Haggle on Your Health Insurance
Worried about high health costs? Take steps to reduce the amount you spend
En español l Worried about high health costs? Fortunately, you can take steps to reduce the amount you spend, while still maintaining the quality you expect. Here's how.
Ask for a cash discount. To avoid insurance paperwork and mandated treatment regimens, doctors and testing facilities sometimes offer discounts for cash-paying patients. You might pay anywhere between 10 and 90 percent off the sticker price, says Jeffrey Rice, M.D., founder of HealthcareBlueBook.com, a free website that helps consumers compare prices for medical procedures in their area.
His advice: First, gauge the fair-market price at HealthcareBlueBook.com, FairHealth Consumer.org or similar websites. Then ask several providers for their "cash rate." Be prepared to pay immediately — with cash, check or credit card. "Some patients with cash-in-hand find success negotiating even lower prices," Rice says.
Ensure that all your health care providers are in-network. "Staying in-network means your insurer has prenegotiated fees and benefits, and will cover a larger percentage of costs. But out-of-network providers can charge whatever they want," Rice says. Typically, that's about 20 percent more for front-line doctors and laboratory testing facilities — money you have to pay yourself.
But the real sticker shock comes with elective surgery. "You really need to ensure that the 'Big Three' are also in your network — the hospital, the surgeon and the anesthesiologist," Rice says. Remember: Referrals are often made by physicians connected to certain facilities and to their colleagues. Double-check with your insurance company that the referred physician is "in-network."
Rethink the emergency room. Of course, if you face a life-or-death emergency, head to the nearest emergency room (ideally by ambulance, so you get faster treatment). But less serious conditions — fractures, sprains and the like — can be treated at urgent care facilities for a fraction of the cost, and often with less waiting time because ERs first treat patients with the most severe conditions. Rice offers an example. When his son needed foot surgery, "the local hospital would have charged $20,000. But I called a nearby ambulatory surgery facility, where the one-hour procedure cost only $1,500."
Get schooled about teaching hospitals. Whether it's for emergency room treatment or routine procedures, know that prestigious and teaching hospitals affiliated with medical schools often charge premium prices that may not be fully covered by insurance. "Teaching hospitals tend to have higher expenditures because they're set up to deal with the most complicated cases — organ transplants and the like — even though their doctors also handle less serious conditions," says David E. Williams, of the Health Business Group, a Boston-based consultant to the health care industry. "The very same treatment at a nearby community hospital, by an equally qualified doctor, may cost much less."
Get free advice or treatment. Want to avoid a doctor's visit you may not need? Look into telephone help lines staffed by nurses or other trained personnel provided by insurance companies or third-party businesses hired by employers as an employee benefit. "True, their primary goal is to cut insurance costs, but they'll tell you if you need to see a doctor, go to the ER or possibly treat yourself at home," says Williams. "Some will even make arrangements for you."
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Save even more with generics. It's no surprise that generic medications — whether for prescriptions or over-the-counter products — are less expensive than their brand-name counterparts. But you can save even more bypassing "traditional" pharmacies. Nationwide, at least 60 chains — supermarkets, big-box names including Walmart and Target and other retailers — sell generics for as little as $4 for a month's supply or $10 for a three-month prescription. That's less than out-of-pocket copayments on many insurance policies, says Richard J. Sagall, M.D., who runs NeedyMeds.org, a website that provides information on low- or no-cost prescription programs. Some of these stores also provide no-cost, no-strings-attached antibiotics for people as well as pets in hopes these "loss leader" bargains sway you to move all your medication purchases to their in-store pharmacies.
Look into a manufacturer's savings card. For medications that have no generic equivalent, or for patients with problems taking the generic (active ingredients are the same but fillers may differ), ask your pharmacist about a manufacturer's "savings card."
With these programs, you may be entitled to additional savings from manufacturers for brand-name medications. That will largely depend on your income, insurance rules or other factors, says Tiffany Ngo, a pharmacist in Fairfax, Va. "The program is not valid for patients that have Medicare, Medicaid, or any other federal or state insurance," she says. "But this is a great way for patients to save money on brand-name drugs; always check for manufacturer discount before filling them.
For cheap generics, store insurance cards can save a lot of money. Always inquire with pharmacy staff for opportunities to save money," Ngo adds. Also visit the Partnership for Prescription Assistance website to determine if you're eligible for other programs offering low- or no-cost medications.
Ask your doctor for a 90-day script. Your copayment may be the same as with a 30-day supply — and these larger quantities are routine when meds are mailed to you by a provider affiliated with your insurer.
Negotiate. "A big part of cost isn't necessarily the medicine, it's dispensing it — and prices can vary greatly from one pharmacy to another," says Sagall. "If you're paying cash, call around and you may find the same prescription for less around the corner. Then call others and say 'Can you beat it?'"
Save by splitting. Medications that are "scored" often can be split in half —giving you twice the amount for the same out-of-pocket cost, Sagall says. For medications that can be split, ask your doctor if it's safe to prescribe double your recommended dosage (for example, a 20 milligram statin if you need 10 milligrams) and take half a pill per day. Be aware, though: Most coated or "extended-release" medications should not be split.
As part of the federal economic stimulus program, doctors were provided financial incentives for employing electronic health records (EHR) — along with meeting other criteria.
Part of this so-called "meaningful use" money, says Williams, goes to physicians who not only use and share EHR, but also communicate with patients by email through patient portals — typically at no charge — again, to avoid unnecessary office visits. Currently, about one in three doctors provide email advice, but studies suggest that number will grow to a majority within three years.
Visit ClinicalTrials.gov, run by the U.S. National Institutes of Health, to see if you qualify for a clinical trial. Not only will you help with important medical studies, but treatment and medications are usually free — and in some cases, patients are paid for their participation.
If you don't have insurance, are underinsured or have insurance but meet certain income levels, check out HRSA (Health Resources and Services Administration) health centers. Your local health department or this website run by the U.S. Department of Health and Human Services can help you locate these free or low-cost health clinics in your area.
Sid Kirchheimer is the author of Scam-Proof Your Life, published by AARP Books/Sterling.
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