By Kim Fredericks | Reader’s Digest
Navigating the world of healthcare and keeping your medical bills in check can be overwhelming. These tips can help you understand the process and save you money.
Don’t avoid the doctor or pharmacy
It’s not surprising that 64 percent of Americans want to lower their healthcare bills, as a recent survey found, but, it is that avoiding the doctor when sick or in need of medication to keep costs down is a tactic used by 56 percent of people without medical insurance and 27 percent of Millennials. If a patient is not getting their prescription filled because of expense, they need to have a conversation with their doctor, says Raffi Terzian, MD, senior medical director at Health Advocate. Avoiding the doctor can lead to serious gaps in preventative care and result in costlier medical expenses down the road.
Here are the secrets to finding the best doctors, according to doctors.
Do the research
Once your doctor prescribes a procedure, it’s up to the patient to shop around for the best facility, specialist, and care. “Research can be a lot of work,” says David Vivero, co-founder and CEO of Amino. “Considering that the cost of procedures such as an ACL surgery can vary by as much as $17,000, it’s worth the time to compare cost (and quality) and confirm that your care is in-network.” Here are 16 questions that could save you money on prescription drugs.
In-network versus out-of-network is the big driver for cost, but it is sometimes not that easy to know if a health care provider or lab or physician is in- or out-of-network, especially if you are in an emergency situation and several procedures are required, explains Younes Ghanian, co-founder of Mebex. “If you have the ability to do the research to ensure the health care providers are in-network, it will make a big difference,” he says. “But if you are not able to do that, when you get the bill, check to make sure procedures and processes listed on the bill are something you received.” If the charges are out-of-network, there is the chance that you will be able to get a discount from the provider, explains Ghanian, but you need to present a case that is viable. Companies such as Mebex and other healthcare advocates can help patients sort out the paperwork because they work with payers and providers. Learn about how each state ranks in health care.
Seek prior authorization
Before you agree to have a procedure, ask your doctor to submit a prior authorization (pre-approval) to your insurance company before you have the service, says Dr. Terzian. Health insurance companies use the prior authorization to verify that a procedure or drug is medically necessary before it is done or the prescription is filled. By receiving prior authorization, the doctor will be able to understand how something will be covered and if it will be covered, says Dr. Terzian. Taking the risk of having the service done or the prescription filled before the insurance company approves it can be costly—leaving the patient responsible for the cost.
If it’s not covered, negotiate
Sometimes, especially when you’re dealing with new technology, newer treatments, and therapies, some procedures will not be covered by the insurance company. “If you learn that you are not covered, there are opportunities to negotiate,” says Dr. Terzian. “Start the conversation directly with the provider or hospital,” he says. “Ask them about arranging a discount or payment plan.” If that doesn’t work, patients can turn to an advocacy service who can do the negotiating on their behalf.
Check your prescription
When it comes to the costs of prescription drugs, it’s important to know how much your pharmacy plan will cover. “Many plans have tiers for prescription drug coverage, and will automatically give the generic first,” says Dr. Terzian. Some doctors want to prescribe a particular drug, and will make an argument for coverage, he says, but it is always worth asking if there is a suitable generic available at a lower cost, and there is no harm in shopping around to different pharmacies to get the best price. “If your prescription is not covered, look to larger retailers, like Walmart, as they may offer a better discount.” Here are 10 important questions to ask before you take prescription medications.
Order in bulk
If you are on a maintenance drug where you need a 90-day supply, such as birth control pills or drugs for certain conditions such as diabetes and high blood pressure, ordering by mail might help you save money, along with a trip to the drug store. “Some healthcare plans will tell you to use mail order,” says Dr. Terzian. They use mail order pharmacy programs that operate through a pharmacy benefit manager, intermediaries that negotiate with pharmaceutical companies and pharmacies to get the best rates. While ordering prescriptions by mail may help save money, there are certain precautions one should take before using this system.
Set up an HSA
If you anticipate having a procedure down the road, setting up a healthcare savings account (HSA) can help you save money in the long run, says Dr. Terzian. An HSA can be used by patients with high-deductible health plans—those with a deductible of at least $1,350 for an individual or $2,700 for a family, according to HealthCare.gov. An HSA allows you to be proactive and start saving for future healthcare expenses, says Vivero. It allows you to put pretax money aside, grow that money tax-free, and use it later for qualified medical expenses—without paying any taxes–while it rolls over year after year. “Think of it as a powerful 401K for healthcare that you actually have the keys to.”
When you don’t understand a medical bill, it is important to ask questions, especially at the doctor’s office, says Vivero. According to Consumer Reports, only 31 percent of Americans haggle with doctors over medical bills, but 93 percent of those who did were successful, with more than a third of those saving more than $100, says Vivero. At the end of the day, if there is an opportunity to negotiate the bill, having the right information, asking the right questions, and collecting the right information will help the situation at hand,” says Ghanian. “Be organized about collecting all the information so when it comes time to negotiate, you don’t have missing pieces.” Here are 12 insider tips for choosing the best primary care doctor.
Make lifestyle changes
One way to reduce your medical bills is to take care of your health. Numerous studies have proven that exercise and following a healthy diet can reduce your risk of cancer, diabetes, and heart disease while one study shows the financial impact of improved behaviors. According to the U.S. Centers for Disease Control and Prevention, an estimated 10 percent weight loss could reduce an overweight person’s lifetime medical costs by up to $5,300. The American Heart Association recommends 30 minutes of moderate-intensity exercise five days a week and following a healthy diet to help control your weight, blood pressure, and cholesterol.