Maybe you’ve experienced this on your own: Out-of-pocket expenses for hospital patients have jumped sharply, according to a recent report in the Journal of the American Medical Association. Between 2009 and 2013, patient shares of the cost of in-hospital stays were up 37 percent. Deductibles grew by 86 percent and coinsurance was up a third.
Many consumers don't realize there are ways to reduce such costs.
Wendie Howland, a Cape Cod, Massachusetts-based certified nurse life care planner and legal nurse consultant, had a routine screening procedure — and then received a copay bill she didn't expect. Under the Affordable Care Act, tests like mammograms and colonoscopies for screening purposes "are free, with no copay or coinsurance" if there was no previous diagnosis and no other procedure performed at the time. She checked the diagnostic codes and then got on the phone. "I had to teach my insurance company not to pay those claims if they're submitted that way," she said.
Given the complexity of the medical and health insurance system, finding these cost-saving measures isn’t always easy. So we turned to the people who know the system best — medical professionals. Here are tips from industry pros on how to contain your health care costs.
Study Up, Then Look for Mistakes
First, get educated. Yes, it’s a hassle, but it can really pay off in terms of both your health and your finances.
Learn basic first aid from a text or course and bone up on what over-the-counter medicines you should have on hand and how to use them. "Don't go rushing reflexively to your primary care or [local clinic] for everything," Howland said. Knowing some basics — like the fact that antibiotics don't work on viruses so are no use if you have a cold — will help you avoid unnecessary costs.
Read your insurance plan to know specifically what is covered. If a specialist charges too much for a copay, you'll know it. Ask for reports after examinations and procedures to see if a term like "polyp" unnecessarily turns a screening into something more expensive. To translate between codes and procedures, go to a web search engine.
Lynn Pokrifka, a Jenkintown, Pennsylvania insurance broker, says time pressures for medical personnel can create problems for you. She finds ambulance services are frequently charged incorrectly, for example. "Because they're in a rush, [ambulance personnel] don't take insurance information," Pokrifka said. The bill then doesn't receive the right processing and someone decides to get the money from the patient. The same happens if lab bills come in and don't immediately match office visits.
Bring comparison shopping skills to health care. Your doctor may send you to a hospital lab or imaging center, but it doesn’t hurt to check whether other options are available to you. "Free-standing labs...usually give bigger discounts to insurers than hospitals," Pokrifka says. If you have an unfulfilled deductible, having a test done by one of these labs rather than hospital facilities may be cheaper.
Online tools like phone app Health4Me and website Guroo.com can let you see typical market prices for common medical services, according to Dr. Sam Ho, chief medical officer of UnitedHealthcare. Price isn't the only consideration, but if it's unusually high at a facility, you want to know.
A number of experts suggested urgent care centers instead of emergency rooms for many issues. For treatment of broken bones, lacerations, acute allergic reactions and some other needs, "urgent care can often provide a better service that's faster, more efficient, more focused," said Dr. David Mathison, mid-Atlantic regional medical director of PM Pediatrics.
Some insurance companies require lower copays for urgent care facilities than ERs. Other types of standalone centers, like medical imaging, orthopedic surgery and even chemotherapy facilities, may also offer lower-price care because they don't support the same broad overhead of a hospital.
Mark Bogen, senior vice president and chief financial officer of South Nassau Communities Hospital in Oceanside, New York, says patients should ask for discounts. "All hospitals today have some form of a prompt pay discount," he said. Pay at the time of service and you might get between 5 percent and 15 percent taken off. If it's not clear what you owe because of a deductible, call the insurance company.
Invest in Cost-Effective Coverage
Picking the cheapest plan isn’t necessarily the best way to go. "Often we see patients pick a plan that's $5 cheaper a month only to end up spending thousands of dollars in extra out-of-pocket expenses throughout the year," says chiropractor Susan Lowery of Tumwater, Washington.
Dr. Stephen Schimpff, a retired specialist in Catonsville, Maryland, says that people with a chronic condition such as hypertension or heart disease and a high-deductible insurance plan might consider a direct primary care physician, also known as a membership or concierge doctor. Patients pay a monthly or annual fee in addition to insurance.
"It costs more for primary care but the downstream savings can be very substantial," Schimpff said. Rates run from $60 to almost $170 a month for unlimited primary care. "This means visits for as long as necessary, being seen within a day of calling, having the doctor's cell number to use 24/7 and use of email," he said. The doctor may pass on discounts from radiology and laboratory centers and sell you medicines at cost.
Find Discounts for Your Prescriptions
Speaking of prescriptions, a combination of discount cards from pharmacy chains and coupons from pharmacies and manufacturers can also offer better prices. "I provide health insurance to the employees and very good drug coverage," says Tod Cooperman, a non-practicing M.D. who founded PharmacyChecker.com, which shows prices from international pharmacies. "We actually found it was less expensive to provide prescription medications using discounts that are available, often for free in the U.S., than using our company insurance." And sites like PharmacyChecker or GoodRX.com can show you how prices for the same prescription vary among pharmacies.
Most important, remember that no one will look out for your interests more than you. So get educated, shop smartly, evaluate your options and negotiate for the best prices you can.