The Expatriated Consumer

Imagining life without debt. Working to make it reality.

Doc, that hurts!

Posted by Max Finkle on June 27, 2008

Never thought it would come to this. I’ve now had to start bargain hunting for medical care. Yep. That’s what I’m reduced to. The cost of medical care has skyrocketed, never mind that that my out-of-pocket costs increased dramatically when I relocated, what with a higher payroll deduction for insurance, to higher copays for services and prescriptions, and having to pay out of pocket for expenses that are not covered.

I find myself having to improvise, to stretch my dollar as much as possible. I am not going to skimp on my health, or my family’s because the cost is too much. I consider it a non-discressionary expenditure, so I work the system as much as I can to my advantage. Some things I do, in no particular order, to reduce my overall medical costs:

Shop around to get the best price on prescriptions and over-the-counter medications. My favorite is CVS’s ECB bonus program; at one time I was receiving a $5 off a $20 dollar purchase coupon for each new prescription I brought in. That paid dividends numerous times this year. You can also use those same coupons towards your copay. According to my local store, you can’t use ECB’s accrued from product promotions, though. Check with the pharmacy, too to see if your prescription qualifies for a discounted copay, as many are offering hundreds of prescriptions for as low as a $4 copay now.

I also shop at in-hospital pharmacies. Most hospitals have one, and oftentimes they offer many over-the-counter medications for retail sale, as well as prescriptions. One near me offers a bottle of 100 ibuprofen (same thing as Advil) for a mere $1.86. The generic version at the local big box retailer is upwards of $7. Children’s acetamenophen (Tylenol) & children’s ibuprofen are offered for 2-3 dollars less than the retail giants. I don’t get there often, but when I do, I stock up.

Find an “in plan” provider. Contact your health insurance company and ask them if they offer a list of doctors that are preferred providers for your plan. This can pay in a couple of ways, the most obvious being that often times there is a reduced copay for seeing those doctors on the list as opposed to one that is part of the “extended network,” or providers that accept your insurance, but aren’t part of the “inner circle” as I like to refer to it as. Weigh the pros & cons; for example, before I relocated halfway across the country, I continued to see the same doctor I had for the previous ten years despite higher copays with my last job’s insurance plan. This paid off because he knew me, knew what to expect of me, and tailored my care to that.

Ask the doctor if a recommended follow up appointment is truly necessary. She may put the decision in your hands. I’ve gone to the doctor for everything from broken ribs, to cuts, colds & sore holes and my previous doctor never recommended follow ups unless I felt like I needed it. He never blindly had me schedule another appointment simply so I could fork over a copay to be told the treatment worked, when I knew that already. Instead of having me come in to review lab work, he would call me, and council me over the phone, if say, my cholesterol was high, to remind me of the consequences, and encourage me to change my eating habits.

Conversely, I’ve been to a doctor who wanted to follow up every 4 months to evaluate a treatment I was receiving, when I knew the treatment was working for me, because I felt better, and was experiencing no side-effects. After the first 4 months I didn’t bother going back. I emphasize that I am comfortable with that decision because of the nature of the issue. Use your head, though, and don’t skip out on follow up appointments that are truly necessary – please don’t endanger your well being, or your life. Your doctor needs to monitor the effects of many therapeutic drugs, such as Coumadin, Depakote, and blood pressure medications, for example. Some of those medications, when not monitored properly can cause very serious problems. Carefully evaluate your circumstances, talk with your doctor, but most importantly, if you’re unsure, go to the appointment.

Utilize telephone triage services at your doctor’s office, your local hospital, or through your insurer. Don’t be afraid to call in and ask to speak to a nurse or a doctor over the phone to discuss health concerns. This can work well if your doctor knows you well, and especially if she knows your financial situation. You may have to leave a message with the office to call you back, but oftentimes they can tell you from your description of your concerns whether or not you should make the trip to town. The worst that will happen is they will recommend that you come in to be seen. All it cost you is a phone call, and it can save you copays & mileage, and even the entire office visit fee, as was my case a few years ago when I was uninsured.

Make sure that auxilliary services in your doctor’s office are covered by your insurance. I know here in Texas, insurance coverage is very fragmented, and I’ve received bills in the mail for laboratory services that I assumed were covered at my doctor’s office, only to find out after the fact that my insurance mandates that my labs be processed by one particular contractor, leaving me with a big ‘ol bill to add to the top of the pile.

Price shop for procedures. We had a recent non-emergency surgery in our house, to take place in an outpatient setting. We received a call from the anesthesiologist’s office letting us know that we had to pay an additional $500 for their services that were not covered by our insurance (instant headache & nausea…) After pow-wow’ing with our doctor, we discovered that it was cheaper for the procedure to occur in the hospital surgical center next door, than it was going to cost in the doctor’s office. Why? Because our insurance is directly associated with the hospital, and the anesthesiologist was not. The doctor’s office explained that for most folks, it’s less expensive in the outpatient setting, and oftentimes more convenient, so they had blindly assumed that was the case for us. The icing on the cake: we even saved on the office visit copay, since hospital procedures are covered in their entirety. Work with your doctor & insurance to find out what works best for you.

Utilize your healthcare spending account (HSA) benefits at work. May as well pay for as much of your healthcare as possible with pre-tax dollars. That can equal as much as a 30% savings on all of your healthcare expenditures up to $1500 annually. Watch yourself though, because once you commit a particular amount to the HSA, you’re locked in, and whatever you don’t use, you lose. There is a myriad of things you can use it for, so familiarize yourself with it to get the most out of it. Don’t be afraid to talk to the folks in your human resources department if you have questions.

Healthcare costs keep growing and growing, with out of pocket contributions from patients increasing annually. Get the most bang for your buck, by knowing what’s covered by your insurance, and familiarizing yourself with the in’s & out’s of healthcare in your area. Ask questions. It’s your right to know all the alternatives, and you have the final say in what happens to you. Hopefully, with a little bit of work, and utilizing some of the ideas above, you can get the healthcare you need, without finding yourself in the poor house.

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