Syda Productions / Shutterstock.com
Editor’s Note: This story originally appeared on Living on the Cheap.
The last time I went to the pharmacy to fill out a prescription for generic ear drops to treat eczema, I nearly had a heart attack when they handed me the bill: $184.
Last time I paid $10. I pulled out my phone and found a coupon that reduced the price to $23 as long as the purchase didn’t get through my insurance company—which didn’t pay anyway.
In recent years, consumers have found themselves paying a higher percentage of their medical expenses.
The Affordable Care Act has given more Americans access to health insurance, but many of those plans come with high deductibles — which are also becoming common in employer-provided plans.
This change has made it important for consumers to approach medical care as they do with other purchases – when shopping not only for quality but also for price.
Unfortunately, the system doesn’t make it that easy.
A rule to know
Elnur / Shutterstock.com
“You’re going to get really frustrated if you try to behave like a consumer,” says Jeanne Pinder, Founder and CEO of ClearHealthCosts. “You’re going to get really frustrated because the system is broken.”
The first rule, experts and advocates say, is to ask your doctor lots of questions: Is this test really necessary? Is there a generic version of this drug? Are there cheaper alternatives to this treatment? And finally, how much will this procedure cost?
Pinder, a former New York Times editor, launched ClearHealthCosts in 2011 to provide more transparency on healthcare costs.
The site includes costs for common procedures in eight metro areas – New York City, Metro New Jersey, San Francisco, Los Angeles, Miami, Tampa-St. Petersburg, Philadelphia, and Dallas-Fort Worth — plus what Medicare pays for those procedures in cities across the country.
But to buy things like a gallbladder removal or a knee replacement, it may mean calling individual doctor’s offices, hospitals, independent clinics, and your insurance company. And even after all those calls, you still might not get good answers.
“It’s very difficult to figure out these things,” says Tracy Watts, a senior partner at Mercer, an executive search firm. “The more complicated the procedure you need, the harder it is to set a price.”
Why it is difficult to set prices
Zenstock/Shutterstock.com
It is difficult to pin down a price as most procedures involve multiple actors. A clinic’s fee may include the surgeon, the anesthetist, and the facility. Another can bill each separately.
That means before you commit to anything, you need to ask who will be involved in the process, make sure everyone is part of your insurance plan, and then compare prices.
If a high deductible means you pay most of the bills yourself, you might want to ask about the cash price, which could be lower than what you would pay if you claimed your insurance, says Michelle Katz, a registered nurse at Los Angeles who wrote “Health Made Easy”.
“It’s about being your own advocate,” says Katz. “It can be the difference between paying $150,000 for a procedure and paying $30,000 for a procedure.”
Despite the complexity of the system, there are things consumers can do to get better healthcare for less.
Here are 12 ways to save money on healthcare.
#1: Choose the right insurance policy
Valery Potapova / Shutterstock.com
That takes some work, says Katz.
You want a plan that includes your doctors, your medications, and provides care for all chronic conditions. Online information may be incomplete or out of date. So call the doctors to make sure they’re still on any plans you’re considering.
#2: Look for medication
worawit_j / Shutterstock.com
GoodRX lists cash prices for generic Lipitor in Fort Lauderdale, Florida ranging from $12.60 at Publix to $30.25 at CVS, with coupons on the website. Here I found the price of $23 with coupon for the ear drops.
The site does not include Costco, whose pharmacy is open even to non-members and often has lower drug prices. Walmart, Target, and many supermarkets offer $4 generic drugs — but not the same — that may cost less than your insurance copayment.
#3: Know what your health insurance covers
Rawpixel.com / Shutterstock.com
It’s time to deal with your policy before you have to use it.
Learn about pre-authorizations, emergency room visits, co-payments for doctor visits, and co-insurance for procedures.
#4: Ask if tests, prescriptions, or procedures are really necessary
AshTproductions / Shutterstock.com
The newest drugs aren’t always better than older, cheaper drugs. If you tell the doctor you’ll pay cash for what he’s ordering, he may suggest that you wait and see if the condition improves before ordering an expensive test.
Instead of paying for 20 physical therapy sessions, pay for one and learn exercises to do at home.
#5: Ask for prices in advance and ask about cash discounts
Floor image / Shutterstock.com
This may require calling your insurance company, doctor, and hospital to find out what a procedure or office visit will cost.
Remember that some doctors and institutions give a discount if you pay cash.
#6: Choose the right facility
LAND PROD / Shutterstock.com
Unless your condition is life-threatening, don’t go to the emergency room. A persistent cough or a broken finger may be treated better and at a much lower cost at a pharmacy or emergency center.
But not all clinics or emergency centers are created equal. Research the facilities in your area before you need them so you can make the right choice when you get sick.
#7: Check invoices and insurance statements for errors
insta_photos / Shutterstock.com
Even those with the best insurance policies are often billed for procedures that should be fully covered.
A coding error can mean the difference between a no-cost mammogram and a mammogram that costs $600.
Be vigilant in reviewing invoices and statements of benefits, the statements summarizing what procedures and services are covered and those you have yet to pay for. Keep track of who you spoke to and when, as calls are often recorded.
#8: Get copies of all your medical test results and records
Antonio Guillem / Shutterstock.com
Bringing these with you to consultations can reduce the number of tests and doctor visits required. If you recently had a test, you often don’t need to take it again.
Also, if you see a doctor with test results, they can advise you right away, rather than making another appointment after the test results come in.
#9: Take advantage of free screenings
Monkey Business Images / Shutterstock.com
Every community has health fairs that offer free screening for diabetes, HIV, high blood pressure, and other diseases.
By law, ACA-compliant insurance plans offer a series of screenings without co-payments.
#10: Negotiate large medical bills
fizkes / Shutterstock.com
If you go to a hospital or have an expensive procedure, you will receive an itemized bill, preferably before you leave the hospital.
Once you’ve verified that it’s error-free, ask the hospital’s billing department for financial assistance, a cash discount, or a payment plan.
If you have a lot of large bills, consider hiring someone to negotiate for you.
#11: Consider online, phone, or video consultations
Josep Suria / Shutterstock.com
Since the pandemic, video consultations have become common.
Amwell is among the companies offering video consultations with doctors ($79 for an emergency visit, less if your insurance covers it).
Some insurance companies and employer plans offer toll-free telephone hotlines that can sometimes answer questions 24 hours a day to help you decide if you need an urgent care visit.
#12: Practice prevention
imtmphoto / Shutterstock.com
That means taking prescribed medications, maintaining a healthy lifestyle, and seeing your GP for treatment of chronic conditions.
