Below are some Healthcare Hustler’s tried and true ways to save money on healthcare.
1. Always (yes, we mean ALWAYS!) stay in-network
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
Generic prescriptions are much cheaper than branded prescriptions. Ask your doctor if you can take a generic.
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.
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.
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