When it comes to saving money and shopping around for the best value when purchasing groceries, books, electronics, clothing, automobiles, and vacations - you have the tools you need to help you find the best value. You know how to compare costs, clip coupons, look up prices and research recommendations to determine value. But do you know how to save money on your prescription drugs, contact lenses, dental care and doctors visits?  CNN.com recently published an article to help you save money on drugs and doctors. The article covers tips on:

Dental Care: Have you considered using dental schools for your next dental check-up? These schools charge a lot less than regular dentists. The American Dental Association publishes a list of accredited dental schools you can review.

Contact Lenses: Why pay more than you have to for contact lens? You can purchase your next pair of contact lenses online and save yourself up to 50% of what your eye doctor charges for the exact same contacts. Here is one of many online shopping sites to compare costs.

Prescription Drugs: If you don’t have a sufficient prescription plan, why pay more than you have to when you fill your prescriptions? The Consumer Reports Best Buy Drugs website tells you if there is a less expensive drug that could work the same as the one you’ve been prescribed.

Hospital Bills: It is common knowledge that hospitals often make billing errors. You should always review the detailed charges on your bill, and expect to find errors. The Patient Advocate Foundation will help you review your medical bill for no charge.

If you need to become a better consumer of health care (who doesn't?) be sure to read the book recently published by change:healthcare  titled "My Healthcare Is Killing Me."  This book is available online and provides a practical guide to health care covering insurance basics, some helpful terminology, how to choose a provider, and how to select an insurnance plan that's right for you.  The book includes many helpful resources, definitions and examples.  This is a quick read of 140 pages -- well worth your time.  . You will be a more informed health care consumer after reading this book.  Congratulations to the change:healthcare team that wrote this book.

One excellent reason to purchase health insurance is so that you do not have to pay full price (list) for services.  When you have health insurance, you get the discounted (negotiated) price for services that the insurer has negotiated with the health care provider.  If you don’t have insurance, then you are on your own to negotiate a price with the health care provider – and you should definitely ask the provider for a discount. 

 

Insurers and health care providers consider t the “negotiated prices” proprietary information that they don’t want this price publicized.  These negotiated prices are what insured consumers are expected to pay for services, but they are kept a secret and it’s difficult, if not impossible, to find out what these prices are until after you have visited the provider. 

 

From what I have heard, Blue Cross Blue Shield negotiates the best discounts from provider list prices.  Where BCBS negotiates 60% off list, other insurers negotiate 40% off list.  Knowing this can help consumers make informed decisions when purchasing health insurance.

 

Office visit list price:  $100

BCBS negotiated price for office visit: $ 40

Other insurer negotiated price for visit:  $ 60

 

It’s also very interesting that a provider can have up to 100 different prices for the exact same service, one for each type of insurance they accept.  Most price differences have more to do with a doctor’s negotiation power than with the quality of care from the provider.  Wouldn’t it be nice to know up front what providers offer the best value?

 

EyeCare America just announced a public service program to provide senior citizens with free eye exams.  Individuals should call the help line at 1-800-222-3937 to determine if they are eligible.  For additional information on this program, visit the news release.

The perfect health care system is based on transparency. The Healthcare Infomatics blog posting by Michae Craige titled, Healthcare Transparency – a vision of change, shares some interesting thoughts on how transparency, if done correctly, will create incentives at all levels, and motivate the entire health care system to provide better care for less money.  Transparency is a major component of a perfect health care system.

Providers Paying Consumers $$$ for Sharing their EOBs

Here’s an interesting approach to exposing “true” health care prices (the negotiated price providers really charge for their services).  As you well know, most providers and health plans are unwilling to share pricing information before services are delivered.  In a bold move, two innovative health care providers are collecting contracted prices for services from consumers - for a reward. In April 2008, Alliance Community Hospital in Ohio launched a program offering consumers $100 if they share their EOBs so the hospital can find out how much health insurers paid for health care services received at rival hospitals. They received a lot of participation and this program is still active today. Just recently, Wuesthoff Health System in Florida announced a new transparency initiative offering consumers $100 in gas cards if they share cost information on health care services from providers in the surrounding area. This is an attempt to provide consumers with meaningful information on the true cost of health care services.

Transparency brings good things for consumers like:

1. lower prices
2. more innovative services
3. expanded choices
4. better patient care

Wouldn't it be nice to see more providers sharing true price information with consumers?

Today, HSAeducator.com, an online community and educational website on HSAs, posted a blog entry about a consumer's personal experience using OutofPocket.com to look up prices for a strep throat culture. 

" I typed "strep throat" into the OutofPocket.com website and POOF, it gave me pricing for strep throat testing in my area. The tests ranged from $10.00 to $55.00. Unfortunately, the locations listed were really not that near my house, so I couldn't hit the $10.00 strep test store. But I will have an idea of whether the price of the test was good, bad or ugly. "

Thanks for sharing your story.   We invite everyone to use this search tool to look-up prices for routine health care services (MRIs, vaccinations, x-rays, lab tests, office visits, mammograms, dental, vision) and don't forget to post/share prices you paid for actual visits after you receive your statement or EOBs for the service.

Good news for consumers. There are some simple steps you can follow to make sure you keep control of medical bills and make sure you are not being overcharged for services.

First, review your bill very carefully. You can request an itemized bill. Use free online tools to find out what other consumers paid for similar services using OutofPocket, CMS Medicare CPT look-up tools, and Vimo.

Second, you should know if your insurance covers your treatment. If your procedure falls into a gray area, you should submit letters and official paperwork from providers, including referrals that explain why the treatment was necessary.

Third, remember you always have an opportunity to negotiate down the charges. The total charges that appear on your medical bill have no relationship to what the provider will accept as payment in full.  Health care providers bill everyone the same amount, from Medicare to private insurers to the uninsured.  However, the full charges that appear on your bill are much higher than the provider’s actual costs.  The Government and private insurers negotiate a reduced price for services.  Here’s an idea to consider – start by asking your provider how much Medicare would pay for a procedure similar to yours.  Using this information, you should talk to the CFO or billing manager and ask for a reduction to the provider’s actual cost, plus 25%.  By the way, doctors have also suggested patients without insurance try this approach.

Fourth, hire an expert to help you review and appeal your medical bills. If your medical bills are complicated and large, you can hire a medical billing review service.

Source: Elizabeth Ody, “Some simple steps to keep control of medical bills,” Premium Health News Service, September 1, 2008.

The next time you have an injury or illness that requires immediate care, consider using an urgent care center rather than the traditional hospital Emergency Room.  Urgent care centers are staffed by physicians, offer sort wait times, are less crowded, cost a fraction of what hospital ER visit would cost you, and you can walk in without an appointment.  The urgent-care centers are equipped to handle anything from a simple cut and treating broken bones, to deploying advanced life-support equipment.  Some offer discounts and payment plans and many health insurance plans cover urgent-care clinics.

The CDC published interesting statistics on the unnecessary and overuse of hospital Emergency Rooms. In 2005, 115.3 million people visited Emergency Rooms and only 5.5% of the patients needed to be seen immediately. Only 21% of theses ER visits were identified as semi-urgent and needing to be seen within one to two hours, and 14% of these visits were evaluated as non-urgent

Source: Laura Landro, "Options Expand For Avoiding Crowded ERs," Wall Street Journal, August 6, 2008.

SmartMoney just published an article, Top 5 Times to Haggle for a Better Deal.  The article incudes useful tips on how you can get a better deal the next time you purchase health care services. 

Pay cash upfront.  Providers sometimes will offer you the same lower rate that they negotiate with insurance companies, or possibly even a cheaper rate if the consumer agrees to pay cash at the time of service.  I tried this and it worked!  Just be sure to ask up front.   

Compare Costs.  Check your providers rates against other doctors in your area.  You can look this information up through tools provided by your insurer, or by using the community search tool, OutofPocket.com to view patient posts of actual prices paid for services.  Providers have been know to lower their fees to stay competitive so be sure to do your homework and research prices before you visit the provider.

Last month the Wall Street Journal forum, Doctors Charges, had an interesting discussion on consumers experience comparison shopping for health care services.  Everyone seemed to agree that is is practically impossible to find out beforehand what patients are expected to pay.    Read what other consumers had to say about their experiences shopping for health care services. 

AOL recently posted tips to help you save money on health care costs.  Consumers should not have to pay full price for services.  One of the tips recommended that consumers should use OutofPocket.com as a tool to help them compare costs and find out what other consumers paid for similar services.  "Providers are often willing to negotiate, with both insured and uninsured patients and those whose insurance only covers a portion of their health expenses", says Jonathan Pletzke, author of "Getting a Good Deal on Your Health Insurance Without Getting Ripped Off."

Paying cash up front helps consumers save money because providers do not have to process billing and insurance forms, and are often willing to discount prices in return for payments at time of service. 

Be sure to compare costs before purchasing health care services.  The more you know, the better informed you will be to negotiate a fair price for services.

If you think you were overcharged for health care services, you should contact MYINSNET.com, an insurance negotiating service that offers consumers assistance in negotiating medical claims.   This company states they have saved insurance companies millions of dollars and an average savings per claim is about 25%.  The same techniques and resources they’ve used to save insurance companies money are now available for individual consumers.  Any patient with a medical bill greater than $200 is eligible to send their bill to INSNET for negotiation.  Consumers can use services such as INSNET to determine if the amount they paid for health care services is reasonable.  If the charges are deemed excessive, INSNET will attempt to negotiate directly with the provider and INSNET charges a fee based on the amount saved on the patient balance.  There is not risk for consumers because they charge no fee if there is no savings.   When you visit the MyInsnet, be sure to indicate you heard about their service on OutofPocket.com and they will offer you an additional savings.

 

Bottom Line Secrets published an article several years ago on tips you can use to fight back if you think you are being overcharged for health care services.  This article was recently brought to my attention because this information still applies today.  Here is a brief summary of some of the tips.

To avoid paying more than you should for doctor bills

1. Remember to negotiate.  Try asking your doctor for a discount. 
2. Have blood tests done at a lab, rather than at your doctor’s office. 
3. Don’t pay for follow up visits. 
4. Ask your doctor if tests prescribed are necessary. Doctors often order unnecessary diagnostic tests including MRIs, CAT scans and X-rays. Ask what these tests will determine.

Tips on how to spot over billing on hospital bills

1. Request a daily itemized bill. 
2. Avoid using the hospital pharmacy.  Have your prescriptions filled at your local pharmacy.
3. Watch out for double billing and review your bill detail carefully.
4. Don’t pay for the last day at the hospital if you are discharged before noon. 

A recent article, Click here for the best health care, offers some very practical advice on how consumers can make smarter decisions when selecting doctors and hospitals - and how to plan ahead for medical expenses. 

Selecting the right doctor

Consumers can find out about a doctor's experience and a hospital's success rates, and even find information on what these services cost.  First, get to know your doctor.  Do some research to find out what other patients have to say about the doctor.  Personal recommendations carry a lot of weight and people trust what other consumers have to say.  Check if your doctor is board certified.  Search the American Board of Medical Specialties to find out.  Make sure your doctor has done this procedure before.  Use Vitals.com to find out how many times a doctor has performed certain procedures in a year, and look up historical data to determine if there are any sanctions or malpractice claims.  If you cannot find this information on public sources, call the doctor’s office and ask. You want a doctor that has lots of experience.  Know the price before you visit the provider.  If you have out-of-pocket expenses, it’s well worth your time to call your doctor and your insurer to determine the amount you are responsible for.

Selecting the right hospital

Hospitals provide a lot more performance data.  Just like doctors, hospitals get better with experience.  You can use Vimo.com to find out how many times a hospital has performed a procedure.   RevolutionHealth.com also provides similar information.  HealthGrades is an excellent source of quality ratings for hospitals. You can purchase a report from HealthGrades to obtain cost and quality information. 

I am pleased to announce the new release of OutofPocket.com, version 2.0.  Our new search engine enables consumers to look-up prices for health care services, and allows providers to list their prices/services in the directory - free of charge.  In addition, the search engine features expanded search technology and searches for health care price data across other public price transparency tools.

I welcome all your feedback and comments on this new release and I would appreciate if you could help us spread the word.  As you know, the more people that contribute and use this tool, the more powerful it will become for everyone.

Thank you for all that you do to help promote health care price transparency. 

NEW FEATURES IN OUTOFPOCKET.COM VERSION 2.0

 

(1) Enhanced search engine provides more relevant search results

(2) Easy for consumers to post/share their own visits and prices they paid for services

(3) Comprehensive search results - searches other websites that publish pricing and websites that offer price transparency tools

 

PRICE DATA COLLECTED FROM MULTIPLE SOURCES

 

·         Providers can submit price lists for their services

·         Consumers are invited to post/share prices they paid for actual visits, along with their personal recommendations on the provider

·         Claims Data from Businesses, Health Plans or TPAs

·         Government CMS Medicare payment data

·         Websites that publish prices for health care services including hospitals, diagnostic testing facilities, clinics and physician practices

·         Price Transparency Tools on public websites including health plan tools and state price transparency tools

 

BENEFITS for BUSINESSES

 

·         Load your claims data into OutofPocket.com to enable your employees to search for their true out-of-pocket costs for specific service

·         Employees can use OutofPocket.com to search for prices for specific services in your network plan

·         Encourage employees to collaborate and post prices they paid for health care services, to share these good deals with other employees

·         Eliminate providers that overcharge - Use OutofPocket.com to direct your employees to affordable, low-cost providers

·         Avoid providers with poor performance by encouraging employees to share recommendations on provider visits

 

BENEFITS for CONSUMERS

 

·         Look-up prices, comparison shop and find the best value for routine health care services in your neighborhood

·         Tool makes it easy for you to post/share prices you paid for actual services with other consumers

·         Share your recommendations on a specific provider with other consumers

 

BENEFITS for PROVIDERS

 

·         Add your true prices/services to the directory – free of charge

·         Consumers can easily find your services and link to your website

·         Include additional information about your practice, services

·         Search results links directly to your website

·         Provides additional exposure for your services

 

 

The California HealthCare Foundation (CHCF) offers some great tips for consumers that are interested in comparison shopping for non-emergency hospital services.    The consumer tips provided by the CHCF are based on the results of a recent mystery shopper study conducted at 64 California hospitals.  Here are some of the highlights, but be sure to visit their site to read all the tips. Most important, be sure to ask the right questions before using hospital services.

 

1.     Call first.  Consumers should call a hospital to obtain pricing information, rather than wait to ask for pricing in-person.

 

2.     Know the CPT or ICD-9 code.  This is the specific American Medical Association (AMA) code assigned to each medical procedure or service and is used for billing purposes.  It’s actually a lot like a specific part-number for an electronics you purchase.   When you know the specific code (part number), you can compare apples-to-apples.  Once your doctor has explained the service or procedure you need, ask your doctor for the CPT code.  It will save you time and money.

 

3.     Ask about a discount.  If you don’t ask, it almost certainly won’t be offered.  Find out how much and under what conditions discounts apply.  You might find that paying by cash or using your credit card entitles you to discount.

 

4.     Find out what’s included.  There’s little consistency among hospitals in terms of the type of prices quoted, making applies-to-applies comparisons difficult.  You should ask as many questions as necessary until you are comfortable with the information about what specific services are included.  If you are not getting the answers you need, ask to talk to someone in Admitting, Financial Counseling, Billing or the Cashier’s Office.

A recent article in RNcentral.com provides 25 tips on how consumers can save money on health care services – even if you do not have health insurance.  Here is a brief summary, but be sure to checkout the entire article for additional information and helpful resources. 

Medical Care

• Take advantage of walk-in clinics
• Consider alternative therapies 
• Try using a nurse practitioners instead of a doctor
• Research medical tourism
• Check out a health fair for free routine screenings
• Volunteer for medical school clinics
• Use phone medical services for less complicated issues
• Avoid the weekend
• Review your bill for errors
• Negotiate your bill

Prescriptions and Equipment

• Shop around and compare prescription prices using resources like Consumer Reports, the AARP or the Medicare Rights Center
• Buy store brands for over the counter medications
• Request generic prescriptions
• See if you qualify for freebies 
• Double up on medication
• Cut your medications in half 
• Get creative. Work with your doctor or pharmacist to see if you can't find a lower cost solution to your prescription drug costs
• Reuse and recycle. Friends, neighbors or even a church group may have equipment that can suit your needs at a greatly reduced cost 
• Shop for frames at retail stores or large chains instead of the eye doctor’s office

A recent article in the March issue of Consumer Reports identifies some contributing factors to the high cost of health care.  The article High Health Care Costs discusses some of the factors including:

 

1. Hospitals and doctors  - in our current health care system financial incentives are given for costly interventions rather than preventative care

 

2. Drug companies -  rise in prescription drug spending and large amounts of money being spent on pharmaceutical advertising (have you seen all the commercials?)

 

3. Insurance companies - increase in administrative and marketing costs contribute to inflated premiums

 

4. Politicians and government regulators - policies affect the bottom line

 

5. Lawyers- malpractice insurance premiums and defensive medicine (overuse of diagnostic tests)

 

6. Health care consumers - modifiable behaviors such as poor eating habits, lack of exercise, and smoking, all contribute to poor health

 

Here’s my recommendation.  Some of these factors consumers have no control over, but two of these factors consumers are definitely in the drivers seat.  First, healthy lifestyles result in healthy people. Make good choices.  Good health is priceless.  Second, consumers need to educate themselves.  Do your research to help you make informed choices about health care services.  Use tools like OutofPocket.com to look up prices, find the best value and make the most out of your health care dollars.  If you shop for health care services the way you shop for electronics, automobiles, and clothing, you will save yourself thousands of dollars.

 

Be sure to read the article When Consumers Are Driving Health Care, in the March 6, 2008 edition of the Raleigh News & Observer written by Max Borders, a Policy Analyst at the Civitas Institute. 

 

The seven million consumers with high-deductible health plans and HSAs, will definitely be able to relate to this story.

 

 

This free prescription discount card is available to residents in 47 states in a joint effort of your local county government and the National Association of Counties (NACo).  The discount card can be used at a participating retail pharmacy and can save you an average of 20% on your prescription medicine.  Nine out of ten pharmacies nationwide accept this card.   The discount card may be used any time your prescription is not covered by insurance.  There are no restrictions and no limits on how many times you can use this card. 

When I looked into this program for Cook County, Illinois, I discovered that many different counties across 47 states (excluding Connecticut, Rhode Island and Vermont) participate in this prescription discount program.  Be sure to checkout the NACo website to find out if your state/county participates in this free program.  This program targets the uninsured, and insured consumers where prescriptions are not covered by their insurance plan.

In January, the Consumer Health Care Blog posted ten useful tips to help consumers reduce their medical bills.  If you haven't read this article that was originally published on BankRate.com, be sure to check it out.

1. Ask your doctor to be your ally
2. Compare costs by using CPT codes
3. Find friends in the billing department
4. Negotiate lower prices, payment arrangements
5. Ask if recommended services are necessary
6. Explore state-sponsored hospital web sites
7. Check your insurance company’s website
8. Ask for the Medicare rates
9. Go generic
10. Sweat the small stuff

On January 24, Vanessa Fuhrmans wrote a story in the Wall Street Journal about insurers paying doctors to prescribe generic drugs, rather than name-brand drugs for their patients.   According to the story, Doctors Paid to Prescribe Generic Pills, the basic idea is to reduce health care costs for patients, employers and insurers by implementing an incentive program set up by health insurers to reward physicians for prescribing generic drug prescriptions instead of the more expensive, brand-name drugs.

 

I think this approach to reducing health care costs is wrong.  Consumers --not the providers are the ones that should be recipients of incentives by asking for generic rather than brand-name drugs.  If consumers can directly benefit by becoming cost-conscious, consumers will be motivated to ask for discounts, request generic prescriptions, and shop around for the best value in order to save money.  In fact, this type of behavior already exists with consumers that have high-deductible health plans.  Do you think a consumer that is responsible for paying $2000-$5000 out-of-pocket would choose to pay $230 for a brand-name prescription when he can save $170 and pay only $60 for a generic drug?  This already happens today just by asking your pharmacist or physician for a generic equivalent when filling a prescription.  Consumers are not rewarded by insurance plans for this cost-conscious behavior, but they do save money by shopping around for good deals.   Insurers and health care industry experts underestimate the intelligence and responsibility of consumers.  In every other industry, consumers are self-motivated to shop for the best value.  The same motivation would occur in health care if consumers were paying out-of-pocket for these services.  I’d like to see health plans reward consumers for making cost-effective choices by offering premium discounts to reward this good behavior.  Automobile insurance policies reward consumers with discounts for good driving records, anti-theft features on your car, vehicle safety, accident free, and new student drivers with good grades in high school. 

 

Mona

 

If you are one of the many consumers out there shopping around for an MRI because you have a high deductible plan and you are trying to manage your out-of-pocket costs --you are not alone.  How much will an MRI cost you?   Interestingly, prices for MRIs can range from $600 - $3500.  See for yourself, use OutofPocket.com to find out what other consumers have paid for an MRI.  Why the huge price difference for the same test?  Isn’t an MRI an MRI?  What’s the difference between a $600 MRI and a $3500 MRI besides $2900?  Personally, I’d much rather save the $2900 for summer vacation and find a trusted provider that offers me the best quality at the lowest price for the MRI.

 

If you live in the Milwaukee, Wisconsin area and need an MRI, you need to know about SmartChoiceMRI.com.  This independent outpatient MRI facility charges $600 for all MRIs, for every insurance plan.  They negotiated this rate with the 50+ insurance plans they accept.  How did they do this when all the other providers have “secret” negotiated pricing with insurance plans that can include sometimes up to 100 different prices for the same provider for the exact same service – but for different insurance plans?   I’d like to see more pricing models like www.smartchoice.com in the future.  It makes it so much easier for the consumer to compare costs, easier to budget, and makes the consumer feel like they are not being overcharged for the MRI.   

 

Results of this pricing model: 

• encourages competition
• creates more consumer-choices
• drives down prices, improves services
• encourages innovation
• increases patient care and improves the quality of care

This is a model we would like the health care industry to strive for!

 

Mona

This year there has been a lot of advice written by consumers, financial analysts, health industry experts, bloggers and even physicians, on how to lower your medical bills.  All the advice suggests that consumers should try to negotiate prices with providers for discounts.   Yesterday I worked up the courage to try out my negotiating skills with a pediatric specialist.  First of all, it was surprisingly easy and I definitely got the impression the office manager was asked this question enough that she had a prepared response.  

 

A survey conducted by the Consumer Reports National Research Center found only 31 percent of Americans have tried to negotiate the price of medical bills.  Of those consumers who tried, 93 percent have been successful at least once and more than a third saved over $100.  If you are insured with a high-deductible, uninsured, or under-insured, or looking out-of-network for services, you should ask the provider for a discount.   A physician I talked to from Mount Sinai Hospital suggested patients should offer to pay the provider the amount that Medicare reimburses and start negotiating from that amount.

 

I have a high-deductible health plan with Blue Cross Blue Shield.  This year my family was blessed once again with good health and we never got close to meeting our deductible.   During the last week of December, I scheduled an appointment with a pediatric specialist for a non-urgent consultation with my daughter.  This specialist came highly recommended and is out-of-network, and charges high rates for consultations -- a perfect opportunity for me to ask for a discount.  Before we saw the physician, I talked to the office manager and offered to pay cash for services even though I had health insurance.  The regular fee for a consultation is over $100 and they offered to charge only $50 for the office visit if I paid cash.  This is a great deal!  Benefits to the provider: they would not be submitting a claim to my insurance company for this service, they would not have to send me a bill for the office visit and they receive payment upfront.  Benefits to the consumers:  I saved more than 50% by writing a check at the time of visit.  Not a bad deal and for your new years resolution I recommend you try this out in 2008.

 

Happy New Year!