Maybe this has happened to you: Your doctor is talking to you about your health, saying you need a test or a medication, and suddenly your brain leaps to a question that has nothing to do with your medical needs:
How much is this going to cost?
Health care in America is too expensive. According to a Gallup poll released this month, about one-third of Americans, equivalent to more than 82 million people, said that they had cut back on other expenses — groceries, gas, even utilities — in order to afford medical services. According to KFF, 36 percent of Americans say they have put off medical care in the past 12 months due to the costs.
So of course many of us think about money in those moments. It would be nice if your provider, the person tasked with looking out for your well-being, could be an ally in navigating the complex web of insurance benefits, prior authorization, and prescription drug formularies that ultimately determine how much you pay for medical care.
But unfortunately, while Americans wish they were having these conversations with their physician, many of them aren't. A 2024 survey of 1,500 people who have cancer or autoimmune conditions found that 62 percent said they wanted to have a cost discussion — but only 32 percent of them had. In a 2023 survey of 1,000 US adults, 41 percent said their doctor never brought up the financial side of their care.
The unavoidable reality is, we each have to act as our own advocate when it comes to our health. If our provider isn't bringing it up, we need to. But that can be intimidating: Many of us already fear being judged by a physician. I've certainly felt that way. Here's a secret: Even doctors feel that way sometimes when they are the patient.
"I have found health care billing in my own experience to be inconsistent and to be surprising and to be shrouded in a lot of mysteries," Dr. Cailly Howell-McLean, a Toledo pediatrician and member of the American Academy of Pediatrics, told me. "So I can't imagine for someone who is not in that kind of role that I am."
To help people with how they can approach those tough talks, I spoke to two doctors — Howell-McLean and Dr. Sarah Nosal, president of the American Academy of Family Physicians — to get their advice.
Here's what I learned.
When in doubt, ask
Here's one assumption I had: There might be some times when it doesn't make sense to ask your doctor about finances. But that's really the wrong way to think about it. As both Howell-McLean and Nosal put it to me, the doctor can't help you if they don't know there's a problem.
"At the end of the day, as providers, we can't assist with concerns we aren't aware of," Howell-McLean said. "So err on the side of bringing it up. And if it's not something your doctor can help you with, they'll tell you that. But better to ask."
Many clinics have staff dedicated to handling billing or financing questions. If nothing else, your doctor will be able to connect you with those people — but, again, you have to ask.
"None of us are perfect as humans or doctors. I have definitely had patients where I only found out that they didn't get a medication because of cost when their, for instance, diabetes was out of control," Nosal said. "And I feel so bad that I didn't explain to them that they can get in touch with us."
Ask your doctor direct questions when you're in the room with them
Some of the questions you'll need to ask will partly depend on your own circumstances: your insurance coverage, your medical needs, your overall financial situation. One question to ask before you ever step foot inside the doctor's office: Are you in my health insurance plan's provider network? What about the blood or imaging labs you work with?
Then when you're seeing a doctor and they are proposing new treatment — a scan, a specialist visit, a new medication — there are some stock questions that are usually worth asking:
- Is this likely to be expensive?
- What are the risks of not doing this?
- If this is not covered by my insurance, what do next steps look like? Are there lower-cost options?
- Could we wait and follow up soon to see if treatment is really needed?
If your prescriptions are surprisingly expensive, don't just let it go
Every time you get a new prescription, Nosal said you should ask about a generic version of the drug. Doctors may write you a prescription for the brand-name version without thinking about it, while there is a cheaper generic available that can save you a chunk of money.
If you get to the pharmacy and discover a prescription is more expensive than you expected, don't just let it go. Call your doctor.
You can also ask your provider to try to make your life easier in other ways. Howell-McLean singled out albuterol, the asthma inhaler medication, as one drug that she tries to assist patients with. Insurers limit the prescription to one per month, but it can be helpful to have multiple inhalers (one at school, one at home; one at mom's house, one at dad's house).
To make things simpler for her patients, she will simultaneously write one prescription for the current month and another for the following month during one visit. That way, her patients can get what they need without the hassle of having to get back in touch with their physician.
There's a good chance your provider will have ideas like this that will make your life easier and save you money, and the best way to know for certain is to ask them.
If you're not sure how to start, focus on how the costs affect your health
In an ideal world, your doctor would proactively bring up the cost of your care or, at the least, take an active interest if you bring it up. But we do not live in an ideal world and sometimes, even if you try to initiate a cost conversation with your doctor, they might seem uninterested or reluctant to engage. What do you do then?
First, you might have better luck getting your doctor's help if you frame the question around your medical care, Nosal told me, rather than strictly finances. So instead of saying you don't think you can afford your new prescription, say you don't think you'll be able to take it. It's a subtle difference, but it's more likely to send up a red flag to your provider.
"The doctor is most worried about getting you the right clinical care," Nosal told me. "Where those two things meet might be an easier way to open that conversation and [get] the doctor to realize, 'Oh, I need to think about that.'"
And at the end of the day, everyone should be able to be honest with their health care provider; that's the foundation of a healthy and trusting doctor-patient relationship. If you don't feel comfortable talking to the provider you're currently seeing about your financial concerns, you might want to consider finding a new one.
Plan ahead as much as you can for emergency care
This is the other nightmare scenario that I brought up to Nosal and Howell-McLean: You or your loved one needs treatment right now. The financial stakes are high, too: While there have been efforts to make sure people don't get surprise bills from the hospital, it still happens, and those bills can be tens of thousands of dollars.
The tension between wanting the best emergency care and not wanting to go bankrupt is acute. But don't panic.
One thing to do right now, before you're in an emergency situation, is research the hospitals in your area. What's in your insurance network and what isn't? If you're in a bad car crash, you may not have a say about where you get treated, but if it's a situation when you're taking yourself or a family member, checking around ahead of time could save you a lot of stress in a high-pressure moment.
If you have a medical situation that demands attention but you have a little wiggle room in terms of time, you might want to call a nursing referral service before getting into your car or calling the taxi. Some health plans have started denying coverage for ER visits they deem to be unnecessary. A quick call to have a clinician confirm that you actually need to go to the hospital could save you some headaches with your insurer later. However, Nosal noted, if you're having signs of a serious imminent medical event — like chest pains that suggest a heart attack — you should head straight to the ER and worry about the costs later.
And once you're at the hospital, many facilities actually have billing support staff who might be able to answer your questions or address your concerns. Ask to talk to one of them as soon as possible.
That's the overarching advice here: Even if you're intimidated or embarrassed or think there's nothing they can do, ask. In most cases, your providers really are on your side.
"We want to help," Howell-McLean said. "We want our treatment plans to be successful. We want our patients and families to be as healthy as they can be."
