Most consumers’ sign up for health insurance plans without fully understanding the 100+ pages of detail that go over the plan specifics.  In fact, most of us select our health plans based a high-level  outline and never bother to read the fine print details that describe coverage limitations that spells out what’s covered and what’s excluded, identifies lifetime limits/coverage caps , deductible terms--- basically things you need to know so you can understand the out-of-pocket you will be expected to pay.  It’ all very confusing and complicated.  And let’s face it, it’s written in a language that consumers find it practically impossible to understand. 

 

An article in the Wall Street Journal written by Anna Wilde Mathews, The Importance of Deciphering Your Insurance, does an excellent job describing the consequences and complications resulting from not understanding your health policy.  Anna describes how confusing this is to consumers and discusses some specific situations where consumers were stuck with large medical bills because they did not understand their coverage limitations (the fine print) when they purchased their health policy.

 

Some things to look over very carefully when evaluating a health policy:

·         Know your out-of-pocket maximum, which represents the most you should have to pay for care in a given year

·         Pay attention to the terms of your deductible

·         Understand how your plan covers out-of-network providers

·         Check for excluded benefits and coverage caps, including lifetime and annual limits on payouts

·         Know what services are covered and what services are not covered

 

Urgent care centers are an affordable option for patients needing non-critical medical care. At urgent care centers, patients are treated by highly trained staff of physicians, nurses and health care technicians for many non-critical medical problems.  If you haven’t heard of urgent care centers, perhaps you are more familiar with some of the other names they are called:

• Immediate Care
• Convenient Care Clinic
• Express Care Center
• After-hours Facility
• Minor Illness & Injury Center
• On-call Doctor/ Physician
• Quick Care Center
• Now Care Facility
• Prompt Care Clinic

The centers are typically open late nights; require no appointments, accept insurance or cash payment and walk-ins are welcome.  The centers usually guarantee you will receive medical care in less than 30 minutes and their services cost considerably less than visiting an emergency room. 

To find an urgent care center near you, you can use search engines:

• Google - search on urgent care and include your city/state
• Bing - search on urgent care and include your city and state
• Find Urgent Care - a directory to help consumers find centers in their area

If you are a savvy consumer you probably review all the bills you receive before you pay them, to make sure they are accurate. This is a really good habit. Have you ever received a bill that was not yours, or a credit card statement with charges that are not yours, or the wrong discount/sale price taken off your retail purchase, or cell phone charges that you should not have been billed for? This happens to consumers all the time. Human errors, billing errors, software updates – there are lots of reasons these errors occur. Whenever you receive a bill for health care services, utilities, charge card statements, electronic purchases and sometimes even groceries – you should take a minute to review the bill for accuracy. When you purchase an item on sale, or use a coupon, don’t you always look at your receipt to make sure you were charged the right amount? This same "double checking" rule applies to medical services. When you receive a bill (or statement) from a provider or an EOB from your insurer, take a minute to review the information to make sure it is accurate. If you have a health insurance policy that covers screenings, office visits and lab tests, make sure you are not being billed for these services.

You also need to review your health plan coverage very carefully so you know exactly (1) what services (exams and lab tests) are covered at 100%; (2) what services you will be billed for; and (3) what percentage you are expected to pay for these services. Some employer health plans are starting to cover 100% of the full cost of routine exams and preventive services (such as physicals, colonoscopies and mammograms) to help employees stay healthy. This can be a great benefit, but if you’re not careful, you might erroneously get billed for these services. Patients are sometimes billed for preventive screening exams that their health plans cover at 100% because of errors in billing/coding at the doctor’s office. Patients can unknowingly receive care that their health plans don’t consider preventative.

Always review your bills for errors. An article in the Healthy Consumer in last week’s Wall Street Journal discusses why patients may be billed for free exams.

What if consumers could shop for radiology tests (MRI, CT scan, ultrasound, x-ray, mammogram, DEXA, PET, and fluoroscopy), the same way they shop for hotels and airline tickets? 

Radiology tests like MRI and CT scans have become key tools for physicians to help diagnose and monitor disease. It's no surprise that diagnostic imaging has become one of the fastest growing segments of healthcare, consuming billions of dollars per year. In fact we will spend over $20 billion in 2009 just on MRI scans alone.

Many consumers are increasingly forced to burden the costs of these high-tech medical tests through high deductible plans, often paying hundreds of dollars out of pocket for a scan. And uninsured consumers are faced with costs that can easily run into the thousands of dollars. For example, a Lumbar Spine MRI scan performed at a hospital can cost an uninsured consumer $3,000.

Healthcare is still mired in complex and opaque pricing strategies that make it difficult, if not impossible, for uninsured consumers to discover the real costs of Radiology tests and receive the same prices that health insurance companies enjoy. Fortunately there are technology companies, like RemakeHealth, that are building online resources to help healthcare consumers.

RemakeHealth recently launched its Radiology shopping website which lets consumers look up prices for nearly any outpatient Radiology test, find a local certified imaging center and purchase the test with a credit card. Radiology tests featured include X-rays, MRI scans, CT scans, Ultrasounds and more. All the imaging center providers on the website are certified by the American College of Radiology and staffed by American Board of Radiology certified Radiologists.

RemakeHealth acts like a travel agent and has negotiated prices for uninsured consumers in advance. When consumers purchase a test they receive concierge like services which include a personal phone call to set up the appointment and answer any questions about the test.

RemakeHealth is also working to eliminate confusing healthcare pricing schemes. For example a Brain MRI usually has 3 different prices: without dye, with dye, with and without dye. They have simplified this by offering one price and not charging extra for dye injections. Consumers are also often unaware of large price variations that occur between facilities in the same town. RemakeHealth has addressed this by creating one price for each type of test in each of their local service areas.

The company was founded by Dr. Ravi Sohal, who is a Radiologist, and its cofounders are from the Radiology industry as well. The founders have dedicated themselves to helping uninsured consumers make informed decisions by building healthcare shopping tools similar to the ones we all enjoy when looking to buy nearly everything else online.  They have always been amazed that you can shop for an airline ticket and hotel room but not for an X-ray and MRI scan, until now.

 

NeedyMeds is a non-profit organization that provides information about assistance programs that are available to low-income patients and their advocates.  The NeedyMeds website provides access to a wealth of databases of information on clinics and patient assistance programs including:

 

Low-Cost Medicine Programs

 

Patient Assistance Programs provide free or low-cost medicine to low-income people who are uninsured or under-insured.  

 

Additional Assistance Programs (PAPs)

·         Application Assistance is a resource of organizations that will help you find and apply for PAPs for free or a small fee.

·         Disease-Based Assistance programs that help with the costs associated with specific diseases or conditions.

·         Government Programs are state and federal programs that assist low-income residents.

·         Discount Drug Cards provider consumers with discounts on prescription medication.

 

Free/Low Cost Clinics

 

The NeedyMeds database identifies more than 4,000 clinics that are free or low cost with a sliding scale base on income.  To find a clinic in your area, click on a map. 

 

Discount Drug Cards

 

There are many different types of drug discount cards. Some offer significant savings while others are not a good deal. Drug company discount cards offer discounts only for certain medications while others offer a wide range of discounts. You may find it best to use certain cards for some medications and others for other medications.

 

1.       Drug Company Discount Card

2.       State Discount Cards

3.       NeedyMeds Drug Discount Card

 

To learn more about these programs, visit the NeedyMeds website.

 

If you have major medical bills and need assistance in making sense of these bills, there are a number of bill review services available that will provide you with advice.  Some of these organizations provide assistance before services are provided, others help review medical bills after the services were provided, to determine if you were overcharged.

 

Here are some resources that can help you make sense of your bills.  Keep in mind that some of these organizations offer help -- for a fee.

 

Claims Assistance Professionals

HealthCare mediation LLC

Health Proponent

Health Champion

Hospital Bill Review

ICS Healthcare (Ingenix)

Medical Cost Advocate

INSNet

Patient Advocate Foundation

Patientcare

 

 

To shed some light on health care prices, Anna Wilde Mathews wrote an interesting article in last week’s Wall Street Journal about how much it costs to have a baby.  She researched prices at hospitals in advance and broke down the different expenses she incurred after her baby was delivered.   She certainly takes the mystery out of how much it can cost to deliver a baby as she reviews some of the itemized costs that appeared on her invoice from the hospital.

 

If you are expecting a baby and have the opportunity to research prices in advance, take her advice and do your homework to eliminate the guesswork on how much out of pocket expenses you will be responsible for.  Here are some interesting charges from her report:

 

ITEM	CHARGE
Total delivery charge for three days in the hospital	$ 36,625
Aetna’s negotiated (discounted)  total	$ 17,300
2006 average nationwide negotiated total	$   6,898

 

Miscellaneous items and charges on the hospital bill:

 

ITEM	CHARGE
Epidural anesthetic injection	$    530
Hospital’s resources for providing the epidural	$ 2,152
Anesthesiologist’s fee	$ 1,530
90 minutes in recovery after delivery	$ 2,382

 

Your actual costs will be based on your deductibles, co-pays co-insurance, the new baby’s deductible, out-of-pocket maximum and the specific services provided by the hospital.

 

Thank you Anna for sharing this information with other consumers!  If you have some interesting prices to share with consumers, please add them to the OutofPocket.com directory by clicking here.

 

If you are insured, selecting a health care provider that is not in your network can cost you more out of pocket.  Network providers in your health plan have discounted rates for their services.  Non-network providers do not provide this discount and you’ll end up paying more for their services.  Sometimes the specialist, or provider that came so highly recommended with the highest quality ratings, is not in your network.  How should you approach this to make the most of your health care dollars?  Here are things to consider when deciding to use in-network versus out-of-network providers.

Quality is very important.  You want to find the highest quality provider that offers the best value.

Get cost estimates from the hospital and the physicians, and try to find out if there are any supplemental fees you can avoid.

Research what portion your insurance will cover. Know that most plans will only cover a percentage of charges they consider "reasonable and customary."  This may be a lot less than what the hospital and doctors charge, and you'll be responsible for the difference.  Find out if your insurance company will pay the entire "reasonable and customary" portion, or if you'll be responsible for some of it due to deductibles or co-insurance.

Ask providers if they are willing to accept your insurance company's payment for their services as payment in full, especially if they work in a hospital that's covered by your plan.   Make sure you take care of this before services are provided.

Negotiate with the provider and even offer to pay cash at time of service for special discounts.  Know what payment amount Medicare allows for this service. If you need help finding out this information, send me an email and I will walk you through the steps on how to find this information.  Know what payment amount your health plan allows for an in-network provider for this same service.  Information can be powerful. 

Millions of people every day struggle to contain their health care costs. The National Center for Health Care Statistics reports 43 million people under the age of 65 do not have health insurance.

Consumer driven health care has arrived on the scene to try and generate competition within the health care market. Consumers need to be more aware of the hidden health care costs, and start holding the health care industry accountable.

A key area neglected due to rising health care costs is proper laboratory testing. Does your family have a history of any of the following: heart disease (652,091 deaths / year), cancer (559,312 deaths / year), diabetes (75,119 deaths / year)? Many people may not want to incur the cost going to a doctor for a lab order, and then having to pay for the lab. Many should have a lab test done every 6 months – 1 year. These costs can pile up quickly when paying full price out of pocket. Having your lab tests done at your doctor’s office can be a lot more expensive than having your lab test(s) done at a stand-alone facility, or ordering your lab tests online. Today, consumers will find a number of websites where they can order lab tests online at a discounted price. One of these sites you should definitely check out is PrePaidLab.

As consumer driven health care expands, we now have the ability to take control of our own health care management via the Internet. PrePaidLab is committed to help health care consumers control costs. PrePaidLab offers the ability to browse and order several hundred lab tests through a secure shopping cart. Tests can be ordered with or without a doctor’s order. In most cases receipts can be submitted to an insurance carrier (if applicable) and the cost of the test will be applied towards the deductible.

Consumers should compare prices with cash pay and other Internet based lab sites. PrePaidLab provides deep consumer savings, and a pleasant customer experience. They have a friendly customer service staff that is available to assist you in finding tests, and answering any questions regarding the process.

If you have never ordered lab tests online before, PrePaidLab has outlined the five easy steps to this process:

(1) LOCATED A LAB NEAR YOU. Check to see if there is a PrePaidLab Laboratory center near you. PrePaidLab uses only nationwide CLIA-certified Medical Reference Laboratories with Patient Service Centers close to where you live or work for the blood draw.

(2) SELECT THE LAB TEST YOU NEEED. Go to PrePaidLab and browse the test categories on the left side of the page. There is also a search box on the top left you if you know the test name.

(3) PROVIDE INFORMATION TO ORDER THE TEST. Select your test and fill out the order form and payment information. A HIPAA form is also available which can be used to give PrePaidLab permission to release the results of the lab directly to your physician via fax.

(4) RECEIVE LAB ORDER REGISTRATION. In 48 - 72 hrs you will receive an email from the PrePaidLab secure email system containing the Lab Order Requisition Form. This needs to be printed out and taken to the Laboratory center at your convenience. The requisition tells the Laboratory Technician what test(s) needs to be performed, and shows that you have paid for the lab service.

(5) RECEIVE YOUR LAB RESULTS. 48 - 72 hrs after the lab work is completed; PrePaidLab will send another secure email containing the lab results.

Take control of your health care costs today!

Every so often you run across a touching story about people who really make a difference in improving the lives of others.  This is one of them.

 

Dentistry From The Heart (DFTH) is a dental program that provides free dental care to those who need it.   Since 2005, this non-profit organization has provided free dental services at more than 50 locations across 29 states. Founded in Tampa, Florida in 2001, Dentistry From The Heart started as Dr. VincentMonticciolo’s way of giving back to his community and providing aid to the growing number of Americans without dental insurance. Over the past eight years, more than 4,000 patients from across the state have traveled to attend Dr. Monticciolo’s DFTH events to receive a free filling, extraction, or cleaning.

 

After realizing the potential impact DFTH could make across the country, Dr. Monticciolo registered DFTH as a national non-profit organization and created all the tools needed for dental practices to host DFTH events in their community.

 

“With the number of Americans living without dental insurance on the rise, my desire is for more dentists to look to Dentistry From The Heart as a way to directly impact lives and provide invaluable services to their community,” said Dr. Vincent Monticciolo.

 

Since 2005, Dr. Monticciolo has enlisted more than 60 dental practices across the United States to host their own events. With their help, Dentistry From The Heart has now served more than 10,000 people and given away more than $2.5 million in free dental work. Dentistry From The Heart is a registered non-profit organization that provides free dental work for people who need it. Dr. Vincent Monticciolo founded the organization as a means to give back to the community and address the growing number of people without dental insurance. In the past eight years, Dentistry From The Heart events have contributed more than $2.5 million in free dentistry and helped more than 10,000 patients across the country.

 

How much does an MRI cost?  What is a fair price to pay for an MRI?  How do you know if you are being overcharged for an MRI?  Where should you go to find the best value?   

 

With so many consumers now paying cash for health care services or using their high-deductible health plans to pay out of pocket, these questions become more and more common.  Consumers are becoming more savvy about purchasing health care services, and need to know up front how much things cost.

 

(1) How much does an MRI cost? 

 

Prices vary a great deal. Research indicates that prices for MRI services can range anywhere from $450-$3500, depending on where you go to have the MRI performed.  If you visit a hospital facility for your MRI, you will end up paying a lot more for this diagnostic test that if you visit a stand-alone facility not affiliated with a hospital.   If you offer to pay cash up front at time of service, the provider will most likely offer you an attractive discount.    Three independent outpatient facilities, one in Milwaukee Wisconsin, one in Lawton, Oklahoma, and the other in Indianapolis, IN offer one price for an MRI.  No matter what insurance you have or don’t have.  No matter what type of MRI you need.   They have taken the mystery out of MRI pricing.   Here’s the scoop.

 

·         DoctorsMRI a diagnostic facility in Lawton, Oklahoma charges patients $599 for an MRI.  No hidden fees.  No surprises.  All MRIs are one price = $599

 

·         SmartChoiceMRI in Milwaukee, Wisconsin offers patients MRIs for $600.  No hidden fees. No surprises.  All MRIs are one price = $600

 

·        MRI Solutions in Indianapolis, Indiana offers patients MRIs for $450.  One flat fee.  They do not accept health insurnace.  All MRIs are one price = $450

 

(2) What is a fair price to pay for an MRI?  

 

Based on the fact that two facilities in the country are offering one standard price for all MRIs, I would conclude that if you are paying much more than $600 for an MRI – you are probably paying too much.  Try to negotiate with your provider to see if they are willing to reduce the price now that you know how much other facilities are charging for the same service. 

 

Be sure to check out HealthcareBlueBook, a website that helps determine “fair” prices for health care services.

 

(3) How do you know if you are being overcharged for an MRI? 

 

Be sure to ask the health care provider’s office staff questions before services are provided.  Use my list of available tools to comparison shop for an MRI.    If you know what other facilities charge for the same service, this information can be powerful.  Remember, higher prices do not necessarily translate to higher quality. 

 

COPAYs, co-insurance, deductibles, list price, discounted price, contracted rate, negotiated price, cash price.  Do you know in advance what amount you will be charged for health care services?

If you have health insurance, your health plan has negotiated discounted rates with each of your providers in the health plans network.   These discounted rates are called “contracted rates.”  When you visit a provider in the network, and show them your insurance card, they will charge you (or your health plan) the contracted rate for services.  The “list price” for services is reserved for people without insurance, and without a doubt, is an inflated price.   The Medicare rate for services is the rate the Government has negotiated for services under the Medicare plan.  Medicare is the lowest rate for services and often does not cover the provider’s true cost of delivering the services.   If you do not have health insurance, be careful because providers will charge you the “list price” for their services.  This list price is an inflated price, and if you pay cash, you should expect to receive a discounted rate, but remember ---you have to ask for it.  Everything is negotiable – including your health care bills.  It varies from provider to provider, but I have seen cash-pay discounts that range from 20% to 60% off the list price!

 

Bargaining down those medical bills

 

I conducted an experiment to find out if it was more cost effective for me to pay cash for visiting a provider, or to pay the contracted rate my insurance plan has negotiated for services.   To give you some background, I have a high-deductible health plan and this looks like a very healthy year for my family so I doubt we will come close to meeting our deductible this year.  In other words, we will most likely pay for all our health care expenses out-of-pocket.  Our high-deductible health plan is really a good deal for us because we save about $8,000 a year on less expensive premiums for this type of plan.  So if I spend less on health care out-of-pocket expenses throughout the year by being a cost-conscious consumer, I have more money in my pocket to spend on other things like vacations and get-away weekends.   That’s a topic for another day.

 

Last week I visited a specialist for a follow-up office visit. No tests.  No equipment. No supplies were used.  Just a follow-up consultation.  When I checked in for my appointment, I inquired about paying cash for my doctor visit rather than have the office staff bill my insurance plan for the service.  The office staff was very confused by my request.  They consulted with three office staff, including the billing manager, and concluded that I needed to wait until after the doctor visit to know what the price is.  This makes sense. They cannot give me an estimate for services until after I see the doctor so they know what level of office visit to charge me for.  After I saw the specialist, I went back to the front desk and asked them what today’s charges would be if I paid cash.  They looked up the CPT code for today’s visit and said, “the cash pay rate for today’s visit is $86.”  I know from earlier visits to this provider, that my insurance plan negotiates a contracted rate of $70.  The list price for this visit is $109.  So here’s what I learned:

• $109.20 is the list price for an office visit with this specialist 
• $ 70.00 is the contracted rate my insurance plan has negotiated with this provider
• $ 86.00 is the cash-pay price the provider charges if you do not have insurance

After all that, I decided to have this office visit processed through the regular insurance claims process, because it provided me with a larger discount. 

 

Conclusion

 

My health insurance plan has negotiated some terrific discounts with their network providers.  The best part is that I directly benefit from these discounted rates for services.  When I signed up for my health plan, this topic never came up with the insurance agent that sold me this plan.  These network discounts appear to be one of the strongest selling points for this high deductible health plan since I end up paying 100% of the negotiated price for these services (until I meet my deductible.)  If there was more transparency in our health care system, consumers would be able to look-up provider prices for services for specific health plans, and determine upfront what their out-of-pocket expenses would be.  In today’s health care system, this is impossible to know ahead of time.

 

A picture is worth a thousand words.  Using a whiteboard to explain complicated issues surrounding our health care system, Humana has created a three minute video on YouTube that does a great job explaining why we need health care reform. The video explains in simple terms what's wrong with our currently health care system and presents some ideas and proposals that are being considered. 

If you haven’t seen this video, you should definitely check it out.

Walgreens recently announced that they are offering free health care services at their retail clinics for all current and future Take Care Clinic patients and their families that experienced a job loss after March 31, 2009 and are uninsured.   They call it the Take Care Recovery Plan.

To learn more about this program you can call 1-866-Take-Care (1-866-825-3227) and press 3 for Take Care Recovery Plan information.

Or you can visit their website to learn more about the Take Care Recovery Plan.

It’s easier and much less expensive to stay healthy.  In today’s tough economic times, it has never been more important for people to really take control of their health and prevent unnecessary health emergencies.  Even though at times it seems like an awful lot of trouble to stay fit, exercise, eat healthy foods and take good care of yourself by having regular checkups and screenings – this behavior is actually a great return on your investment.  When you get sick, things can get very expensive. Many employers reward this type of healthy behavior and insurance premiums are sometimes reduced if you take good care of yourself.   So why wouldn’t you choose to stay healthy? 

In Colorado, a non-profit organization called 9Health Fair promotes health awareness and encourages individuals to assume responsibility for their own health by providing consumers with 20 free and 4 low-cost health screenings.  The low-cost screenings include:

 

·       Prostate Specific Antigen (PSA) screening; identifies a man’s risk for prostate cancer, for $25

·       Blood Count screening; identifies a person’s ability to fight infection, risk for anemia and blood-clotting abilities by checking white and red blood cells, hematocrit and hemoglobin levels for $15

·       Blood Chemistry screening, which tests 28 separate things including cholesterol, blood glucose, liver, kidneys, thyroid and more, for $30

·       Colon Cancer Screening Kit; this take-home/mail-in kit checks for human blood in the stool which can lead colon cancer for $20

 

Wouldn’t it be nice if everyone had access to affordable screening programs like this?  If you know of any programs like9Health Fair that we should tell others about, be sure to let me know and I’ll post it on the OutofPocket.com website, to share with others.

 

If you are uninsured, under-insured, or have a high-deductible health plan, don’t skip taking care of yourself.  In fact, I encourage you to use this information about low-cost prices 9Health Fair offers for screening tests to your advantage.   Call a provider and see if they will match these prices, or at least offer you a discount.

Wondering why your medical bills are so high?  New Hampshire Public Radio’s health reporter, Elaine Grant, revealed some interesting information about hidden facility fees in an interview last week with New Hampshire State Senator Jackie Cilley, Joe Loring, Executive at St. Joseph Hospital and James Unland, President, The Health Capital Group.  Click here for the full transcript.

 

Let’s face it, health care has a lot of “secret pricing”, but state lawmakers are starting to tackle one of the best kept secrets in health care – facility fees.  These facility fees can add hundreds and even thousands of dollars to your medical bill.  Hospitals say the fees are essential to their bottom line, but critics point to these fees as a major contributor to the high cost of health care.   

 

When you are paying out-of-pocket costs for health care services, these prices can make a huge difference.  For consumers that are uninsured or that have high-deductible plans, knowing the difference between an independent practice lab or one owned by a hospital can save you hundreds and possibly thousands of dollars.  When consumers go to a hospital-owned practice or facility, their bill includes the cost of the hospital’s overhead – aka “facility fee.”  This explains why hospital outpatient services usually cost more than the exact same services offered by an independent  stand-alone facility.  For example, an independent diagnostic facility charges $65 for an x-ray, while the hospital charges more than $260 for the exact same service.  The average consumer has no idea these fees even exist.   In many cases, the facility fee is simply included in the total cost of the visit, making it impossible to see.  Many consumers are not even aware that the provider they’re visiting is owned by or affiliated with a hospital.   So be sure to call and ask before you make an appointment at a facility.

 

In 2006 facility fees made national headlines when patients brought two class action lawsuits against Seattle hospitals.  One of the patients had a five-minute procedure performed at a clinic owned by the University of Washington Medical Center and was billed more than $8000.  Nearly $7000 of this bill was for the facility fee.  The medical center settled the case and agreed to disclose its prices.   Interestingly, once the prices were made public, the hospital could no longer justify the unreasonably high prices so they discounted their fees by 40% for about 1400 outpatient procedures.  Here is a link to the hospital’s public prices.

 

Let this be a lesson for all:  you can save a lot of money by asking providers what a procedure will cost – beforehand. 

One out of every ten patients now has a consumer-driven health plan, so hospitals are starting to become proactive bill collectors.  An article in the Minneapolis Star-Tribune discusses how hospitals in the Twin Cities are starting to telephone patients before their scheduled procedure to review how much they will owe out-of-pocket.  As strange as this seems, it’s really a step in the right direction for our health care system.  Patients (consumers) are becoming more aware of the true prices for health care services.  This behavior encourages consumers to comparison shop to find the best value and make the most of their health care dollars.  If patients continue to pressure providers for true prices, we will start to see health care prices become publically available, resulting in competitive pricing, innovative services and improved  patient care. 

 

This is very good news for health care consumers.

 

Today’s Wall Street Journal shares some helpful tips on how you can cut your medical costs.   Many of these tips have been mentioned in earlier posts on this blog, but this information is important enough to repeat once again.  These tips can actually help make a difference in making your health care dollars go further.  I am an advocate of consumers taking control of their health care, including making informed choices, shopping around for the best value and doing your research – before visiting a provider.  

 

For the full article, read Financial Prescriptions:  Seven tips for cutting your medical costs.

 

1.  Find the right health insurance plan for you and your family.  You need to know what your health plan covers, what’s not included and what your maximum out-of-pocket expenses are.   Read the fine print very carefully.  Consider looking into CDHPs with high-deductibles.  A high-deductible health plan can seem daunting, but when you understand and take into account all your costs including premiums, co-pays, deductibles, co-insurance fees, you can actually come out ahead with a high-deductible plan.

 

2.  Shop around for the best care.  Consumers are expected to compare quality and prices for providers and services, but this sometimes is easier said than done.  Comparison shopping is possible to accomplish, but you need a lot of patience and persistence and to be resourceful.  Keep a spreadsheet of providers, prices, inclusions and start making those phone calls.  Call your providers.  Call your health plan.  Make sure you contact your health insurer, potential providers, their competitors, and hospitals --to determine your out-of-pocket expenses for specific procedures.  Be sure to take advantage of websites that publish prices for consumers including vimo.com, healthcarebluebook.com, costhelper.com,  newchoicehealth.com and of course, outofpocket.com.   For a more complete list of websites that provide pricing, visit Tools For Consumers to Look-up Prices.  

 

3.  Take control of your treatment.  You are your own best advocate for your health.  Take an interest, ask the provider questions, bring along another person for a second set of ears, seek a second opinion, and be sure to research the provider before services are performed. 

 

4.  Take care of hospital bills.  Don’t pay providers directly until you receive the EOB from your health plan.  When you receive the bill, make sure you scrutinize the bill for errors.  If you are uninsured and paying cash, make sure you negotiate with the provider to receive a 50% discount from the list price or 125% of the rate Medicare would pay for this service.  By the way, you can easily look up Medicare payment amounts on this public website  

 

5.  Manage your medications.  Always make sure your primary care provider knows about all the medications you might be taking because it may not be necessary to take all the medicine being prescribed.   Some medications might be a version of the same medication, or cause harm when taken together.  Inquire with your doctor about using less expensive generics.   Look into mail-order pharmacies and comparison shop for drugs using the Consumer Reports website.  

 

6.  Focus on prevention.  Being healthy is definitely less expensive.  Simple changes like eating healthy, exercising daily, get enough sleep at night can make a tremendous improvement in your overall health.

 

7.  Be careful about skipping care.  When money is tight, many people cut health care spending and this can sometimes result in more expensive care later as the condition progresses.  Some procedures can be postponed.  Instead of skipping preventative care, you should look into more affordable options like retail clinics, local community screenings, immunizations and urgent health care centers (rather than emergency room visits.)

 

 

OutofPocket.com was launched in 2007 to help consumers look-up prices and find affordable health care services.  For two years, OutofPocket.com has been the consumer’s voice promoting price transparency in health care, appealing to the 47 million Americans that are uninsured and consumers with CDHPs.  Today, with so many employers struggling with rising health care costs, consumer driven health plans are rapidly becoming the number one choice for their affordability.  As these employers adopt CDHPs for their employees, OutofPocket.com becomes a useful tool to help employees reduce their out-of-pocket expenses and make informed choices before purchasing health care services. 

 

Being a savvy health care consumer saves you money and reduces your health care costs.  In addition to reducing your out-of-pocket expenses, here are some other practical tips you can use from CheckPoint HR Benefits Group, on how to reduce your health care costs.

 

Work with your doctor.  Most doctors understand the business and processes of insurance. Tap into their knowledge base for the best possible hospitals for specific procedures.  Many doctors can provide patients with guidance in negotiating fees and/or working with the insurance companies on lowering out of pocket costs. In some instances, doctors will reach out to the hospital's finance department (on behalf of the patient) and request that consideration be made when dealing with the finances of certain procedures. Bottom line, communicate and work with your doctor!

 

Know all of the benefits available to you.  Insurance programs are aligned with a lot of ancillary benefits that consumers should be made aware of. Benefits such as gym reimbursements, employee assistance programs, massage therapy, chiropractic care, acupuncture, vision reimbursements, weight loss programs, free or low cost flu shots or immunizations, disease management programs, health coaching or nurse advice lines, are no cost preventive benefits. Make sure you read the fine print and take advantage of everything that is being paid for via premiums.

 

Be a smart consumer.  Individuals today have better access to information than ever before. With more control over their own health care, consumers are able to make educated and more informed decisions about options, procedures, costs, and treatment. Some insurance companies now have released the costs for certain procedures covered under their plans on their websites. This information allows individuals to better understand the true costs of care before they utilize their plan and allows them to make better financial decisions based upon quality as well.  If your insurance plan does not provide this information, you can use tools like OutofPocket.com to look up prices and find the best value.

 

Go generic.  High deductible plans are taking traction in the workplace and with that so does the need for employees to manage their costs with more scrutiny. One consideration for maximizing your benefits without sacrificing quality is to ask your doctor about a generic drug. When working with your doctor, ask them if the prescribed medication has a generic equivalent that will work for you. If there is a viable equivalent, make sure the medication is listed on the formulary list that your insurance carrier make available on their Website.

 

Focus on wellness.  One of the best ways to reduce health care costs is for people to get healthy! Companies today are rewarding employees who are proactive in their decision making and who lead healthier lives through physical fitness and increased presenteeism. Corporate Wellness programs offered today focus on tobacco cessation, know-your-numbers (BMI, Blood Pressure, Cholesterol), walking clubs and programs that increase physical activity and reduce negative behaviors towards health.

 

The original idea behind OutofPocket.com was to build a platform that would enable consumers to collaborate.  Consumers would use OutofPocket to post/share prices they paid for actual health care services.  This collaborative effort over time would result in a very powerful directory of true prices that consumers could use to find the best value and make the most of their health care dollars.

 

If enough consumers start shopping around for the best value (quality and price), providers would start competing for our attention and good things would result.  Competition and choice will:

·         Lower costs of health care services

·         Promote innovation

·         Expand choice

·         Increase access to medical care

·         Improve patient care

 

My challenge is getting people to participate in OutofPocket.com and start posting/sharing prices.   People respond to incentives.  Perhaps exposing health care prices and helping to create more competition and choice in the health care industry is not enough of an incentive.  If you give people more of a reason to do something, they will do more of it, and if you make it easier for people to do more of something they are already inclined to do, they will also do more of it.  Today health care costs are spiraling out of control; we have more than 47 million people that are uninsured and over 12 million people with consumer-driven health plans.  These combined 59 million Americans have every reason to make the most of their health care dollars and find the best value.   These people are financially rewarded if they make their health care dollars go further.  If I knew I could save myself $500 by shopping around for an affordable MRI in my neighborhood, I certainly would be financially motivated to take advantage of this savings.

 

If you know of one of these 59 million people – please let them know about OutofPocket.com.  Or even better, drop me a note info@outofpocket.com to let me know how I can help.   

 

Be Healthy,

Mona Lori