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Be an Advocate For Your Own Health Care

Health Care

The following is a contribution from my good blogging friend, Kim, from Eyes On The Dollar. If you’re interested in contributing to Frugal Rules please consult our guidelines and contact us.

 

How many of you look forward to visiting the doctor?  Doctor visits can be a turn off for many reasons. It’s uncomfortable and embarrassing to wear the paper gown with your normally covered areas exposed. You might hear something you don’t want to know, and it can be really expensive. Most of us try to make it through the appointment as quickly as possible so we can get back to familiar ground. The downside is that when when we get home, we have no idea what the doctor told us and we don’t understand the bill when it shows up in the mail.  There are some simple steps you can take to be an advocate for your own health care, insuring that you get the most out of doctor’s advice and don’t pay more for things than you have to.

1. Know Your Insurance Plan

I am continually surprised at the number of people who show up for an appointment and have no idea about their insurance plan and don’t carry a card. Telling the receptionist that you have insurance doesn’t work. There is no crystal ball that lets the doctor’s office know what insurance plan you belong to and what it covers.  In the US, all medical insurances are required to pay for preventative services, like your annual physical, immunizations, well child care, colonoscopies, and mammograms when indicated. However, you must make sure you are at least one year out from the date of service and that you use the proper facility for auxiliary testing, so ask before your visit.

For non-preventative visits, you need to know:

  • What your deductible is
  • If you have a copay
  • What percentage you have to pay after your deductible is met

Also, always carry your card and present it when you arrive. If you don’t have a card or know what your insurance covers, be prepared to pay. It is not the responsibility of the doctor’s office to verify your coverage if you have no information to give them.

2. Know Your Medical History

I realize people hate to fill out forms every year, but health problems and changes could have happened since your last visit. Make sure to know what medicines and supplements you take, and whether they are obtained via prescription or over the counter. Know if any of your immediate family has health problems. Don’t ever lie on the history form. Doctors aren’t there to judge, and I promise they’ve seen it all. If you drink a case of beer a day, don’t say you have 2 drinks a week. You might get the wrong diagnosis or medicines that cause terrible side effects.

3. Don’t Be Afraid to Ask About Costs

Even though you generally go to the doctor for advice, that doesn’t mean what they tell you has to be set in stone. If your doctor recommends a specific test or writes a prescription, it’s okay to ask about costs. If you don’t have insurance or know you have a high deductible, ask if there is a generic alternative or a sample you might try. Many drug companies offer patient assistance for low income individuals. If you need lab testing, there might be a community health fair coming up where you can save hundreds of dollars on blood work.  Obviously if it is an emergency, you might not have a choice, but it never hurts to ask. I guarantee your doctor would rather find a cheaper alternative than have you end up not filling the prescription or not keeping follow up appointments due to cost.

4. Ask for a Cash Discount

If you don’t have insurance or haven’t met your deductible, ask if the doctor offers a cash discount. If you know there is no way you will meet your deductible, ask the office not to bill your insurance. They are not required to unless you are on a state aid program like Medicaid. Just keep a few rules in mind. It is not the doctor’s fault that you don’t have insurance, so don’t ever be mean or sarcastic. The cost of health care is a serious debate that we need to have with insurance companies and politicians who set the rates, but it isn’t something the billing department has any control over. You can bet that offices are much more eager to help if you are nice as opposed to yelling obscenities and making snide comments. If you are lucky enough to get a cash discount, pay it promptly with cash or check. By saving the office the time and cost of billing insurance or trying to collect a bill after the fact, you can often save quite a bit.

5. Look Over All Medical Bills and Insurance Remittances

Don’t ever assume your medical bill is correct. Often doctors’ offices outsource billing. The person who does the bill may be in a different state and have no idea what happened other than the codes they receive. A common mistake occurs when you go in for a preventative service like a physical, and the doctor finds something wrong, like high blood pressure. Often the code for the problem, high blood pressure in this case, gets ranked above the preventativecode for the physical. Instead of paying in full, the charge gets applied to your deductible. If you only went in for a physical, you should not have to pay for this visit. This is where being informed helps if you call and ask questions. Again, be nice. Everyone makes mistakes, and it really isn’t that hard to re-bill.

Although it probably isn’t at the top of our list of fun things to do, doctor visits are a necessary part of life. If you have a good relationship with your doctor and keep up with your health care on a regular basis, you can hopefully take care of medical issues before they become big problems. By following these five steps, you can become an advocate for your own health care.

Have you ever gotten cash discounts or caught billing errors with health care services?

 

Editor’s note: Kim offers some great tips on how to try and have a better control your health care costs. Being someone that has experienced billing errors, I can attest first hand to the necessity of looking at your medical bills. She also has a great point of asking for a cash discount. We’ve been able to get 15-20% off on the delivery of all of our children by simply asking.

The above is a guest post from Kim at Eyes on the Dollar. Kim is a private practice optometrist who has been keeping eyes healthy and fighting insurance companies for years. In her spare time she blogs about her journey toward achieving 20/20 financial vision. You can also follow her on Twitter.

 

Photo courtesy of: Fernando Audibert

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I'm the founder of Frugal Rules, a Dad, husband and veteran of the financial services industry. I'm passionate about helping people learn from my mistakes so that they can enjoy the freedom that comes from living frugally. I'm also a freelance writer, and would love to help out if you have the need. If you're wanting to grow your blog, check out my blog coaching services to see how I can help you take your site to the next level.

43 Comments

  • I haven’t caught any errors as such, but I had a horrible incident when I had my wisdom teeth extracted. I called before hand to check that my insurer was going to cover the total cost of the procedure, but it turns out ‘covering it’ is different to fully covering it. They paid something like $300 out of $2000. Lesson learned.

    It was my mistake, but I can’t help but feel I was taken advantage of somewhat.
    James @ Free in Ten Years recently posted…The true cost of eating out at workMy Profile

    • They are misleading. They may cover 100% but only up to a certain dollar amount. We have people come in all the time and want their “free” glasses that the insurance covers. When they find out there is a copay and only a portion is covered, it can be a big surprise.

  • This is something that my wife and I had to recently review with out baby on the way.
    It turns out that our health fund will give us more money back depending on the hospital that we go to. Obviously once we knew this we were able to find the best solution for us that was fairly close and provided the best return for our money.

    It’s definitely worth checking out what is covered though, as some of the out of pocket expenses were going to cost us up to $1000 or more extra.
    Glen @ Monster Piggy Bank recently posted…6 Things You Should be Spending Money onMy Profile

  • Pauline says:

    Great tips. The cash wouldn’t work in France, it is illegal. The state determines how much a doctor should charge, 21 euros for a general practitioner, and 70% is reimbursed by social security. Those rates are very low and many doctors complain that they need to see too many patients to make a living. They can also chose to set their own rates, in which case I guess you can get a discount, and your social security refund based on a 21 euros consultation.
    Pauline recently posted…Preparing Financially for a BabyMy Profile

  • Catherine says:

    Knowing your own medical history seems so easy but so many people have no idea. I would also add the importance of only going to one pharmacy. When you have prescriptions all over the city or see a different pharmacist every few weeks it’s a challenge of receive optimal healthcare. It can also be dangerous if you forget to disclose you’re taking a particular medication and have a new one filled not realizing there is an interaction…happens all the time though!
    Catherine recently posted…How To Fake A More Expensive Christmas GiftMy Profile

    • I believe one point of the new health care law is to make everything electronic and universal so that any pharmacy in the nation can see what meds you have filled at any other pharmacy. I think there are too many people who complain that this is too “big brother” like, and it might eventually get thrown out. I think its a good idea though. Maybe some of the people who abuse prescription drugs won’t be able to.

  • Good advice that I feel will become even more applicable as we move forward into a “brave new world” of health care.
    Roger @ The Chicago Financial Planner recently posted…Friday Finance Links November 16, 2012My Profile

  • Kim, health care is one of my favorite “finance” topics because it is so important that consumers understand what they are paying for. Especially this past year with me unexpectedly having surgery (and possibly having it again next year…) it has become very apparent to me that consumers need to be informed! Taking the time to understand your insurance plan is so important because there can easily be billing errors, and there also can be things consumers are not taking advantage of like HSA accounts. Thanks for sharing your advice in this post!
    DC @ Young Adult Money recently posted…Our Cultural Split-Personality: Frugality and ConsumerismMy Profile

  • Yes ! People need to familiarize themselves with their health plans. It’s so strange that people just are like “okay, we have it” but have no idea what sort of details their plan includes until something arises !
    Gillian @ Money After Graduation recently posted…Unfrugal confessions of a normal spender in the PF blogosphereMy Profile

  • These are great tips! I cannot tell you how many insurance errors I have caught in my favor. When I had my first child, they kept sending me the bills after my deductible was met and they made me jump through hoops and prove that I had indeed met my deductible. WTH? Anyway, if I wouldn’t have been paying attention I would have paid hundreds that I didn’t need to.
    Holly@ClubThrifty recently posted…So You Want to Win the “Lawsuit Lottery”?My Profile

  • This is a great article Kim. I have used the cash discount before, but I have always just asked for a discount upfront. Many hospitals and practices have given it to me because I can usually plead my case for it. I don’t like being overcharged, but many places will do it in a heartbeat. I have saved upwards of 40% off the original bill, just by asking for a discount or by taking off items I don’t believe should have been charged. Many hospital bills have erroneous errors, so it is up to the consumer to fight them.
    Grayson @ Debt RoundUp recently posted…Weekly Personal Finance Blog RoundUp – 11/16/2012My Profile

  • Mandy @MoneyMasterMom says:

    #3, and #4 are great tips. Why are people afraid of asking questions? The worst thing they can say is No, and you’re no worse of then before. You never know until you ask, and 100% of the questions you don’t ask don’t get answered.
    Mandy @MoneyMasterMom recently posted…It’s only a deal if you need it (Black Friday Tip #1)My Profile

    • I think people get really intimidated by doctors. They are just people who put their pants on one leg at a time. If a doctor’s toilet was clogged, you can bet the most important person in the world to them would be a plumber. If the trash was running over, the garbabe man would be pretty important. No one person is any more special than someone else and we should respect everyone and their training, but not be afraid to ask questions.
      Kim@Eyesonthedollar recently posted…How Do You Prepare A Budget With Irregular Income?My Profile

  • This is really insightful! More people need to see this and be educated. I worked for an HMO during college and learned so many ins and outs of the health insurance world. It was sad that it was difficult to ascertain that knowledge. People can find health advocates, but you know what they can also do? Just ask the health care professional (I’m not referring to your doctor) for guidance. Some might be arseholes, but many are in healthcare b/c they care to some extent. Ask for some help!!
    Todd @ Fearless Men recently posted…Humility: The Quiet Trait That Everyone Will NoticeMy Profile

  • Veronica Hill says:

    Kim, I’m curious if anyone has asked you for a cash discount in your optometry practice?
    Veronica Hill recently posted…Making Money From Home – Is It Possible?My Profile

    • Yes, they have and we usually do. If it’s off a $10 copay on the exam, no, but if they have no insurance and are needing to buy something, we are fine with a discount. If it’s a kid without insurance and can’t afford it, we usually just take care of that. No one should not be able to see because of cost if they truly are needy. If you smoke a pack a day, though, my sympathy level goes way down.

  • I like “don’t be afraid to ask about cost.” Now that I pay for my own health insurance, I always ask if certain tests are necessary because I may end up paying lab costs that I don’t really need. I also tell my doctor that I don’t need to have my cholesterol checked every year since every year it has always been good. It can be intimidating, but the more proactive you are the better.
    Budget & the Beach recently posted…Falling in love again with your stuffMy Profile

  • John says:

    I enjoyed this post for the simple reason of how much I hate hospitals so these are good reminders of what to keep organzied to make that trip simpler. I admit I don’t track it all efficiently and find myself looking stuff up last second.
    John recently posted…Humility: The Quiet Trait That Everyone Will NoticeMy Profile

  • Great post Kim
    Ever since I moved to Canada and I have benefits now something I never had I’ve had to get used to all this insurance company talk. I made sure I read the coverage from front to back so I know what I have. We always read our bills as society puts too much trust in computers and human error can happen and cost you if you are not watching. Medical history is important and I always get asked. It’s almost like knowing your resume inside out you should know about your physical health as well. Organization is where it’s at. Mr.CBB
    Canadianbudgetbinder recently posted…Book Review: How To Be Richer,Smarter And Better Looking Than Your ParentsMy Profile

  • Jason says:

    LOL. I love Veronica’s question! I’m sure it’s rare for people to ask for a cash discount but I’m going to do it today when I go pick up my vehicle from the mechanic. It’s a large bill and they’d be crazy not to give me $20 off.

    These are great tips though and things that many people are ignorant of. Insurance in general is confusing and then when you get into deductibles, co-insurance, HMO, and PPOs, it’s tough to understand!
    Jason recently posted…Understanding the Basics of Deferred AnnuitiesMy Profile

  • Great article, Kim! I totally agree with Budget & The Beach. I used to be afraid to ask about costs at the doctor – somehow it seemed like a faux pas to question the necessity of a test recommended by the doc – but I’ve been burned a few times now and it’s hardened my shell. Earlier this year I tweaked my shoulder at CrossFit. At the orthopedist, the first thing they did was take a bunch of X-rays. I could have told them that it was a soft tissue injury – no bone damage or need for X-rays – but I was too hesitant, and it ended up doubling the cost of my visit. We have to remember that medical practices are a business, and it pays to be a savvy consumer/patient.
    Taylor@Repaid.org recently posted…Top Ways To Financially Self-DestructMy Profile

  • Tackling Our Debt says:

    We’ve been with the same doctor for 7 years now so the only time I’ve been asked to fill out a medical questionnaire was when I went to see a naturopath. I think it is horrible that proper medical care is so expensive in the US and that people have to worry about how much everything will cost if they are not fortunate enough to have medical insurance. I wonder how many people live for years with some illnesses because they can’t afford a doctors appointment or the prescriptions.
    Tackling Our Debt recently posted…Do You Even Bother Creating New Year’s Resolutions?My Profile

    • That is one of the problems we have here is that people wait until they are in dire straits to go to the ER after a heart attack or stroke. Preventative care is such an important part of the whole health care picture. I wonder if people are better in countries that have universal care or does everyone procrastinate?

  • Justin@thefrugalpath says:

    I loved it when my brother-in-law’s wife worked for our optometrist, she was the person behind the counter who helped you pick out your frames. It was great. She knew everything about our insurance and didn’t mind telling us when something looked bad on us. It was the best experience we’ve ever had.
    Now she is a Physician’s Assistant and working for a thoracic surgeon. So, unless we need work on the upper respiratory system, we can’t really visit her. Although it is nice to talk to her about random ailments.
    Justin@thefrugalpath recently posted…Frugal Lifestyle: Why Bother?My Profile

  • Thanks, John for giving me the opportunity to be on Frugal Rules and for your wonderful post on Eyes on the Dollar. I love blog swaps!
    Kim@Eyesonthedollar recently posted…How Do You Prepare A Budget With Irregular Income?My Profile

    • John says:

      Not a problem Kim. Thanks for letting me be Eyes on the Dollar as well. I like blog swaps as well. You did MUCH better service to a topic like this than I ever could, thanks for your expertise. :)

  • Preventative healthcare measures are incredibly important, as well. Especially in countries that don’t have universal health care. Without preventative measures, you could be financially and physically “broke”. I think that, no matter what country you live in, it’s important to know your history and your insurance.
    Daisy @ Money Smart Guides recently posted…Buying a House, Things to RememberMy Profile

  • Great post, Kim. As someone who has been on the administration side of healthcare for 15 years, I agree with all of your tips- but especially the one about knowing your insurance. I worked for ophthamologists, and people were always confused about whether or not they had vision coverage. Since some of what we did was medical and some was not, we had to know.
    The one other tip I would give is, if you are having a problem with the facility or the other staff- tell you doctor. As the medical receptionist, I could tell my docs that people complained about ice in the parking lot, but it wasn’t sanded until the patients started telling the docs themselves.
    But also know your doc may not know everything about your insurance. I used to have a doc who would waive the co-pay for his golfing and bowling buddies, except with one of the common vision insurance plans, if we wavied the co-pay, they wouldn’t pay the claim at all. So when the person at the front desk says to you- I know the doc said he’d waive your co-pay, but we can’t do that, don’t cause a scene. Pay your $10.
    shanendoah@the dog ate my wallet recently posted…Money I’m Thankful We SpentMy Profile

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