7 Money-Saving Strategies for Medical Costs
1. You need a pricey drug your prescription plan doesn't cover.
First, ask your doctor if a generic version is available. Generics can cost far less than brand-name drugs and are often covered by your insurance.
If a generic doesn't exist or if your doctor has a medical reason for prescribing the brand-name drug, you've got to go shopping. Prices for drugs can vary by as much as 400 percent, depending on the pharmacy. Often online retailers like Drugstore.com offer the lowest prices.
In addition, look into mail-order prescription services like Medco or Express Scripts, which allow you to buy in bulk for up to 60 percent off the pharmacy price. This option works best if you're purchasing medicine you take regularly -- say, prescriptions for a chronic condition such as asthma. Lipitor, a commonly prescribed cholesterol-lowering drug, for instance, can set you back as much as $140 for a 30-day supply. But buy three months' worth by mail order and those 30 pills could cost you as little as $16.50.
Another trick? Split your pills. There's no law against it -- just ask your doctor to prescribe double-strength tablets. Instead of the prescribed 100-milligram pills, for instance, you'd get a 200-milligram dose. The cost of the prescription is the same but the 200-milligram pills will last twice as long cut in half. Just pick up an inexpensive pill-splitting device at the drugstore. Be aware that pill splitting doesn't work with all medicines (gel caps can't be split and time-release drugs shouldn't be).
2. You need to see an out-of-network doctor.
Be prepared to negotiate.
Many insurance companies will pay 70 to 80 percent of "reasonable and customary" charges when you see a health-care provider outside your network. But "reasonable and customary" is the tricky part, says Tom Billet, a senior executive with the benefits-consulting firm Towers Watson. Say your bill is $100. If your insurer pays 80 percent of out-of-network charges, you may be expecting a check for $80. But your insurer might determine that reasonable and customary charges for that type of doctor visit should be $80, not the $100 you were charged. In that case you would be reimbursed $64.
Thanks to legal action by the New York State Attorney General's office, the prices that insurers use to calculate reasonable and customary charges have become more realistic. Nonetheless, to protect yourself when you know you're going out of network, always ask your insurer what its reasonable and customary fees are for specific treatments. Then go back to your doctor and ask if she'll accept the amount the insurance company is willing to pay.
3. You need a root canal and a crown but your dental insurance maxes out at $1,000.
Spread out the treatment.
Good dentists know what kind of work can be extended over several months. If you stagger the procedures over separate calendar years, you can get more of the cost reimbursed than if you have all of them within one year.
A temporary crown, for instance, will often last for 12 months or more. So if you have a root canal and get the temporary crown sometime this year, you'll likely hit your maximum. But wait until next year to get the permanent crown and you can be reimbursed again.
Another cost-saver? Try a local dental school clinic. "The dental students are supervised by qualified teachers and often offer excellent care for about a third of the price of traditional dentists," says Mark S. Wolff, DDS, associate dean at New York University's College of Dentistry.
4. You need to schedule a surgery or other hospital visit.
Watch out for unexpected out-of-network charges.
You may assume that since your surgeon or primary-care physician at a particular hospital is in your network, the other health-care providers you see at the hospital are as well. But that isn't always so, says Candice Butcher, chief executive officer of Medical Billing Advocates of America, and they could bill you for their full fee. Or the lab work you have done at the hospital may not be covered because the hospital lab isn't in-network.
"Be sure to ask the admissions staff what doctors you'll be seeing, what X-rays and lab work you'll need, and whether those services will be paid for by your insurance at in-network rates," says Butcher. If some providers are out of network, ask if there are in-network alternatives or, more likely, if the out-of-network doctors will accept your insurance company's fee. In many cases they will -- and will handle the negotiations with your insurance company directly.