7 Money-Saving Strategies for Medical Costs
5. You want cosmetic surgery, Lasik, or another procedure that insurance won't consider covering.
Strike a bargain.
Talk to your doctor about the price of the procedure up front and then see if you can get a better deal. "Doctors and other health-care providers are often willing to lower their fees if you ask," says Jonathan Weiner, PhD, professor of health-policy management at Johns Hopkins University. If talking to your doctor about money makes you uneasy, speak to the billing manager instead. She hears these requests often and knows how to make a deal.
In addition, most providers and hospitals will work out a monthly payment plan. Or, if you can afford to make a lump-sum payment, ask if you can get a discount for cash. Providers will often agree because a one-time payment saves them money on billing and administrative costs.
Finally, be sure to take advantage of a flexible-spending account if your employer offers one. Use it to sock away pretax dollars to pay for eligible medical expenses, including Lasik and some cosmetic procedures.
6. You need to fight a denial from your insurance company.
File an appeal.
If your insurer won't pay for a claim and you think it should, you have the right to appeal the decision. But you must be sure to meet all deadlines, file all forms, and otherwise follow your insurance company's rules and procedures carefully or your appeal may not be valid.
When drafting your appeal, enlist your doctor or his billing expert's help. Say you needed a follow-up ultrasound for an ovarian cyst. Your ob-gyn can help you formulate an argument and provide any medical records and other backup you'll need to make your case. "About 53 percent of appeals succeed in our state," says Kansas Insurance Commissioner Sandy Praeger. And according to advocacy groups, the success rate is similar nationwide.
7. You think you need to go to the ER.
Emergency room bills can be sky-high, especially in a hospital that's not part of your insurance company's network. It makes sense to avoid the ER unless you are facing a true emergency.
The top three reasons for ER visits in 2007 were sprains and strains, superficial injuries like bruises and cuts, and upper-respiratory infections, according to Ryan Mutter, a senior economist at the federal Agency for Healthcare Research and Quality. These are all things that certainly need attention, but not necessarily in an ER.
If you're contemplating whether to go to an ER -- you have a swollen wrist that might be broken, for instance -- call your doctor's office for advice. Or head to an urgent-care center. These facilities specialize in treating mild injuries, and insurers recommend them because they're cheaper than ERs. You'll like the fact that you probably won't wait as long. Call your insurance company to find one near you and confirm that it will cover the visit.
The New Rules for Flex Spend
One of the best ways to save money on health care is to take advantage of flexible spending accounts, which let you set aside a certain amount of money before taxes each year, usually through paycheck deductions, to pay for out-of-pocket health-care costs. Many health expenses are eligible, including deductibles, co-pays, eyeglasses, dental work, mental-health counseling, and more. Because you're using pretax dollars, you can save about 20 percent.
There is a catch. If you don't spend all that you've put away each year, you may have to forfeit it. What's more, the new health-reform law makes some major changes to flex-spend accounts. Starting January 1, 2011, over-the-counter drugs will no longer be an eligible expense unless you have been specifically directed to use them by a doctor. Previously you could get reimbursed for any OTC medication. And starting in 2013 the annual maximum you can contribute to your flex-spend account will be $2,500; currently companies set the annual maximums and many allow much higher contributions. "Neither of these changes should deter you from setting up an account," says Jennifer Calhoun, a principal with Mercer, a health and benefits consulting firm in Philadelphia. If a big elective medical or dental procedure is in the offing -- like Lasik surgery or tooth implants -- you may want to schedule these treatments while you can still pay with pretax dollars.
Originally published in Ladies' Home Journal, February 2011.