I’ve always been fit. Even well into my 50s, I felt physically invincible. I could still jump out of bed for a morning run, followed by a strength class and then even possible game of tennis later in the day. Nothing could quell my energy.
Going into retirement with my husband, we had a world of adventures before us. Then menopause slammed into me like a Mack truck, ravishing what seemed like every joint and muscle in my body. I could barely get out of bed in the morning. Yet, I was determined this could be fixed.
Countless visits to multiple medical specialists did little to stem the growing aches and pains. The bills started to pile up. And to add insult to injury, our insurance coverage was far less generous since we had left the work force.
I soon realized that I couldn’t continue seeking medical advice unless I found ways to cut the associated costs. I’ve since discovered that there are a number of ways to keep medical costs in check.
We’ve learned to keep a close eye on our medical bills because of several experiences. At one time, we were billed improperly for my husband’s colonoscopy – a procedure considered preventative by our insurance plan and therefore 100% covered regardless of whether we met our deductible.
In the event a polyp was identified and removed during the procedure, we would be billed only for the surgical removal; not the baseline diagnostic procedure or the facility. However, the gastroenterologist billed us for part of the baseline procedure and the facility, in addition to the surgical removal.
After several phone calls to our insurance agent and the doctor’s office, we were reimbursed for the charges. But nobody reimbursed our time and stress.
What did we learn from this ordeal?
- First, call your insurance company in advance of a procedure and find out exactly what they will cover.
- Second, be specific. Ask your insurance agent for the code associated with your procedure and provide that code to your doctor’s office.
- Third, never pay a bill until you’ve received the EOB from your insurance company that lays out how much the procedure costs and how much out-of-pocket you’ll be expected to pay.
There are many other steps you can take to protect yourself from unnecessary costs. Following are tips from the experts. For a more in-depth review of possible cost-savings, I recommend you read the full reports cited.
The most basic and important consideration is whether your medical provider (for example your doctor, hospital, radiology facility, etc.) is in-network or out-of-network.
Insurers will pay a larger portion of your cost for those providers they have an in-network contract with. This can be daunting if you find yourself hospitalized with multiple doctors checking in on you.
According to one investigative report on medical costs, many hospitals around the country hire physicians employed by staffing companies. These contracted physicians may not be part of the hospital’s insurers’ network, and therefore, can charge the patient more than the in-network fees.
Always ask whether the doctor seeing you is in-network.
According to a May 2018 Consumer Reports in-depth study of prescription, total drug costs went up with 6.3 percent from 2015 to 2016. The study offers a laundry list of options for reducing costs. Following are just a few highlights:
- If a drug is necessary, ask whether there is a generic or less costly alternative that would be equally effective.
- Cost compare with different local pharmacies. CR found that the same prescription drug can vary by hundreds of dollars at different pharmacies, even within the same locality.
- Investigate 90-day prescriptions to reduce how often you need to cover co-pays. Or paying in cash for a 90-day supply may be cheaper than the three co-pays.
- Search for manufacturer coupons by checking the manufacturer’s website or visit Medicare’s online pharmaceutical assistance program.
Urgent-care centers are usually far less expensive than emergency rooms and often cheaper than a doctor’s office. According to Cigna, a health insurer, the average emergency room visit costs $1,757 compared with $153 for an urgent-care center. (Kiplinger’s Personal Finance, November 2017).
However, that said, there can be a wide spectrum of quality among urgent-care centers and the doctors serving within those centers. Do a bit of sleuthing to identify the best centers near you and always make sure in advance that they accept your health insurance.
Radiology fees for the same procedure may also vary significantly, without any difference in the quality of service. Shop around for the best price. Costs for an MRI can fluctuate by a couple of thousand dollars, according to one study.
For example, an abdominal MRI at one facility cost $4,458 out-of-pocket, while another local facility charged $672 for the same procedure. Independent radiology centers often charge less than hospitals, even though the same radiologist may be reading the x-rays.
- Call your insurance company in advance of a procedure and find out what they will cover.
- Never pay a bill until you’ve received the EOB from your insurance company.
- Make sure your doctor is in-network with your insurance plan.
- Ask for the generic version of a drug you need or shop around for better prices.
- Shop around for urgent care and radiology centers (See box).
How much did you pay when you last visited your doctor? Have you had any incidents with overcharging? Are you cautious when it comes to medical bills? Please share any valuable lessons you have learned.
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