By Victor H. Chou, M.D.
With gas and food prices through the roof, families everywhere are looking to save wherever and whenever they can. Did you know that the average family spends double what they should on their out-of-pocket medical costs? In this article, I’ll describe nine tips to help your family save on medical costs, yet still receive the same high quality care that you deserve.
TIP #1: Have a good primary care doctor.
Families that have a good primary care doctor can save a lot of money in a year’s time. There are a number of reasons why, but one of the main ones is that your doctor will often be able to manage simple illnesses over the phone, avoiding the need for a trip to the doctor’s office (and subsequent co-payment). If you get sick when the office is closed, calling the regular office number will usually transfer you to an on-call service that can promptly connect you to your family’s doctor or nurse.
TIP #2: Take advantage of nurse advice lines
If you can’t get in touch with your normal physician, a good next step is to call a nurse advice line. Some community hospitals provide this service free of charge and the service is usually available 24 hours a day. Also, your insurance company may include a free nurse advice line as part of your insurance benefits. The nurse can help you decide whether you need immediate care or whether you can wait until the next day to be seen and give you additional advice to help you get through the night in one piece.
TIP #3: Plan your after hours options beforehand.
Many people don’t realize that if you seek medical care after hours, your out-of-pocket cost could be double, triple, or even ten times higher than your regular doctor’s co-payment (depending also on whether you go to a walk-in clinic or the emergency room). Unfortunately, many patients seek care first and then get sticker shock when they get a bill in the mail for a $100 co-payment, when their regular co-pay would have been $10 had waited until the next day to see their regular doctor.
Because it’s sometimes difficult to double-check your insurance options in a pinch, find out the locations and hours of nearby walk-in clinics and hospitals and verify ahead of time the co-payments that you would pay at each one.
TIP #4: Stay in-network.
Why pay huge bills to see an out-of-network specialist when the very same specialists are available in-network for a fraction of the price? If your doctor recommends evaluation by a specialist, make sure to call your insurance company before your visit to see if the specialist is an in-network provider. If he is, then your costs will be more predictable and follow the terms of your insurance contract. If not, then I would call your doctor back and ask for a referral to a different, in-network specialist. Better yet, bring a list of the specialists who participate in your insurance plan with you to your appointment and your doctor will have an easier time picking out someone that’s right for your medical situation and your finances.
TIP #5: Double-check any additional bills with the provider and insurance company.
If you’ve stayed in-network and receive additional bills beyond what you’ve already paid for co-payments and deductibles, the first thing to do is to call your insurance company and find out why they denied this particular claim. Sometimes, patients do get double billed even when the insurance company has paid the claim, so be careful that you’re not paying twice! Other times, a simple mistake like the wrong policy number, social security number, or date of birth is enough for a claim to be rejected. If the error was on the part of the provider, have them correct their mistake and re-submit their claim to the insurance company. If you believe that the insurance company was in error, then your next step is usually to file a formal appeal as outlined in your insurance documents.
TIP #6: Choose a high deductible plan only after careful consideration.
You may have noticed a new type of insurance plan being offered by your employer featuring drastically lower monthly premiums. These newer plans are called high deductible health plans (HDHP). They feature lower premiums than your more traditional health insurance plans but with one big caveat: the deductibles are very high, sometimes as much as $5,000 for a family plan. So while you might save a few hundred (or possibly even a few thousand) dollars a year on insurance premiums, if you have one bad illness or injury, it could wipe out a couple year’s worth of savings in one swoop!
In my opinion, patients with chronic illnesses or who are likely to run up large medical bills (such as children who participate in contact sports or a mother who plans to get pregnant again) should avoid these particular plans. Of course, every family’s personal situation varies, so please consider carefully and speak with a professional if you are considering changing to this type of plan.
TIP #7: Ask for generic medications.
Did you know that the average generic medication costs around $5 while a similar brand name medication costs around $25? With these types of savings, it amazes me that more patients don’t ask for generic medications. Generic medications are also very safe and effective, even when compared with their name brand counterparts. Next time you’re prescribed a medicine, ask your doctor if a generic version is available. The savings could be substantial.
TIP #8: Know your insurance plan’s formulary.
Sometimes, a generic medication isn’t available for your medical condition. In those cases, a brand name medication will be necessary. That doesn’t mean, however, that you’re stuck paying high prices each and every time. Have your insurance plan’s formulary (which is basically a list of in-network medications) with you when you see the doctor and ask your doctor to prescribe a medication that’s on the formulary. For example, many insurance plans charge $15 for medications on their formulary but charge $50 for medications not on their formulary, even though both medications are basically the exact same thing. Having the formulary with you (call your insurance company for a copy) allows the doctor to easily prescribe the medications that will cost you the least amount of money but still meet your medical needs.
TIP #9: Preventing illness is more cost-effective than treating illness.
One of the most underutilized techniques for saving money on health care is to prevent illness rather than treat it. This technique works for a large variety of conditions, including the flu. For example, a preventive flu shot usually costs around $25, but if you instead came down with the flu, you’d probably spend closer to $100 on doctor’s visits and medications, not to mention all the days of missed work and school.
Dr. Chou practices in Baton Rouge, LA. His website is www.choumd.com.
