Break through the bureaucratic maze and become an empowered consumer with these tips.
At the doctor's office
- Go prepared to your physical. Call ahead and describe the services you want or nagging symptoms you have. Then write down your questions for your doctor. Be on guard against doctors pushing extra services or tests.
- Don't let your time be wasted. The next time the doctor is running late, say that you can only wait until a specific time. Faced with a deadline, chances are the staff will fit you in.
- Ask for a discount. You are not obligated to use your insurance plan; you are free to pay less in cash. Tell the doctor face-to-face about your financial situation and perhaps show him a pay stub. Many have standing discount policies to cut their fees roughly in half — or to as little as 10 percent. Or they may simply charge their lower Medicare or Medicaid rates.
- Get the right specialist. Call your insurer for the names of board-certified specialists in your plan's network, then talk it over with your primary doctor. Check a doctor's credentials online through the American Board of Medical Specialties at certificationmatters.org.
At the pharmacy
- Find the best fit for you. If you are in a Medicare Part D plan, make sure you fill your prescriptions at a preferred pharmacy. Preferred pharmacies can save you up to 20 percent on drug costs compared with other drugstores in your network. Call your health plan for preferred stores near you. If insured at work, stick to your plan's network pharmacies for the best rates.
- Use deep discounts wisely. Big-box stores and supermarkets lure customers with deep-discount prices of $4 or so for popular generics. But be careful. Some chains cover fewer than 100 specific generics. If your doctor writes a script for a different dosage or form, like a gel rather than a pill, you can get whacked. Ask for copies of your chains' deep-discount lists of generics to show to your doctor before she writes a prescription.
- Befriend your pharmacist. Make a formal appointment to discuss your drugs and exact dosages. She may save you money by suggesting generic options or different dosages or by pointing you to coupons and assistance programs.
- Hunt for generics. The FDA will approve around 500 new generics next year. Each will have the same active ingredient, quality, safety and strength as its branded original. So keep asking your doctor or pharmacist if they're hearing that a brand-name drug you are taking may soon get a generic option.
- Ferret out freebies. With more drug plans introducing or increasing deductibles, don't overlook medicines that you can pick up for free.
- Go to the manufacturer. If you need an expensive specialty drug and your insurance company refuses to pay, don't waste time fighting with the carrier. Instead, call the drugmaker. Virtually all drug companies selling wonder drugs that cost $1,000 to $20,000 a month have customer-assistance teams ready to supply their drugs to stricken families with household incomes up to $100,000.
At the Hospital
- Negotiate your stay. If you expect a hospital visit in 2017 for elective surgery or treatment for a chronic condition, negotiate your bill now. Sit down with the hospital’s ombudsman. Arrive with pay stubs and tax returns and work out a plan you can afford. Shop among competing hospitals.
- Scrutinize your bills. First, ask for a detailed bill; some hospitals send only summaries. Then look for obvious mistakes. You should get any honest mistakes dropped with one call to billing. If the situation drags on, you could hire a health care advocate—a fast-growing cottage industry. To find an advocate near you, check the Alliance of Claims Assistance Professionals at claims.org.
Dealing With Medicare/Insurance
- Shop around every year. When the open-enrollment period rolls around next Oct. 15, shop for a better Medicare plan. Just go to Medicare.gov/find-a-plan.
- Get the best value. Never shop for a health plan based on the premium alone. Instead, get the plan’s actuarial value (AV) from your company’s HR department or the carrier. That’s the percent of your estimated total medical costs that the carrier’s expert expects the company to cover; you pay the rest.