How to cut down health care costs?
November 30, 2011 7:26 AM   Subscribe

How to cut down health care costs?

I'm hoping the collective advice and wisdom of metafilter can help me out.

Earlier this year my daughter broke her arm and at the advice of a friend we took her to a hand/arm specialist. In total we had 3 visits. Each visit was pretty routine. Take x-rays, doctor looks at x-rays for about 5 minutes to see how bone is doing, says it looks to be healing, put on a new cast, then come back in a few more weeks to check the progress. I think I have pretty good insurance (Blue Cross/Blue Shield) from my work, but there is a couple thousand dollar deductible.

In total we paid out of pocket about $600-$700. The insurance covered some expenses, but apparently not enough, and the doctor's office of course charges through the roof. The doctor's office did give us a discount for prompt payment, but still I think we paid quite a lot for a simple broken bone.

I'm not really looking to start a discussion of how bad, impractical, etc. the health care system is in the US. Please save that for another discussion. What I'm hoping to get are some ideas on how I can cut back the medical expenses next time this happens. I'm a novice when it comes to health care industry.

Is it possible to negotiate with my insurance company? What about finding a doctor? Is it feasible to shop around for the cheapest doctor? What other tricks help save money?

Thank you in advance.
posted by aarondesk to Health & Fitness (13 answers total) 4 users marked this as a favorite
FWIW, $700 over three visits including xrays, consults and re-casting seems totally reasonable to me. If this isn't sustainable for you, you need a lower deductible or a gap insurance plan.
posted by DarlingBri at 7:37 AM on November 30, 2011 [4 favorites]

The explanation of benefits from your insurance for the services should tell you your responsibility. If the doctor asks for more than this, talk to your insurance carrier. In many cases these are pre-negotiated rates, I have had doctors accidentally bill for more than the negotiated rate and a quick call to the insurance carrier (and I'm sure a call from the carrier to the doctor) cleared it up.

If these numbers line up, then it comes down to your insurance plan. I suspect a conversation with them might lead you to the best money saving tips - depending on your plan, certain doctors might have preferred rates ("in network") but this is all plan dependent.
posted by NoDef at 7:41 AM on November 30, 2011 [1 favorite]

I would start with a call to your insurance company to find out if they have a more preferred method of care. For example, depending on your plan, it might be much cheaper to take her to particular hospitable or doctor group. Specialists can be treated differently in regards to deductibles, % of costs reimbursed, etc.
posted by machinecraig at 7:42 AM on November 30, 2011

Also just to add - when shopping for a doctor, I always start with doctor's that are listed on my insurance site.

Other things to keep in mind if you are new to health care:
- Family Practice physicians can be great for checkups, routine shots, etc
- Your kids will need a pediatric practice, but for your own healthcare you may want to consider using an Internal Medicine doctor as your general "go-to" guy. I don't want to ruffle any feathers, but I have heard from doctors in my family that the difference in training and experience between Internal Medicine and Family Practice can be significant. It often means going to see one doctor rather than seing your Family Practice guy once, who then has to give you a referral to someone else, etc.
- With kids, I would find a Pediatric group that works well with my insurance.
- With kids, I would try to find an insurance plan that offers a very low deductible and very good coverage of costs. I would also try to get a prescription drug plan if one is offered through work. I think all of these are worth the extra money, because kids seem to be very prone to medical excitements.
- If you or your depedents have any chronic medical needs, you should check into whether your work offers a Flexible Health Savings Account. It lets you contribute pre-tax dollars to pay for health care.

Obviously your mileage and situation may vary - but that's what I would look for.
posted by machinecraig at 7:54 AM on November 30, 2011

That sounds (unfortunately) sounds like a realistic amount of co-pays for a broken bone. I paid about $700 in co-pays when I separated my shoulder and they didn't even do anything to it, just gave me a sling and told me it would be ok eventually on its own.

Anyway, some things that might help:

- avoid the ER unless it's actually necessary
- make sure you stay in-network
- mention to your doc that money's tight. It probably won't make a difference in most cases but they might decide to skip some x-rays every once in a while.
- You mentioned that you got a discount for prompt payment. If a doc is not willing to do that they may let you spread the bill out over several months with no interest charged. I called lately about some medical bills I have and they were willing to let me spread payments out over up to 6 months. Doesn't save me any actual money but it makes it a little easier to to not blow up the budget.
posted by ghharr at 7:58 AM on November 30, 2011

I sympathize. This (past) year, husband and I looked at the low-deductible and high-deductible (+ taxfree savings acct) plans, and went high-deductible. Preventative visits covered. Then husband's doctor said "you never did those things we talked about at the last couple of preventative visits, did you?" and husband decided he must handle those (long term low-importance) issues immediately. Saw an allergist ($900). Got a prescription ($150x3). Had a cyst removed ($4000, of which $3000 was, blessedly, covered). Plus a few $200 follow-up visits.
The conversation we had when those medical bills started coming in was about why he decided to take care of these things after we changed insurance, why we had changed insurance and whether we should change back, and - most relevant to your question - how he should really have asked the doctor how much a procedure was likely to cost before going in to have it done.
The other important point is, we signed up for the lower-deductible plan, plus the savings account. We put into that the difference in premiums plus the $60/month or so we averaged on health care the previous (disaster-free) year, not including the $1500 of dental work. Basically, we accepted that the amount we were likely to spend on health care was the same no matter which plan we chose, and elected to gamble that if it were lower we'd get to keep the difference in a tax-free savings account instead of having it all evaporate in premiums. Our gamble didn't pay off, the savings account is empty, but it cost us only $400 more than if we'd done the same under the "better" plan. It hurt a bit more, though, because we had to see all the bills instead of it all being a big black box of large premiums and small checks to the doctor. Despite all this, we've decided to sign up the same plan for this coming year.

I've never tried negotiating with the insurance company. I do know that the doctor and dentist charge less (their"insurance rates") because I have a plan, even if the plan covers nothing. Because the effective rate is thus set by the insurance company, all doctors cost the same to me, whether their nominal (no-insurance billing) rates vary or not. I did get my dentist to do a cash discount on a root canal. I didn't try negotiating with my husband's doctors; probably should have. If it's not an emergency room visit, the key time to negotiate is before the procedure is done - if the doctor's aware that insurance isn't covering much, you can break it down into choosing whether or not to do particular tests, getting drug samples instead of a prescription, trying to get something listed as preventative instead of treatment.
posted by aimedwander at 7:59 AM on November 30, 2011

$700 for three rounds of x-rays and three casts? A veritable bargain. A single MRI can cost that much.

Is it possible to negotiate with my insurance company?

Absolutely! When you buy your policy. Not afterward. Once you've paid your premium, you've already negotiated the terms of this policy period, and the insurance company has absolutely no incentive to accept anything other than the terms you agreed upon. If you want different terms, get a different policy.

What about finding a doctor? Is it feasible to shop around for the cheapest doctor?

No, it isn't. You can look around, certainly, but physicians don't really compete on price. Two reasons. The first is that they're expensive as all-get-out regardless of what happens,* and like many industries where prices are embarrassingly high, they don't advertise their prices ahead of time. But second, at the time of service most don't even know what they're going to charge you, because medical billing is such an arcane process that you can get an associates degree in it. People choose their doctors based on beside manner and experience, with some allowance for what insurance they accept, but generally not on the basis of actual cost.

What other tricks help save money?

1) Avoid the emergency room like the plague. If it is at all possible to handle something with a scheduled appointment, that will absolutely save you money.

2) If something absolutely does need to be taken care of now, go to an urgent care center if at all possible. Emergency rooms are basically advanced trauma and life support centers staffed by specialist physicians who deign to take care of routine stuff if there isn't an actual emergency, but never stop charging like the specialists they are. Urgent care centers are staffed by generalist physicians and, more importantly, non-physician providers like physicians' assistants and nurse practitioners, who are entirely competent to handle routine medical emergencies but don't charge like physicians. Urgent care centers don't handle serious traumas or critical, systemic illnesses (acute renal failure, cardiac anything, etc.), but they're perfectly set up to handle the odd broken arm or case of the sniffles, and they charge way less than emergency rooms.

3) While you can't really negotiate with your insurance company mid-policy period, you can negotiate with your doctor's office when it comes time to pay the bill. In addition to offering compete payment discounts, a lot of offices will set up interest-free payment plans for very low monthly amounts. At a pinch, but usually once an account has gone to collections, they'll even agree to write off parts of the bill.

*The main exception here is the rare cash-only practices that are springing up in various places. These don't take insurance at all and demand payment at the time of service, but they tend to be very reasonable price-wise, as they don't have to deal with either writing off the vast majority of their bills with insurance and bad debts or staffing huge billing and collections offices. I think there are probably only a few dozen of these places nationwide, but if you can find one, go for it.
posted by valkyryn at 7:59 AM on November 30, 2011

I hesitate to suggest this because I actually don't think that they're a good deal but one option is a health savings account or HSA. I think you set it up through work and say you're going to put a certain amount of money in there per paycheck pre-tax. Then when you have a co-pay or something, you can either swipe the HSA card they give you or you can pay for it out of pocket and submit the receipts later to get reimbursed. It's not bad if you have a good card but if you have to get reimbursed, you have to pay for something twice before you get any benefit. And all you're doing is saving on taxes.

That said, if you know you will need glasses and your insurance doesn't cover them, you can at least get out of paying taxes on them. You have to use the money that's in your account by the end of the year though. It was funny at my old job because everyone had an HSA and at the end of the year, they would all go to and buy everything covered by the HSA - sunscreen, Advil, Bandaids, etc.
posted by kat518 at 8:27 AM on November 30, 2011

Earlier this year my daughter broke her arm and at the advice of a friend we took her to a hand/arm specialist.

This seems to me to be the point where you could have influenced costs the most. The hardest part about saving money when it comes to medical stuff is that there's always going to be an argument (from friends, family members, your own brain) that you should go to the super-duper no-expenses-spared specialist "just in case." IANADoctor, but my understanding is that absent a really weird fracture a broken arm is a pretty routine thing to handle.

You could get a policy with a lower deductible/cost-sharing level, but you'll pay the difference in premiums; as others have explained above, it's probably not feasible to negotiate prices with insurance companies or doctors if you already have insurance and the doc is already billing a negotiated rate. Honestly, the single most effective thing you can probably do to keep costs under control is to: (1) find a pediatrician (for your kid) and primary care doc (for you and your spouse) that you trust, and (2) listen ONLY to those doctors when deciding whether a given medical issue can be handled by them and when it needs the attention of a specialist or a hospital or other high-cost care.
posted by iminurmefi at 9:09 AM on November 30, 2011

$700 might be reasonable for fee-for-service; in my HMO this would have cost me $60 out of pocket, max--$20 per office visit. Does your employer offer an HMO?
posted by massysett at 10:47 AM on November 30, 2011

The simple answer is no, there's nothing you can do. You might be able to shave a small share off (less than 5%, tops) with a lot of legwork, doctor shopping, red tape, etc. But it's probably not worth your time.

The one thing you can do is keep track of your overall annual health care expenses and anticipated expenses for the next year. When it comes time for you select your health plan option from your employer (assuming they offer more than one option), you will have information enough to make the best choice.

Aside from that - and what others have said about using the ER only when it's a true emergency - it's out of your hands.
posted by thatguyjeff at 10:57 AM on November 30, 2011

The only thing that can really help is keeping healthy. Exercise and watch your diet. This helps avoid disease and injury, which in turn keeps you out of the doctors office. A broken arm is one thing, but if diabetes can be prevented then thats a win you should take.
posted by amazingstill at 11:11 AM on November 30, 2011

Response by poster: Excellent answers all around. Thank you!
posted by aarondesk at 5:38 AM on December 1, 2011

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