Keep health care costs in check

By Melissa Erickson | Healthy Living

The average American spends more than $10,000 a year on personal health care, according to the most recent estimates from the Centers for Medicare & Medicaid Services, but there are ways to keep health care expenses down.

Be healthy

While staying healthy is the most straightforward way to minimize health care expenses, that’s easier said than done. Chronic health problems cost Americans big bucks, and many of them are the result of poor health choices, said Angela Snyder, director of health policy and financing at the Georgia Health Policy Center and associate professor at Georgia State University.

Diet and nutrition matter in the prevention of chronic diseases so follow these tips: Eat healthfully and get moderate exercise, regular checkups and adequate sleep. Doing those simple things can go a long way to minimize long-term health expenditures, Snyder said.

Be a smart shopper

“Shopping around for the lowest cost is an important part of being a health care consumer,” said Dr. Raffi Terzian, senior medical director at HealthAdvocate Solutions, which works with companies and organizations to communicate insurance benefits to employees. To avoid surprise bills, find out how much procedures will cost before having them done, Terzian said.

Price-shopping can pay off big when it comes to medications. Request generics, which are required to have the same active ingredients and must work the same as their brand-name counterparts to obtain FDA approval.

“Other ways to defray costs include taking advantage of drugstore discounts and manufacturers’ coupons,” Terzian said.

Stay in-network

While how much you pay depends on your health plan, it’s always better to stay within your health insurance network. It’s also in your best interest to know what your plan covers, Terzian said.

“Certain fixed amounts are set, but out-of-pocket costs may be independent. Find out how much (a procedure or test) will cost, and have a conversation with your provider,” Terzian said.

The best time to ask for a discount on a noncovered procedure is before service is rendered.

“You have a better opportunity to negotiate on the front end,” Terzian said.

Be proactive

If your health plan offers preventative services, be sure to use them, Terzian said. For example, the Affordable Care Act requires that most health plans cover blood pressure, colorectal cancer and cholesterol screenings and flu and tetanus shots for free. If you’re taking advantage of these screenings, it’s more likely a physician will notice a serious condition earlier, which may help reduce health care costs long-term.

Use a health spending account

Health spending accounts allow a person to put money aside for future health care costs, Terzian said.

“You need to anticipate what expenses will be ahead of time and put money aside to cover them. It’s good for a whole host of medical, dental and vision expenses,” Terzian said.

For people with high-deductible health plans, a health savings account is a great way to save for medical expenses and reduce taxable income, but a user must qualify for the program, Terzian said. The government sets the limits for annual contributions, and for 2018 the limit is $3,450 for singles and $6,900 for families.

Read your bill

Mistakes happen. Protect yourself from overpaying by checking your bill. If you see something you don’t understand or think there’s an error, contact your provider and ask about the charge.

Dr. Raffi Terzian | BenefitsPRO

As health care continues to grow increasingly complex, the repercussions can be especially apparent during open enrollment season. Whether organizations are changing their plans, adding new offerings or switching their approach, open enrollment can often best be described as controlled chaos for those leading the charge.

With this year’s open enrollment just around the corner for most organizations, now is the time to think ahead. Brokers and consultants can play an integral role in reducing the burden for their clients by helping them stay abreast of both ongoing and emerging trends and issues facing HR professionals. Here are nine trends and common issues to be aware of:

  1. HDHPs – The continued adoption of high-deductible and other consumer-driven health plans are driving employees to look for options that make the most of their health care dollars. Helping employees understand their options and how their choice may impact costs can help avoid issues later on.
  2. Plan changes – Between policy updates, mergers and cost shifts, the plans available to employees frequently change. This can adjust their level of coverage, premiums and cost-sharing responsibility, and provider network, making it critical that they have resources to help determine the best fit for their needs.
  3. Prescription coverage changes – As part of other plan modifications or new offerings, yearly changes to prescription coverage can also have a big impact on employees (especially those on long-term medication for chronic conditions, etc.), so it’s even more important to communicate these changes effectively to avoid issues down the road.
  4. Diverse workforce – Employees represent a span of generations, lifestyles and backgrounds, so one size plan does not fit all. It’s important that open enrollment options provide for this variety of needs.
  5. Digital options – From online platforms that help employees select plans to plan offerings like telemedicine, digital technology is playing a growing role in open enrollment as well as benefits in general.
  6. Multi-channel outreach – In addition to utilizing technology, many employers are looking to diversify their benefits communication in order to reach more employees in the ways they seek information. This can include mailers, posters, emails, small meetings, and much more.
  7. Concierge services – Due to the increasing confusion of open enrollment, more and more organizations are offering resources and services to help employees navigate the complexities. This can help reduce the burden on HR as well as ensure employees make more informed decisions.
  8. Addons – Many employees have a wide variety of additional options to consider adding during open enrollment, which may lead to confusion about what is best for each individual and their family. Effectively explaining these options, their costs and their benefits can make a big difference.
  9. Overworked HR team – As benefits continue get more complex, HR teams field an increasing number of questions and concerns from employees, especially during open enrollment.

Addressing some of these key challenges or issues in advance can help make this year’s open enrollment process smooth and successful. Open enrollment may be challenging, but working together with clients to plan ahead can enable organizations to overcome issues, leading to a more effective benefits year ahead.

Dr. Terzian is a board certified Emergency Physician with nearly 20 years of clinical and administrative experience. Before joining Health Advocate, Dr. Terzian led educational programs at a number of the country’s top teaching hospitals.

Episode 17: Addressing Opioid Misuse and Abuse in the Workplace

The inappropriate use of opiodis is a fast-growing public health issue nationwide, and the impact is also being felt in the workplace. In this episode of Health Advocate’s Ask the Expert series, we’re joined by Dr. Raffi Terzian, Health Advocate’s Senior Medical Director, to discuss strategies to address prescription drug misuse and abuse in the workplace.

James Davis | HR Daily Advisor

At the recent #SHRM2018, I attended a session entitled “Addressing Prescription Overuse in the Workplace,” given by Norbert J. Alicea, Executive Vice President with Health Advocate’s EAP+Work/Life Services, and Raffi Terzian, the Senior Vice President of Clinical Operations and Senior Medical Director at Health Advocate. Their session addressed the astounding and alarming impact that addiction has on the workplace.

Much of the session was eye-opening and deeply concerning. Perhaps one of the most powerful things that Alicea said was that “People lose their family 5 years before they lose their job, it’s the last thing to go.” Addicts on average experienced destruction because of their addiction for at least 5 years before their addiction cost them their jobs. That’s 5 years that an addict would, at the very least, be underperforming at work and, at worse, be destructive to his or her organization.

I can’t think of a better way to characterize how important it can be to address addiction in the workplace.

The Numbers

The session covered a wealth of facts and figures. Here are a few that were presented, all about 2016:

  • 116 people died every day from opioid overdose—over 42,000 a year.
  • 2,100,000 people misused prescription opioids for the first time.
  • The economic cost due to opioid misuse and overdose was $504,000,000,000 (2015).
  • The total cost for opioid addiction and overdose treatment for enrollees in large employer plans was $2,628,000,000. In 2006, it was $278,000,000, just shy of a 10-fold increase.

While opioid deaths and new opioid addictions grow every year, and while organizations lose resources and productivity, employees who are abusing drugs continue to work. The numbers above are just a tiny slice of the true impact of opioid and prescription drug use and abuse. But how do they specifically influence the individual workplace?

Alicea and Terzian explained that, according to the National Safety Council, employees who abuse drugs are 2–5 times more likely to:

  • Take unexcused absences.
  • Be late for work.
  • Quit or be fired within 1 year of employment.
  • Be involved in workplace incidents.
  • File workers’ compensation claims.

Those costs add up very quickly with just one employee struggling with substance abuse at work and even faster if there are multiple abusers.

Addiction Is a Disease

Terzian introduced the session by saying, “We have to view opioid use through the lens of addiction. It’s not a moral failing, it’s a brain disease.” Both presenters repeated this statement many times because it’s that important. Alicea elaborated, “I’ve never run into the person who wants to be an addict in 25 years.”

The image of a hooded figure slumped in an alleyway with a needle in his or her arm does not represent the clear majority of prescription drug abusers. Most are now, or were, like everyday people, with families, lives, and careers. The difference? They have a powerful addiction, and without help, they will succumb to it.

The Red Flags of Addiction

If employers are to help, they need to be able to identify the warning signs of a drug abuser. Alicea exclaimed, “I’d bet every person in this room, in this conference, across the states, knows someone with a substance abuse problem. We all know at least one person. But if I asked that question, we won’t see a lot of hands go up. That’s the power of denial.” The presenters also mentioned that drug abusers’ fellow employees know about substance abuse problems long before the employers do. How? Because the warning signs are visible to those who know them best.

The more of the following red flags that an employee exhibits, the “greater the probability of an issue,” said Alicea.

Monday and Friday absenteeism—Users who have kept it together for the workweek might be hurting to use their drug of choice unimpeded or be spent from using over the weekend.

Absenteeism the day after payday—These habits are expensive. Payday might be the only time a user can afford to purchase his or her drugs.

General tardiness and/or absenteeism—Especially opioids can drain users of energy and make it difficult for them to come to work on time, or at all.

Poor quality of work and/or poor quantity of work—If a user can’t use at work, he or she might be experiencing the beginning of withdrawal. If he or she can use at work, the effects of the drugs have an equally distracting effect. Either way, his or her work will be affected.

Theft—The power of addiction leads many to make choices that you or I would never consider, especially if they are struggling to pay for their habit. Stealing equipment and other goods and money from work can help fund their addiction.

If drug abusers’ fellow workers know about their cohorts’ drug problems, “they are looking to see what HR or a manager is doing about this problem,” says Alicea. By not addressing the problem, what message is the company sending to its drug-abusing employees, never mind its loyal and clean employees?

Drug Abusers Know Where to Apply

Alicea said, “people who use drugs and alcohol know exactly where to go and apply for a job. They know.” What does that mean for employers that don’t drug-test new employees? It means a high probability that the workplace will experience continuous problems from drug-abusing employees. After the session, I asked Alicea and Terzian about that phenomena. They related to me a few examples of organizations that, for various reasons, wanted to avoid preemployment drug tests. “And they wonder why they constantly have problems,” said Alicea.

What Can You Do?

Once an employer realizes that employees who abuse opioids and other prescription and illegal drugs need help, it can begin to find a way to administer that help.

“A lot of companies had zero-tolerance policies. A lot of them are doing away with it, and I’m all in favor of a second chance,” said Alicea. He explained, “If you have an employee who worked for you for 10 years and they are relatively good, and they end up testing positive, and you terminate them—you don’t know if the new person has a problem, too, and you lose all of that knowledge.”

Alicea said the best way to help is to offer employees a one-time chance to get clean through a program (and prove it after the program is over) or be fired. Work, he said, represents a critical part of many people’s identity. Remember, by the time they are potentially losing their jobs, many drug abusers have already pushed their friends and family out of their lives. Their work identity might be all they have left. And that can be a powerful motivator, says Alicea. That makes them decent candidates for rehabilitation.=

Alicea said, “by threatening the job, the core values of a person, that person has a high probability of success in making the change provided that it’s monitored.” He focused heavily on the value of monitoring and reinforced it when we talked after the session. He said, “the success rate in treatment today is really, really low. But if you have someone monitoring that person for 90-120 days after the treatment, the rate is really, really high.” The reason is that they know that if they don’t follow through with aftercare, they will lose their job—their core personality—and that’s too much.

The Takeaway

This topic is incredibly complicated; the research is far from complete; and even with treatment, drug abusers have very real challenges ahead. If you deal with substance abusers at your organization—and it’s just a matter of time before you do—it behooves you to explore how you can help those people.

Employers must be aware of drug abuse

By Chrstine Hansen | The Daily Record (Md.)

In a 2017 survey conducted by the National Safety Council, a nonprofit organization dedicated to eliminating preventable deaths at work, more than 70 percent of employers in the U.S. have been impacted by prescription drugs. The prescription drug epidemic in the U.S. is far-reaching, and costs organizations billions of dollars each year. Yet, only 19 percent of employers feel extremely prepared to deal with prescription drug misuse, according to the survey.

Navigating Maryland laws regarding drug abuse is somewhat tricky, says Brian Markovitz, a Beltsville-based labor and employment attorney at Joseph, Greenwald & Lake. While Markovitz largely focuses on helping victims who have suffered severe injustice in the workplace, he says when it comes to drug abuse in the workplace, employers should take immediate action.

“If you have anyone abusing drugs, you fire them. If they are currently abusing drugs, you can’t have someone working there. You just don’t know what they will do,” Markovitz says. Under current Maryland law, employers can drug test their employees, as long as it is a “legitimate business reason.” The law dictates the procedures for testing, confidentiality and other procedures. However, the Americans with Disabilities Act has provisions that may protect workers who have been rehabilitated or in recovery.

“You cannot discriminate against anyone because they used to be a drug abuser,” says Markovitz. “If they have a history, and they are rehabilitated, they are protected by the ADA.” Markovitz says the courts are not super clear on what constitutes being in recovery or rehabilitated, especially how long of a period an employee has not been on drugs. That’s why he says it needs to be addressed on a case by case basis. Employers also have to keep liability in mind.

“These drugs in particular are so addictive, and it takes a certain amount of income to keep getting these drugs. Sometimes people are so desperate, they will do things you don’t want,” Markovitz says.

Bert Alicea, a licensed psychologist and vice president of employee assistance programs at West’s Health Advocate Solutions says employers should not only make their drug policies clear, but to also make all resources – wellness programs and services – easily available so employees know how and where to access them.

He and his colleague, Dr. Raffi Terzian, a board-certified emergency physician, senior vice president of clinical operations and senior medical director at Health Advocate, recently presented at the Society for Human Resource Management’s annual conference on the topic of opioids and the workplace.

“A lot of attention has been placed on the opioid crisis and it’s a critical public health problem – specifically, prescription opioid use, misuse and abuse,” Terzian says.

Alicea and Terzian recommend employers develop clear guidelines on their drug policies. Eighty-one percent of employers lack a comprehensive drug-free workplace policy, according to the National Safety Council survey. That shouldn’t prevent employers from developing guidelines says Alicea. The U.S. Department of Transportation has one of the best.

“DOT’s guidelines really are the gold standard of guidelines. It includes clear policies on testing and is a legal- and federally-mandated policy,” Alicea says.

What makes the Department of Transportation’s drug testing policy stand out is its inclusion of the testing of opioids. According to the National Safety Council’s survey, 41 percent of those who drug test all employees are not testing for synthetic opioids at all.

Recognizing the signs of opioid use and abuse are key. Employers should provide training programs for managers and supervisors and provide a safe anonymous place for all staff to report potential issues.

“Turn this from an ‘I’ issue into a ‘we’ issue. It takes a village – not just the chief – to raise levels of awareness,” Alicea says.

Alicea believes employers should, in addition to substance abuse training, consider adding “reasonable suspicion” training for managers and supervisors. This training prepares supervisors on how to appropriately and effectively identify possible substance abuse in the workplace, and what to do when they suspect it. Reasonable suspicion training also helps mitigate potential liability for companies. While slurred speech, staggering walk, lack of concentration and sleepiness may be signs of substance abuse or misuse, there may be other signs an employee is struggling, such as excessive tardiness or absences.

Overall, an ounce of prevention is worth a pound of cure, says Marc Engel, a Bethesda-based partner and employment attorney at Lerch Early Brewer. Engel represents for-profit and nonprofit employers in employment claims, and with more than 30 years of litigation and counseling experience, is a sought-after speaker on employment issues.

“Employers need to be careful. It’s a delicate balance of empathy for an employee versus taking appropriate steps to ensure an employee’s actions do not harm them or others in the workplace,” he says.

By Dave Shadovitz | HR Executive

The workplace is the perfect place for intervention, experts suggest.

Attendees at the Society for Human Resource Management’s annual conference who were in search of some disturbing numbers weren’t disappointed during a Monday morning session on the opioid crisis titled “Addressing Prescription Overuse in the Workplace.”

Below are just a sampling of figures fitting that description. They were shared by Health Advocates’ Senior Vice President of Clinical Operations Raffi Terzian and Vice President of EAP+Work/Life Services Norbert Alicea at SHRM’s gathering in Chicago this week:

  • In 2016, 11.8 million people abused prescription medication;
  • 116 people die every day from opioid-related drug overdoses;
  • More than 70 percent of employers are impacted by prescription drugs;
  • Prescription-painkiller abuse costs employers almost $42 billion due to loss of productivity; and
  • Providers wrote nearly a quarter of a million opioid prescriptions in 2013, enough for every American adult to have his or her own bottle of pills.

Employers are worried—and rightfully so. A recent study by the National Business Group on Health, a nonprofit association of more than 420 large U.S. employers, found that eight in 10 employers were concerned about the opioid crisis at work, Terzian said. Yet despite this fact, he added, only 30 percent of them reported they have restrictions in place for prescription opioids.

(NBGH issued a recommendation earlier this week that employers work with their health plans and pharmacy-benefits managers to ensure they are implementing national guidelines for prescribing opioids.)

Alicea addressed the necessity for more thorough training so managers and supervisors are better equipped to recognize the red flags. They need to be able to identify the early warning signs, such as absenteeism on Mondays and Fridays (or the day after a payday), lateness, poor quality of work, theft and morale, he said. (He also touched on this topic in a brief video recorded at the conference. See below.)

Workers, he said, often know long before HR that a person has an issue, and they’re looking to see what HR is doing or what the manager or supervisor is going to do about this troubling problem.

“I can’t even tell you how many times an HR person has called me about a problem employee who has tested positive, even though it has been going on for five years,” said Alicea, adding that the problem often has less to do with the employee and more to do with the manager or supervisor who has allowed it to continue.

“HR needs to help the managers and supervisors understand that this is a real issue and teach them how to supportively confront employees, including what to say and what not to say,” Alicea said. “That’s where HR can come in as a partner, helping them focus on identifying the early warning signals and helping them remain objective.”

HR also needs to educate them on the barriers they are likely to run into and how they may be enabling the problem to continue.

“I always tell managers and supervisors to use ‘I’ messages,” said Alicea. “When you’re speaking to an individual about work-performance issues, stay away from those blame statements that include the word ‘you.’ ‘You need help. You have an alcohol or substance-abuse problem.’ I think it’s a lot better that they take a step back and address it as, ‘We have a problem. The organization has a problem. We are concerned about your work-performance issues and, based on what we have observed in the last hour, we’re going to send you for a medical evaluation, which includes a drug and alcohol test.’ ”

Employers have a critical role to play in addressing the opioid crisis at work, Alicea said. “Think about it for a second: What’s the second or third question that you’re asked in a social situation? ‘How are you, how’s the family, how’s the job?’ Whether we love our job or hate it, we all take pride in it.”

By threatening a person’s job, he explained, you’re threatening the “core values” of that individual and therefore have a much higher probability of success.

“If you have an employee who’s worked for you for 10 years—and they’re a relatively good employee, and they end up testing positive—to terminate that employee, retrain another employee, and then go ahead and hire that [other employee who could also have a substance-abuse problem] will cost you more money in the long run than to give that person an opportunity for rehabilitation by putting them on a last-chance agreement,” Alicea said.

The workplace is “the perfect place for the intervention, better than any place else in the world,” he said.

By Simon Shaykhet | 7ABC Action News (WXYZ-TV)

Opioid abuse in the US is staggering. One place you may not think of it being a problem is at work, but the most recent stats show the number of people dying from overdoses on the job has increased 32 percent in one year. And we found some employers are finding new ways to help employees who want to fight their addiction.

Joe used to be addicted to prescription painkillers and opioids and heroin. The disease drove him to constantly crave the high, even on the job.

“I used to come to work under the influence of drugs every day and, obviously, in the world that I worked in, construction, it’s obviously an unsafe mix,” Joe said.

With opioid abuse at an all-time high it’s now becoming an on-the-job issue. One poll found misusing prescription drugs impacts more than 70 percent of US workplaces.

“People have a vision or a misconception that a drug addict or a drug user uses out in the streets, whether it’s in alleys or hidden corners,” Dr. Sal Raichbach, psychologist with the Ambrosia Treatment Center, says.

Raichbach helps people fight addiction and tells us the person in the cubicle next to you could be abusing drugs.

“We’ve seen impaired professionals. We’ve seen teachers, we’ve seen physicians, we’ve seen blue collar workers, we’ve seen white collar workers. It can inflict just about anyone, because addiction is a disease,” he says.

That same poll also reveals 65 percent of employers say on the job drug use is a justifiable reason to fire someone. But we found some companies aren’t showing these workers the door, they’re offering them a second chance.

Norbert Alicea, a licensed psychologist with Health Advocate, tells us, “What they are now doing is saying, ‘OK, if we had an employee that worked for us for 10 years and they now test positive for drugs or alcohol, do we really want to terminate that employee? Or do we want to give that employee an opportunity to get into, you know, some type of program that we can help them and still retain their job?'”

Some employers put employees with drug problems under special contracts. It’s like a last chance agreement: Get professional help, sober up and your job will be waiting for you.

“These programs can be a win-win for employers and employees alike,” Raffi Terzian, MD, medical director at Health Advocate says.

Joe says his employer and union paid for him to go to rehab. Now he’s kicked drugs, is back at work, and married with a family. “I do think this program saved my life,” he says.

The opioid crisis is also hitting America in its pocket book, costing employers, the health care and criminal justice systems hundreds of billions of dollars a year.

To view the video broadcast, click the link here.

By Nick Otto | Employee Benefit News

Employers weighing how to deal with substance abuse issues among their workforce are facing an expensive task as the cost of abuse continues to skyrocket from healthcare costs and lost productivity.

“We’re all aware and have come to understand this has become a major public health crisis on a national, state and community levels,” said Raffi Terzian, senior VP of clinical operations and senior medical director at Health Advocate.

The cost burden for people with employer-based healthcare coverage saw an eight-fold increase since 2004, Terzian said Monday, speaking at the Society for Human Resource Management annual conference here.

Employees who often abuse drugs are two to five times more likely take unexcused absences, quit or be fired within one year of employment or be involved in workplace incidents, he added.

But Terzian points to recent National Business Group on Health data that shows only 21% of employers have programs in place to help manage prescription opioid abuse.

And for employers looking to put a program in place, or beef up existing programs, Norbert J. Alicea, executive vice president of EAP+ Work/life services at Health Advocate says managers need to focus on the red flags and early warning signals — both physical and behavioral — of substance abuse.

Among some of the early warning symbols, he says, are frequent absenteeism on days like Monday or Friday, or drastic increases in tardiness and use of sick leave.

“Also look for a change in morale among colleagues,” he added. “Employees know long before HR knows that a person has an issue.”

In addition, Alicea advised employers to train managers to focus on these early warning signs and teach them how to supportively confront workers.

“Use ‘I messages.’ Stay away from blame statements which are ‘you need help’ and instead ones like ‘I am concerned,’” he said. “Managers and supervisors struggle with tact. It isn’t so much what they say, but how they say it, and that’s where HR can come in and assist them with that conversation.”

In addition to employee engagement in combating substance abuse, Alicea said many employers are also taking steps to change culture, such as moving away from a zero tolerance policy.

From a financial standpoint, it is 4 to 5 times better to offer rehabilitation for workers than to terminate, hire and retain new talent, he added.

He also says employer scan take more proactive approaches to stemming the stigma around substance abuse. Alcohol awareness month, suicide prevention numbers … create visibility around the topics and engage workers, he added.

Join Health Advocate at one of the nation’s leading HR conferences. Bert Alicea, Executive Vice President, Health Advocate’s EAP+Work/Life Services, and Dr. Raffi Terzian, Senior Medical Director at Health Advocate, will co-present a timely presentation, Addressing Prescription Overuse in the Workplace on Monday, June 18, 2018 at 10:45 AM CT.

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.

Stay in-network

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.”

Ask questions

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.