choose any medical or dental provider. Now that you are aware of why health care costs may vary, shop around when you can. If you are unhappy with the quality or cost of the service you received, you may select another provider at any time.
Keep in mind that a high price does not always equate to high quality. Studies have shown that quality is not always the main factor driving costs. For example, an Urgent Care Unit may not be the same as a hospital, but may provide less expensive and just as effective treatment for certain illnesses. (Read the Dartmouth Institute’s Study: Health Care Spending, Quality and Outcomes: More Isn’t Always Better.)
BEST Life lists a few non-affiliated websites you can go to for pricing (Treatment Cost Calculators), or you can always rely on recommendations from friends or from your favorite dentist or physician.
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