Spending and Saving

Keeping Healthcare Costs Down

The cost of medical care can be astonishing in the best of times. In a down economy you feel the pain even more—especially as policies change. For example, doctors may require you to pay up-front for services, then collect from your insurance company. Or, they may charge you for the remainder of their fees not fully covered by insurance. Then there are the health insurance companies, which are more prone to question, delay or deny insurance coverage for treatments.

You don’t have to feel helpless in the face of these challenges. Armed with some knowledge and the willingness to argue for your rights, you can keep those costs from killing you.

Be proactive: Before having a procedure, get preauthorization or clearance from the insurance company. This way you know what to expect in terms of coverage and payment responsibility.

Need creative ways to get coverage? Read our No Insurance Survival Guide.

Know your rights: Say you see an in-network surgeon at an in-network hospital, but have an out-of-network anesthesiologist. Often insurance companies will reject or limit the anesthesia coverage, claiming that you did not use an in-network provider. But the surgeon and hospital were both in-network, and you had no choice in the anesthesiologist. Fight it. There’s a lot of money at stake.

Know your responsibilities: Often doctors send bills indicating the total amount as your tab, either not deducting the insurance amount received or simply leaving it up to you to recoup fees from your insurer. Before paying a medical bill, check with your insurance carrier to find out what’s your responsibility, so you don’t overpay.

Get prescriptions by mail: Using the mail order option provided by big insurance companies like Cigna and United Healthcare, you can order a three-month supply of medication while paying for only two months. The doctor has to write out a three-month prescription and you send it in with your two-month payment. Just keep in mind that there is a lag until you actually receive the prescription; so make sure you have enough of the medication on hand to carry you through the waiting period.

Shop around: If you need your medicine right away, comparison shop at your local pharmacies. Consider some of the deals offered by retailers like Walmart and Costco. Some offer generics at a reduced rate and don’t require store membership to use the pharmacy.

Get a pill cutter: Since a pill with twice the dosage doesn’t necessarily cost twice as much, doctors will often prescribe a higher dosage of medication and tell you to cut the pills in half, thus lowering your cost. Some insurance companies even suggest doing this.

Keep track of  bills and payments: Keep a careful record of what has been charged and what has been paid. Errors are made all the time, so be sure to take up discrepancies with your insurance carrier.

Don’t be intimidated: In-network providers cannot charge you more than the fee they have agreed to with the insurance company. If the doctor seeks payment beyond that, remind the staff that you are an in-network patient. If they won’t remove the charge, contact your insurance company to have the discrepancy resolved.

Nancy C.L. Stein, an attorney and a health-care coverage consultant, assists patients in obtaining insurance recoveries and resolving doctors’ billing disputes. She can be reached at 516-816-3691 or nancyclstein@yahoo.com.

Tags: frugal, health, spending