Healthcare in the US can be very expensive and confusing. Below are some Healthcare Hustler’s tried and true ways to save money and better navigate healthcare.
This article was originally published September 2018 and was last updated September 2020.
1. Always (yes, we mean ALWAYS!) stay in-network
Check out our previous article to find an in-network provider.
Staying in-network is the easiest way to save money in healthcare. You will receive the in-network discount, and any costs will apply to your in-network benefits, which tend to be better than the out of network benefits. Your costs will also apply to the in-network out of pocket maximum, which is essential in limiting your total annual costs in case of emergencies or costly care episodes.
2. Be wary of facility fees
Many hospital-based providers will charge you or your insurance company an expensive facility fee on top of the usual fee to see the doctor. This can happen for services other than a doctor’s appointment as well, such as an MRI. While the only certain way to avoid a facility fee is by calling the billing office directly to ask if they charge a facility fee, you can usually avoid them by seeing independent doctors who are not affiliated with a hospital, or who are located at an ambulatory/outpatient location away from the hospital.
3. Don’t talk about new problems during your annual physical
Under the ACA, annual physicals with in-network providers are free to the patient, as they are billed with unique “preventive” codes. However, if you are at your physical and start to tell the doctor about your sore throat and your hurting knee, this changes the coding from preventive to diagnostic - the doctor is now diagnosing your ailments. Depending on your plan, you may now be responsible for a copay or for the full cost of the visit if you have a HDHP.
Set expectations with the scheduler, the front desk, the Medical Assistant/Nurse, and the doctor that you are here for an annual physical. If you aren’t sure if something will change the cost of the visit, ask the following: “Does talking about this condition today change my visit from preventive to diagnostic?” Most doctors will be able to give you an answer. If they say yes, ask them to set up a separate visit to discuss these concerns.
4. Ask your doctor for generic prescriptions and check out the $4 generic list, GoodRx and Manufacturer Coupons.
Generic prescriptions are much cheaper than branded prescriptions. Ask your doctor if you can take a generic.
Check here to see if your prescription is available for just $4 per month and check out this link to learn about some grocery stores that offer FREE generics!
Check out GoodRx for tons of coupons, and google the prescription manufacturer’s name and “coupon” to find coupons directly from the manufacturer. Read this to understand more about saving money on prescriptions.
Do you need something that is over the counter? Check Coupons.com before you buy to see if you can get a discount!
5. Sign up for 90 day mail order prescription refills
The 90 day option through your insurance company’s mail order program is likely cheaper than paying for a monthly refill, and they ship it to your door! Call your insurance company to ask about this option. Learn more about prescriptions here and here.
6. Get a second opinion
If your doctor recommends an expensive and invasive surgery or treatment, you may want to get a second opinion from a different provider. Second opinions are usually covered by an insurance plan as a specialist visit, and there are online options available. These specialists can review your case to either confirm the diagnosis and treatment plan, or recommend alternative treatments that are less invasive and potentially lower cost. You can even schedule a second opinion with a provider online - check out Cleveland Clinic, Johns Hopkins, or UCSF.
7. Need imaging, Simple Outpatient Procedures, or Other Types of Care? Call around for prices (and see rule #2)
Shopping around for imaging services (such as x-rays, MRIs, and CT scans) or simple outpatient procedures is one of the easiest ways to save money. Ask your doctor for the CPT procedure code of the procedure you need, and call several in-network facilities in your area to ask what their “BCBS/Cigna/UHC in-network rate” is for that procedure. About 75% of the offices will give you the information, and you will find that the research could save you thousands of dollars. Read the details of how one Healthcare Hustler saved about $4,000 on her outpatient surgery with just two hours of research. If you are shopping for imaging, remember to ask if they charge a facility fee in addition to the imaging fee!
Note: Most imaging facilities have high-quality machines, but you may want to ask them about the quality of their machine while you get the price, that way you can compare both pieces of information. Your doctor should be able to tell you if the machine quality is sufficient for their needs. In this case higher quality means a sharper image for the doctor to read. Learn more about the types of imaging (MRI, X-Ray, CT Scan) here.
8. If it isn’t serious, go to the urgent care rather than the ER.
If you’re lucky, you might have a copay of a few hundred dollars. If you are unlucky, one trip to the ER could cost you more than a family of four’s trip to Hawaii. This is because ER visits often come with expensive bills from the facility, the doctor, and the imaging or anesthesia group.
Urgent Care visits are cheaper and are usually subject to an Urgent Care copay or the cost of an office visit (if you have a deductible).
Go to an Emergency Room for a true emergency, and stay in-network. While it is expensive, you’ll have a fully equipped hospital to take good care of you.
Go to an Urgent Care if it’s not have an emergency, but you need care ASAP.
Learn more about the price difference between an Urgent Care and an ER here. Do you already have a bill? Learn more about what to do with expensive medical bills here.