Sometimes, the devil is in the details. That’s a rule that applies to health care as well; the more you know, the better off you will be. Here are 10 ways you might be surprised to know you can save money on the one truly priceless thing you have: your health.
1. Prescriptions may cost you less if you don’t use your insurance.
As difficult a pill as this is to swallow, your best deal on some commonly prescribed drugs may be found by ignoring the drug coverage you pay for and instead just reaching for your wallet. Often, your insurance drug plan requires a copay that is higher than the cost of paying cash at the register.
Several pharmacies, including Walmart, charge as little as $4 for a 30-day supply of some generic drugs, or $10 for a 90-day supply. Costco has an even longer list of low-cost generics and doesn’t require a membership to use its pharmacy. Costco also offers a home delivery service and will also fill prescriptions for your pets.
David Belk, a physician in the San Francisco Bay Area, who runs the website, TrueCostofHealthcare.org, suggests that before you hand your insurance card to the pharmacist, use your insurer’s or employer’s tools to check your out-of-pocket costs for your medications. Compare that with the pharmacy’s cash price. This strategy often saves money on generics, but might not bode as well with brand-name drugs, Belk says. With more expensive drugs, the insurance company may have negotiated a lower rate.
2. Ask your doctor for both samples and coupons.
When your doctor prescribes you something you haven’t taken before, neither of you know whether you will have an adverse reaction. It is a perfectly legitimate to ask for a sample that you can try before you spend money on filling a prescription.
But also ask for a coupon! Yes, drug manufacturers frequently give the doctor a pad of discount coupons to dispense along with the prescriptions. The last thing the drug manufacturer wants is for you to get to the pharmacy, hear the price and walk out. The coupon strategy, while a bit like buying cereal in the supermarket, makes the customer feel good about a break. But a good many physicians simply ignore or forget about the coupons; you, on the other hand, shouldn’t.
3. Hit up the drug manufacturers for discounts.
Many drug companies have assistance programs for their medications. In some cases, they are need-based ― but not always. Sometimes you just need to know to ask. You can check what’s available here based on drug name. Or google the name of your medication and the word “coupon” and see if the drug manufacturer’s website has details. Prozac is covered by the Lilly Cares program. The high price of Renvela, a phosphate binder frequently prescribed for kidney dialysis patients, drops to $5 a month with a simple one-page form asking for the patient’s name, date of birth, address, and the location where dialysis was being given. Renvela costs several hundred dollars otherwise.
4. Consider an HMO.
In an HMO, you are restricted to treatment by providers who work for the HMO. Visits to doctors and hospitals outside of that HMO typically aren’t covered, except in emergencies. Doctors work for the HMO, not the patient although they are professionally bound to deliver the best care possible. The long-ago days of HMOs having a bad rap have passed.
HMOs restrict your choices, but greater freedom has a heftier price.
5. If you don’t need a Cadillac, why not just buy a Ford?
In general, you will pay higher premiums if you want to retain the flexibility of seeing any doctor of your choosing.
Why do people care about doing that? In some cases, they have a long-standing relationship with a particular doctor who doesn’t happen to be in their company’s insurance network. They want to keep seeing him, so they choose a PPO that allows them to do so even if it means they will pay more.
Why else? Some people feel that if they should get seriously ill, they will want to see the top specialists in that field. It’s the old joke: What do you call that guy who graduated dead last in his medical school class? You call him “Doctor.” If you’ve just been told you are terminally ill, you may not want that guy.
It seems obvious but bears repeating: If choice isn’t important to you, why pay for it.
6. Practice asking: “Are you in-network?”
Whenever it is in your power to do so, book appointments with practitioners who are in-network for your plan. This means they have agreed to accept a certain amount for their services and you will only have to pay your copay and deductible. At least in theory.
Alas, if it were only this simple.
Your doctor may be in-network, but is the lab he sends your blood to also in-network? If not, you may get a bill and be expected to pay it. What about the specialist he sends you to for that rash? Before you make an appointment, find out if she is in-network.
Things get really dicey when your in-network doctor sends you to an in-network hospital, but the emergency room doctor, the hospitalists, the surgeon or anesthesiologist are all out-of-network. Yes, what you are supposed to presumably do is stop the doctor with the chest paddles and ask if he takes your insurance in-network. Absurd, right?
The situation has gotten so out of hand that a Kaiser Family Foundation study reported that nearly 7 in 10 people with unaffordable out-of-network medical bills did not know that the health care provider was not in their plan’s network at the time they received care.
7. Ask if your doctor plans to “balance bill” you, and if he does, go elsewhere.
Balance billing is when a provider takes the money from your insurance plan, decides he’s entitled to more, and then sends you a bill for the rest of their desired fee, aka the “balance.” Mind you, they likely never told you upfront that they intended to do this. Nor do they tell you just how much they will bill you for.
Balance billing has been deemed illegal in some states under certain circumstances. Just last year, New York set limits on these bills from out-of-network providers in emergency situations and in non-emergency situations when patients receive treatment at an in-network hospital or facility.
Talk about a situation begging for a federal solution.
8. Ask to see the itemized charges sent to your insurer.
You may be amazed to see how often your doctor’s office messes up. A wrong billing code can cost thousands of dollars more. There is plenty you can learn from seeing an itemized bill, and a lot of it may raise your blood pressure. You might even discover that you were billed for procedures and things that didn’t actually occur.
NerdWallet found that 49 percent of Medicare medical claims contain medical billing errors ― resulting in a 26.4 percent overpayment for the care provided. Stephen Parente, a professor of health finance at the University of Minnesota who has studied medical billing extensively, estimates that 30 percent to 40 percent of medical bills contain errors. The Access Project, a Boston-based health-care advocacy group, says it’s closer to 80 percent. And these mistakes are adversely impacting our credit. An estimated 9 million people in 2016 were contacted by a collection agency because of a billing mistake, according to the 2016 Biennial Health Insurance survey by the Commonwealth Fund, a Washington-based nonprofit focused on health-care research. Medical bills account for more than half of all debts in collection, said a Consumer Financial Protection Bureau study.
So it behooves you to ask exactly what you are being billed for.
“Sometimes, just requesting this information [an itemized bill] is enough to rattle a billing employee into action,” notes the Medical Billing Advocates of America.
Let’s rattle, shall we?
9. Take advantage of free screenings and flu shots.
Nothing beats free. Drugstores, employers and even shopping centers are getting in on the free game. Blood pressure tests, health screenings and flu shots can generally be found in your local community. If you are a senior, try your local senior center. If you can’t find free, Costco and Sam’s Club offer them for about $15, which may even beat your copay for an office visit to your doctor.
10. Try Living Social for dental cleanings.
Dental insurance is often capped and won’t pay for cosmetic work. If you get it from your employer, good on you. But the idea of buying it on the open market gets mixed opinions.
Instead, consider this: Negotiate a cash price with your dentist for any major dental work and use Living Social vouchers for routine cleanings and exams with X-rays. The prices range from $19 to $50 and are generally offered by dentists hoping to grow their practices.