COPAYs, co-insurance, deductibles, list price, discounted price, contracted rate, negotiated price, cash price.  Do you know in advance what amount you will be charged for health care services?

If you have health insurance, your health plan has negotiated discounted rates with each of your providers in the health plans network.   These discounted rates are called “contracted rates.”  When you visit a provider in the network, and show them your insurance card, they will charge you (or your health plan) the contracted rate for services.  The “list price” for services is reserved for people without insurance, and without a doubt, is an inflated price.   The Medicare rate for services is the rate the Government has negotiated for services under the Medicare plan.  Medicare is the lowest rate for services and often does not cover the provider’s true cost of delivering the services.   If you do not have health insurance, be careful because providers will charge you the “list price” for their services.  This list price is an inflated price, and if you pay cash, you should expect to receive a discounted rate, but remember ---you have to ask for it.  Everything is negotiable – including your health care bills.  It varies from provider to provider, but I have seen cash-pay discounts that range from 20% to 60% off the list price!

 

Bargaining down those medical bills

 

I conducted an experiment to find out if it was more cost effective for me to pay cash for visiting a provider, or to pay the contracted rate my insurance plan has negotiated for services.   To give you some background, I have a high-deductible health plan and this looks like a very healthy year for my family so I doubt we will come close to meeting our deductible this year.  In other words, we will most likely pay for all our health care expenses out-of-pocket.  Our high-deductible health plan is really a good deal for us because we save about $8,000 a year on less expensive premiums for this type of plan.  So if I spend less on health care out-of-pocket expenses throughout the year by being a cost-conscious consumer, I have more money in my pocket to spend on other things like vacations and get-away weekends.   That’s a topic for another day.

 

Last week I visited a specialist for a follow-up office visit. No tests.  No equipment. No supplies were used.  Just a follow-up consultation.  When I checked in for my appointment, I inquired about paying cash for my doctor visit rather than have the office staff bill my insurance plan for the service.  The office staff was very confused by my request.  They consulted with three office staff, including the billing manager, and concluded that I needed to wait until after the doctor visit to know what the price is.  This makes sense. They cannot give me an estimate for services until after I see the doctor so they know what level of office visit to charge me for.  After I saw the specialist, I went back to the front desk and asked them what today’s charges would be if I paid cash.  They looked up the CPT code for today’s visit and said, “the cash pay rate for today’s visit is $86.”  I know from earlier visits to this provider, that my insurance plan negotiates a contracted rate of $70.  The list price for this visit is $109.  So here’s what I learned:

• $109.20 is the list price for an office visit with this specialist 
• $ 70.00 is the contracted rate my insurance plan has negotiated with this provider
• $ 86.00 is the cash-pay price the provider charges if you do not have insurance

After all that, I decided to have this office visit processed through the regular insurance claims process, because it provided me with a larger discount. 

 

Conclusion

 

My health insurance plan has negotiated some terrific discounts with their network providers.  The best part is that I directly benefit from these discounted rates for services.  When I signed up for my health plan, this topic never came up with the insurance agent that sold me this plan.  These network discounts appear to be one of the strongest selling points for this high deductible health plan since I end up paying 100% of the negotiated price for these services (until I meet my deductible.)  If there was more transparency in our health care system, consumers would be able to look-up provider prices for services for specific health plans, and determine upfront what their out-of-pocket expenses would be.  In today’s health care system, this is impossible to know ahead of time.

 

A picture is worth a thousand words.  Using a whiteboard to explain complicated issues surrounding our health care system, Humana has created a three minute video on YouTube that does a great job explaining why we need health care reform. The video explains in simple terms what's wrong with our currently health care system and presents some ideas and proposals that are being considered. 

If you haven’t seen this video, you should definitely check it out.

Walgreens recently announced that they are offering free health care services at their retail clinics for all current and future Take Care Clinic patients and their families that experienced a job loss after March 31, 2009 and are uninsured.   They call it the Take Care Recovery Plan.

To learn more about this program you can call 1-866-Take-Care (1-866-825-3227) and press 3 for Take Care Recovery Plan information.

Or you can visit their website to learn more about the Take Care Recovery Plan.

It’s easier and much less expensive to stay healthy.  In today’s tough economic times, it has never been more important for people to really take control of their health and prevent unnecessary health emergencies.  Even though at times it seems like an awful lot of trouble to stay fit, exercise, eat healthy foods and take good care of yourself by having regular checkups and screenings – this behavior is actually a great return on your investment.  When you get sick, things can get very expensive. Many employers reward this type of healthy behavior and insurance premiums are sometimes reduced if you take good care of yourself.   So why wouldn’t you choose to stay healthy? 

In Colorado, a non-profit organization called 9Health Fair promotes health awareness and encourages individuals to assume responsibility for their own health by providing consumers with 20 free and 4 low-cost health screenings.  The low-cost screenings include:

 

·       Prostate Specific Antigen (PSA) screening; identifies a man’s risk for prostate cancer, for $25

·       Blood Count screening; identifies a person’s ability to fight infection, risk for anemia and blood-clotting abilities by checking white and red blood cells, hematocrit and hemoglobin levels for $15

·       Blood Chemistry screening, which tests 28 separate things including cholesterol, blood glucose, liver, kidneys, thyroid and more, for $30

·       Colon Cancer Screening Kit; this take-home/mail-in kit checks for human blood in the stool which can lead colon cancer for $20

 

Wouldn’t it be nice if everyone had access to affordable screening programs like this?  If you know of any programs like9Health Fair that we should tell others about, be sure to let me know and I’ll post it on the OutofPocket.com website, to share with others.

 

If you are uninsured, under-insured, or have a high-deductible health plan, don’t skip taking care of yourself.  In fact, I encourage you to use this information about low-cost prices 9Health Fair offers for screening tests to your advantage.   Call a provider and see if they will match these prices, or at least offer you a discount.

Wondering why your medical bills are so high?  New Hampshire Public Radio’s health reporter, Elaine Grant, revealed some interesting information about hidden facility fees in an interview last week with New Hampshire State Senator Jackie Cilley, Joe Loring, Executive at St. Joseph Hospital and James Unland, President, The Health Capital Group.  Click here for the full transcript.

 

Let’s face it, health care has a lot of “secret pricing”, but state lawmakers are starting to tackle one of the best kept secrets in health care – facility fees.  These facility fees can add hundreds and even thousands of dollars to your medical bill.  Hospitals say the fees are essential to their bottom line, but critics point to these fees as a major contributor to the high cost of health care.   

 

When you are paying out-of-pocket costs for health care services, these prices can make a huge difference.  For consumers that are uninsured or that have high-deductible plans, knowing the difference between an independent practice lab or one owned by a hospital can save you hundreds and possibly thousands of dollars.  When consumers go to a hospital-owned practice or facility, their bill includes the cost of the hospital’s overhead – aka “facility fee.”  This explains why hospital outpatient services usually cost more than the exact same services offered by an independent  stand-alone facility.  For example, an independent diagnostic facility charges $65 for an x-ray, while the hospital charges more than $260 for the exact same service.  The average consumer has no idea these fees even exist.   In many cases, the facility fee is simply included in the total cost of the visit, making it impossible to see.  Many consumers are not even aware that the provider they’re visiting is owned by or affiliated with a hospital.   So be sure to call and ask before you make an appointment at a facility.

 

In 2006 facility fees made national headlines when patients brought two class action lawsuits against Seattle hospitals.  One of the patients had a five-minute procedure performed at a clinic owned by the University of Washington Medical Center and was billed more than $8000.  Nearly $7000 of this bill was for the facility fee.  The medical center settled the case and agreed to disclose its prices.   Interestingly, once the prices were made public, the hospital could no longer justify the unreasonably high prices so they discounted their fees by 40% for about 1400 outpatient procedures.  Here is a link to the hospital’s public prices.

 

Let this be a lesson for all:  you can save a lot of money by asking providers what a procedure will cost – beforehand. 

One out of every ten patients now has a consumer-driven health plan, so hospitals are starting to become proactive bill collectors.  An article in the Minneapolis Star-Tribune discusses how hospitals in the Twin Cities are starting to telephone patients before their scheduled procedure to review how much they will owe out-of-pocket.  As strange as this seems, it’s really a step in the right direction for our health care system.  Patients (consumers) are becoming more aware of the true prices for health care services.  This behavior encourages consumers to comparison shop to find the best value and make the most of their health care dollars.  If patients continue to pressure providers for true prices, we will start to see health care prices become publically available, resulting in competitive pricing, innovative services and improved  patient care. 

 

This is very good news for health care consumers.

 

Today’s Wall Street Journal shares some helpful tips on how you can cut your medical costs.   Many of these tips have been mentioned in earlier posts on this blog, but this information is important enough to repeat once again.  These tips can actually help make a difference in making your health care dollars go further.  I am an advocate of consumers taking control of their health care, including making informed choices, shopping around for the best value and doing your research – before visiting a provider.  

 

For the full article, read Financial Prescriptions:  Seven tips for cutting your medical costs.

 

1.  Find the right health insurance plan for you and your family.  You need to know what your health plan covers, what’s not included and what your maximum out-of-pocket expenses are.   Read the fine print very carefully.  Consider looking into CDHPs with high-deductibles.  A high-deductible health plan can seem daunting, but when you understand and take into account all your costs including premiums, co-pays, deductibles, co-insurance fees, you can actually come out ahead with a high-deductible plan.

 

2.  Shop around for the best care.  Consumers are expected to compare quality and prices for providers and services, but this sometimes is easier said than done.  Comparison shopping is possible to accomplish, but you need a lot of patience and persistence and to be resourceful.  Keep a spreadsheet of providers, prices, inclusions and start making those phone calls.  Call your providers.  Call your health plan.  Make sure you contact your health insurer, potential providers, their competitors, and hospitals --to determine your out-of-pocket expenses for specific procedures.  Be sure to take advantage of websites that publish prices for consumers including vimo.com, healthcarebluebook.com, costhelper.com,  newchoicehealth.com and of course, outofpocket.com.   For a more complete list of websites that provide pricing, visit Tools For Consumers to Look-up Prices.  

 

3.  Take control of your treatment.  You are your own best advocate for your health.  Take an interest, ask the provider questions, bring along another person for a second set of ears, seek a second opinion, and be sure to research the provider before services are performed. 

 

4.  Take care of hospital bills.  Don’t pay providers directly until you receive the EOB from your health plan.  When you receive the bill, make sure you scrutinize the bill for errors.  If you are uninsured and paying cash, make sure you negotiate with the provider to receive a 50% discount from the list price or 125% of the rate Medicare would pay for this service.  By the way, you can easily look up Medicare payment amounts on this public website  

 

5.  Manage your medications.  Always make sure your primary care provider knows about all the medications you might be taking because it may not be necessary to take all the medicine being prescribed.   Some medications might be a version of the same medication, or cause harm when taken together.  Inquire with your doctor about using less expensive generics.   Look into mail-order pharmacies and comparison shop for drugs using the Consumer Reports website.  

 

6.  Focus on prevention.  Being healthy is definitely less expensive.  Simple changes like eating healthy, exercising daily, get enough sleep at night can make a tremendous improvement in your overall health.

 

7.  Be careful about skipping care.  When money is tight, many people cut health care spending and this can sometimes result in more expensive care later as the condition progresses.  Some procedures can be postponed.  Instead of skipping preventative care, you should look into more affordable options like retail clinics, local community screenings, immunizations and urgent health care centers (rather than emergency room visits.)

 

 

OutofPocket.com was launched in 2007 to help consumers look-up prices and find affordable health care services.  For two years, OutofPocket.com has been the consumer’s voice promoting price transparency in health care, appealing to the 47 million Americans that are uninsured and consumers with CDHPs.  Today, with so many employers struggling with rising health care costs, consumer driven health plans are rapidly becoming the number one choice for their affordability.  As these employers adopt CDHPs for their employees, OutofPocket.com becomes a useful tool to help employees reduce their out-of-pocket expenses and make informed choices before purchasing health care services. 

 

Being a savvy health care consumer saves you money and reduces your health care costs.  In addition to reducing your out-of-pocket expenses, here are some other practical tips you can use from CheckPoint HR Benefits Group, on how to reduce your health care costs.

 

Work with your doctor.  Most doctors understand the business and processes of insurance. Tap into their knowledge base for the best possible hospitals for specific procedures.  Many doctors can provide patients with guidance in negotiating fees and/or working with the insurance companies on lowering out of pocket costs. In some instances, doctors will reach out to the hospital's finance department (on behalf of the patient) and request that consideration be made when dealing with the finances of certain procedures. Bottom line, communicate and work with your doctor!

 

Know all of the benefits available to you.  Insurance programs are aligned with a lot of ancillary benefits that consumers should be made aware of. Benefits such as gym reimbursements, employee assistance programs, massage therapy, chiropractic care, acupuncture, vision reimbursements, weight loss programs, free or low cost flu shots or immunizations, disease management programs, health coaching or nurse advice lines, are no cost preventive benefits. Make sure you read the fine print and take advantage of everything that is being paid for via premiums.

 

Be a smart consumer.  Individuals today have better access to information than ever before. With more control over their own health care, consumers are able to make educated and more informed decisions about options, procedures, costs, and treatment. Some insurance companies now have released the costs for certain procedures covered under their plans on their websites. This information allows individuals to better understand the true costs of care before they utilize their plan and allows them to make better financial decisions based upon quality as well.  If your insurance plan does not provide this information, you can use tools like OutofPocket.com to look up prices and find the best value.

 

Go generic.  High deductible plans are taking traction in the workplace and with that so does the need for employees to manage their costs with more scrutiny. One consideration for maximizing your benefits without sacrificing quality is to ask your doctor about a generic drug. When working with your doctor, ask them if the prescribed medication has a generic equivalent that will work for you. If there is a viable equivalent, make sure the medication is listed on the formulary list that your insurance carrier make available on their Website.

 

Focus on wellness.  One of the best ways to reduce health care costs is for people to get healthy! Companies today are rewarding employees who are proactive in their decision making and who lead healthier lives through physical fitness and increased presenteeism. Corporate Wellness programs offered today focus on tobacco cessation, know-your-numbers (BMI, Blood Pressure, Cholesterol), walking clubs and programs that increase physical activity and reduce negative behaviors towards health.

 

The original idea behind OutofPocket.com was to build a platform that would enable consumers to collaborate.  Consumers would use OutofPocket to post/share prices they paid for actual health care services.  This collaborative effort over time would result in a very powerful directory of true prices that consumers could use to find the best value and make the most of their health care dollars.

 

If enough consumers start shopping around for the best value (quality and price), providers would start competing for our attention and good things would result.  Competition and choice will:

·         Lower costs of health care services

·         Promote innovation

·         Expand choice

·         Increase access to medical care

·         Improve patient care

 

My challenge is getting people to participate in OutofPocket.com and start posting/sharing prices.   People respond to incentives.  Perhaps exposing health care prices and helping to create more competition and choice in the health care industry is not enough of an incentive.  If you give people more of a reason to do something, they will do more of it, and if you make it easier for people to do more of something they are already inclined to do, they will also do more of it.  Today health care costs are spiraling out of control; we have more than 47 million people that are uninsured and over 12 million people with consumer-driven health plans.  These combined 59 million Americans have every reason to make the most of their health care dollars and find the best value.   These people are financially rewarded if they make their health care dollars go further.  If I knew I could save myself $500 by shopping around for an affordable MRI in my neighborhood, I certainly would be financially motivated to take advantage of this savings.

 

If you know of one of these 59 million people – please let them know about OutofPocket.com.  Or even better, drop me a note info@outofpocket.com to let me know how I can help.   

 

Be Healthy,

Mona Lori

WebMD provides valuable health information for consumers.  A recent article by WebMD Health News writer, Miranda Hitti, provides useful tips on how you can spend less on health care services.  The article is a three-part series that covers topics on how to manage costs of children’s medical care, cutting prescription drug costs and reducing costs of doctor visits. Below are highlights of the article.

 

Children’s Medical Care

 

Children need lots of medical care for vaccinations, routine checkups, sniffles, sore throats and fevers.  Look into local and state resources that provide assistance based on financial need.  Check with your local state or local health department. Most of these agencies can refer you to affordable health care providers that offer sliding scale fees based on your income.

 

Don't skip children's vaccinations.  Kids and teens – and even adults, need to stay up to date with their immunizations.  Many retail clinics offer affordable vaccinations.  Local health departments offer health and wellness services through hospital community outreach programs, at affordable costs to the community.  Contact your village hall for more information.

 

You should first try to phone or email your pediatrician's office with basic questions. You can often avoid a costly trip to the emergency room by taking advantage of telephone counseling for many routine kinds of problems. 

 

Doctor Visits and Medical Tests

 

Skipping doctor appointments could be risky and you could end up spending more money later on for expensive emergency treatment or health consequences for more severe conditions.  Be sure to follow through with preventive care.

 

Take care of your health --- it’s your most important resource.  A healthy lifestyle can pay off – literally.  Your good health makes you wealthy.  Think about it, if you are healthy, you might need fewer prescription drugs, you might be less likely to develop high-maintenance conditions such as heart disease, diabetes, and high blood pressure.  Your insurance premiums might even be reduced.

 

Eat healthy foods, exercise, and lose the extra weight.  Even simple walks can make a huge difference in your overall health. Walking is free and you can walk anywhere!

 

Negotiate with your doctor, or the financial counselor at your doctor's office, about medical test costs and office visits.  If you are uninsured or have a high-deductible plan, providers will often provide you with a big discount (up to 70%) for paying cash at time of service.  If the discount they offer is not a fair price, offer to pay the Medicare rate (these rates are public information).

 

Research your local and state health resources.  Look into community health centers (which typically charge fees on a sliding scale), free clinics, and local or state programs for children.  A community center charges as little as $20 for what an urgent care center will charge around $110 and most doctors’ office charges $120.  You can save a lot of money by being a savvy consumer.   If you have children and meet certain income standards, check with your state or local health department about insurance.

 

If you are uninsured, investigate what coverage you may be eligible for, that you might not know about.

 

Don't use the emergency room for problems that aren't emergencies.  Because emergency rooms are overwhelmed, you may wait hours to be seen. And if you're paying out-of-pocket, you could wind up with a very expensive bill, which you will be responsible for.

 

Prescription Drug Costs

 

Ask your doctor about generic drugs and over-the-counter drugs.  Many people respond as well from generic drugs as on brand-name drugs.  Generic drugs are a lot more affordable.   Be sure to ask your doctor if you can get higher-dose pills to cut in half because high and low doses of drugs often cost the same amount.  Cutting your pills in half not only makes your pills last longer, but you can save a lot of money.  For instance, a patient who takes 20-milligram doses each day of a drug that costs $100 per month could save $600 a year if his doctor prescribes a 40-milligram dose and the patient cuts each pill in half.   Be aware that some pills don’t work properly if they are split so ask your doctor or pharmacist.

 

Shop around and compare costs for the best price on your prescription drugs.  The cost of your prescription drugs may vary a great deal across different pharmacies.

 

Look into drug companies' assistance programs.  Drug companies offer assistance programs to help cover medication costs for people who meet certain financial criteria.

 

Consider your Medicare Part D plan.  If you're 65 or older, or have Medicare because of a disability, you can switch Medicare Part D plans each year from Nov. 15 through Dec. 31, so you may want to assess whether your current plan is still the best deal for you.

 

Store your pills correctly.  Heat, moisture, and darkness can reduce the potency of the medication.  You spend a lot of money on your prescription drugs so be careful how you store them to avoid waste.

 

Be careful with promotions for expensive drugs. If your doctor gives you a card offering a one-time deal on an expensive prescription drug, you might want to remember that that deal won't help you if you refill that prescription.  Keep in mind that you are going to have to pay for the refill out-of-pocket.

 

Reducing health care expenses involves much more than simply finding the best value for services.  Everyone knows that eating healthier and exercising more can improve your health.  Maintaining good health goes a long way and here are some practical tips, in addition to eating healthy and exercising every day, that are guaranteed to improve your overall health.   These tips are easy to follow, cost nothing and you can start following these tips today to make a big difference.

• Drink more water
• Eat breakfast every day and try to include protein and fiber
• Increase your fiber intake
• Eat more fruits and vegetables.  Remember to eat a variety of colorful fruits & vegetables (red, orange, green, yellow and purple)
• Get at least seven hours of sleep a night
• Floss your teeth every day
• Find your spiritual self
• Develop a supportive network of friends
• Stop drinking soda
• Smile more often

Over the past few years, I have researched most the price transparency tools that are available to consumers.  Some of these tools can be accessed only by members of health insurance plans.  Some tools require a subscription or fee to access the pricing report data.  There are many other free tools that enable consumers to look-up prices of health care services.

 

Here is a short list of free public tools that consumers can use to look-up price of health care services.  If you would like the list of URLs to access these tools, please send us an email info@outofpocket.com

• AMA CPT Online
• Carol
• Cost Helper
• DoctorPricing
• Healthcare Blue Book
• Health Pricer
• LesliesList.org
• MainStreetMedica
• MyHealthScore
• New Choice Health
• OutofPocket
• Spectrum Health
• State Hospital Websites
• USA Healthcare Costs
• Vimo

Consumers with health insurance plans that have low-deductibles and low co-payments have absolutely no motivation to shop around for the best value or compare prices before visiting a provider for even the most routine type of services (MRIs, x-rays, mammograms, lab tests, dental and vision).   They purchase health care services from whomever, regardless of price or quality of service.  They visit emergency rooms for non-emergency conditions because “it only cost $75 co-pay for a visit to the ER.”  They often overuse medical services, have an unnecessary number of diagnostic tests performed, and fill every prescription a doctor prescribes without questioning generic alternatives.  These consumers are not concerned about the true cost of health care services.

When consumers have high-deductible health plans, they are rewarded financially for making good choices.  Spending health care dollars is spending their own money so they are interested in making cost-effective choices.  Everything changes.  People become responsible about their health and their health care costs, and expenditures drop like a rock.

Healthcare Prices:  Looking Behind the Curtain is a new blog that you should follow. Jeffrey Rice, CEO, HealthCare Blue Book, covers healthcare transparency news and discusses issues that you will find interesting.  His recent post discusses the disparities in health care pricing and how paying more doesn’t always mean better quality.  The fact is that the price for an MRI can range from $500-$2500 in the same geographic area.  Let’s take a look at some of the real out-of-pocket savings when consumers choose a provider that charges $500 for an MRI, rather than the provider that charges $2500 for the exact same diagnostic test.

• An individual with a co-pay would save $100 out-of-pocket by selecting the $500 MRI , rather than using the $2500 provider
• An individual with a high-deductible would save $2000 by selecting the $500 MRI
• Employers that are self-insured would save ½ million dollars a year just on MRIs of the knee, if they encouraged employees to use the cost-effective provider that charges $500 for their MRI.
• Total dollar amount of claims would be reduced, and this could result in lower premiums
• Just imagine how much $$$$ insurers would save if consumers adopted cost-effective behavior 

One of the greatest challenges in getting people to use cost-effective providers is how do we encourage and enforce this cost-effective behavior?  One of the few unquestionable principles of economics is that people respond to incentives.  If you give people more of a reason to do something, they will do more of it.  If you make it easier to do more of something they are already inclined to do, they will also do more of it.  Reducing my out-of-pocket expenses is enough of a reason for me to select the provider that offers the best value. 

 

The cost of medical care is rising by the day, and it’s becoming harder to stretch your dollars to meet medical expenses, especially if they occur on a regular basis. Even if you have health insurance, it’s important to spend your out-of-pocket dollars wisely. If you’re wise and careful enough, it’s easy to make the most of your healthcare dollars, by:

• Preventing illnesses by following routine precautions and basic cleanliness.
• Adhering to a healthy lifestyle – not smoking and drinking, eating healthy food, exercising regularly, drinking enough water, and keeping your mind relaxed and stress-free.
• Preventing accidents and keeping your home safe from potential hazards.
• Following safety precautions and road rules to avoid meeting with accidents that could prove to be extremely costly affairs.
• Getting yourself checked routinely to identify potential health risks.
• Understanding your illness, if you have one, its conditions and implications, and making an informed decision about the best treatment.
• Opting for treatment before conditions become serious and hence more expensive.
• Taking the medication that’s prescribed for you – some people stop taking them when they begin to feel better, but it’s imperative that you finish the course your doctor has prescribed.
• Reviewing your medication on a regular basis (if you have a chronic condition like diabetes) and ensuring that you’re not taking any that are not necessary.
• Asking questions about medication to ensure that they’re necessary and to know what they treat.
• Switch to generic drugs that are as effective but not as costly as the branded ones.
• Asking relevant questions about any prescribed diagnostic tests to ensure that they are absolutely necessary.
• Understanding the benefits you are entitled to under your insurance plan.
• Planning ahead for pregnancies and other medical routines that can be put off.

It’s a well know fact that health is wealth, and it’s absolutely imperative that we’re physically and mentally fit if we’re to enjoy and savor life. It’s also true that prevention is better than cure, so do your best to prevent diseases before they catch you. And if you still fall sick, make sure you do all it takes to get better soon rather than spend unnecessary time and money at the doctor’s office.

  

This article is contributed by Sarah Scrafford, who regularly writes on the topic of online pharmacy technician training. She invites your questions, comments and freelancing job inquiries at her email address: sarah.scrafford25@gmail.com.

 

The Chicago Tribune reported some great tips on where consumers can find affordable dental care in the Chicago area and suburbs.
 
Here are four options for you to check out:

• Children's Dental Clinic, 2100 Ridge Ave., Evanston. Call the clinic at 847-866-2953.
• Cook County Department of Public Health Dental Clinic, Suite 250, 2121 E. Euclid Ave., Rolling Meadows, Illinois.  Patients must live in Cook County and meet income guidelines. The clinic, in the Rolling Meadows branch of Circuit Court, accepts patients by appointment. Call the clinic at 847-470-7398.
• Northwest Community Hospital, Mobile Dental Clinic, 800 W. Central Rd., Arlington Heights, Illinois. The clinic accepts Public Aid and Kid Care.  Fees are charged according to sliding scale. All patients must be screened before receiving treatment. Call the clinic at 847-618-5573.
• Waukegan-Belvidere Medical Clinic, 2400 Belvidere Rd., Waukegan, Illinois. The clinic offers dental care for ages 3 and older. Patients must reside in Lake County. It accepts Public Aid and Kid Care and charges fees on a sliding scale. Call the clinic at 847-360-6525.

If you know of other clinics that offer affordable dental, vision or medical services, please send us an email so we can share this information on our blog with other consumers.

Mona Lori
info@outofpocket.com

Many of you are struggling to make ends meet while your health care expenses continue to rise. If you are well informed and you do your homework, you might be able to reduce your medical expenses by following some simple tips. Just remember A-B-C-D.

Ask the provider upfront (before services are delivered) for a price break. Each provider has their own rules about negotiating bills, and you should always ask. Explain your circumstances and offer to pay cash at time of service or develop a payment plan.

Bill review. Be sure to review your medical bills for possible errors. I can’t tell you how many times I found small errors on my medical bills just by casually browsing through the detail. As soon as the bill arrives, read through all the line items and make sure that you are being charged the correct price and charged only for services you received. Medical billing errors occur all the time. Why pay more than you have to? I am assuming you already review many of your household bills (cell phone, utilities, cable, appliances, groceries, auto insurance) for accuracy. Treat your medical bills with the same level of scrutiny.

Compare prices using online tools. Insurers sometimes provide their members with tools to look up out-of-pocket costs for a specific plan. Other online tools are available to give you an idea of a fair or estimated price for a specific service. The more you know about fair pricing, the better price you will be able to negotiate. In addition to outofpocket.com be sure to check out healthcarebluebook.com, AMA CPT online, and costhelper.com to look up prices for services. For a more complete list of price tools, refer to the this list of price transparency tools. Remember also that where you go to receive care can also make a big difference in your costs. Emergency-room visits tend to cost $300 to $1000, compared with $150 at an urgent-care center, $65 to $75 at a doctor’s office, and $35 to $45 at a convenience-care clinic. For non-emergencies, it pays to call your insurer’s 24-hour advice hotline for guidance on where to go for care. Make sure the facility and provider are in your health plan’s network. In fact, don’t wait for an emergency to find the nearest ER or urgent care center in your network. Look it up now and keep this information handy so you can easily refer to it in case of an emergency, when it is often difficult to make cost effective decisions.

Discounts can make a big difference. You should make the most of discounts that are available to you from your insurer, dental/vision programs, prescription medications, and incentives from your employer. All these discounts help reduce your medical bills. Many insurers offer discounts on services to promote healthy lifestyles, including gym memberships, smoking-cessation and weight loss programs, chiropractic service and acupuncture. Ask your insurer or employer about these programs. Providers also offer discounts for paying in cash, or paying at time of service.

Consumers of health care services don't have a clear understanding of just how much medical services really cost.  For many years, health plans insulated members from the true cost of these services by making payments directly to doctors or hospitals. As a result, consumers received medical services for co-pays as low as $10, or some plans provided these services at no cost to the consumer. With the rise in consumer-driven health plans, it’s important for consumers to understand the true cost of medical services, and be knowledgeable about finding the best value before visiting a provider. Here are some interesting facts on what these services really cost.

Did you know:

• The national average cost of an MRI is nearly $2,000
• Heart bypass surgery costs about $57,000
• The average cost of a 30-day prescription of one name brand drug is $71 compared to $22 for the generic equivalent
• National healthcare expenditures are expected to nearly double over the next 10 years

Knowing what you're spending and keeping an eye on health care costs are important parts of keeping health care affordable for all of us. Here are some things we can all do to make a difference:

• Ask for FDA-approved generic drugs instead of more expensive name brands
• Make sure you're getting the right treatment, and always ask your doctor any questions you may have
• Review all explanation of benefits for accuracy, and ask about any costs that you don't recognize or understand.
• Understand what your out-of-pocket costs will be before you receive medical services. Online tools are available for consumers to look-up average prices if your insurer or provider cannot answer this question.

You’ve heard of the Kelly Blue Book, a trusted resource for looking up new and used car prices. Now there is a Blue Book of health care prices. A new website recently launched to help consumers look-up fair prices for health care services. The website, Healthcare Blue Book is an excellent resource to help consumers make informed choices. If you have ever wondered if you were being overcharged for health care services, or what a specific service might cost - this website can answer those questions. The health care Blue Book fair price is the cash price consumers should pay for a service or product at the time of treatment. It is the payment amount that many high quality health care providers accept from insurance companies as payment in full. Americans can’t control the economy, but they can do a much better job of educating themselves about what they should pay for health care.

Price variations for healthcare services, even within the same market and provider network, may be thousands of dollars. So knowing what the fair price is can help consumers better manage the cost of their health care. Unlike many other health care price tools, Healthcare Blue Book is very easy to use.  Type in the kind of healthcare service needed plus a zip code and the Healthcare Blue Book pulls up the fair price based on fees paid by Preferred Provider Organizations (PPO) to doctors for services in that market. Consumers can then use the suggested Healthcare Blue Book price to discuss prices for services and treatments with their doctors and other healthcare providers.

Americans do price/value comparisons for their homes, cars, vacations and the majority of goods and services they buy. “Why not healthcare?” asks Dr. Jeff Rice, Healthcarebluebook.com founder. The former CEO of CareSteps, Rice has a long history in the healthcare industry of developing innovative products for consumers.

“Patients should not assume that a high price means good quality,” says Rice. “It is up to patients to ask about the cost of services and to learn about the quality of their providers. Doctors and hospitals that charge a fair price, often provide the best value. Healthcarebluebook.com can help consumers figure out what they should pay.” Consumers need better education about the healthcare services they purchase and 2009 is a good year for them to start. Using the Healthcare Blue Book can help people learn how to obtain fair prices for their healthcare.

In addition to fair pricing, the website provides information on useful resources for patients including a list of websites by state that provide health care pricing.

Thank you for your interest in our community directory of health care prices --OutofPocket.com.  Over the past several months we have been fine-tuning the OutofPocket server and database to provide consumers with more meaningful price information.  At this time I would like to invite you back to take another look at www.Outofpocket.com.  The directory helps consumers look-up prices for routine health care services by utilizing a custom search engine that collects prices from consumers, providers, Government databases and public websites.
 
Can't find what you're looking for in the OutofPocket.com directory? 
 
We rely on consumers to post/share prices they paid for actual medical services, to share with other consumers.  We also invite providers to list their services/prices in the directory free of charge. The more prices that are added to the directory, the more meaningful the directory will become for everyone. Just imagine how interesting the directory would become if 500,000 consumers posted out-of-pocket prices they paid for actual health care services.
 
Do you have ideas on how we can improve this price transparency tool?   Have any tips to share with us?
 
Send me an email at mona.lori@outofpocket.com.  I'd love to hear from you. 

In this economic downturn, consumers are aggressively looking for ways to cut back on expenses – including health care expenses.  Three and half million people have lost their jobs and their health insurance.  People that have health insurance are paying more for premiums, co-pays and deductibles and employers are passing on more health care costs to their employees.  Health spending is rising faster than wages and many are forgoing medical services in an effort to cut back on health expenses.   People are cancelling gym memberships, eating more unhealthy (comfort) food in these tough economic times, skipping medications to save money, experiencing more stress than ever before, going without health insurance and delaying preventative care.

An article in the Los Angeles Times Health Section, Cut health costs, not your care,  provides some valuable tips and techniques to help you reduce your health care costs  - while you continue to take care of your health. Here are some of the highlights:

Saving Money on Prescription Medications

• Compare drug prices before making a purchase by using tools like destinationrx.com and drugstore.com
• Save up to 80% by selecting generic rather than brand-name drugs
• Consider purchasing your medications in bulk to save money
• Do your research to find drug companies offering discounts on brand-name drugs
• Consider purchasing medications online (be sure to visit the U.S. FDA site for consumer information)
• Look for discounts on brand-name drugs by searching for coupons at www.internetdrugcoupons.com

Save Money on Doctor Visits

• Stay proactive about your health.  A doctor visit is a lot less expensive than an emergency room visit.
• Use network providers whenever you can.  Ask network providers for referrals from your network if you need to see a specialist.
• Consider bartering to help pay doctor fees. 
• Utilize retail clinics for non-emergency medical services
• Utilize urgent care centers rather than emergency rooms for conditions that are not life threatening
• Visit community health centers to locate medical help at low cost.
• Use resources like public libraries to find affordable medical services in your area.
• Contact disease/condition foundations for additional resources and options on affordable screenings.
• Negotiate a price for services if you are paying cash to save 50% or more off the list price.
  

In the Personal Journal section of today’s print version of the Wall Street Journal, Aetna has a full-page ad.  The headline of this ad, “How Aetna can even help you keep your wallet healthy,” caught my attention because the ad promotes a few tips on how consumers can keep health care costs down including:

 

·         Use generic prescriptions rather than brand-name

·         Use mail order service to fill prescriptions

·         Preventative care to keep yourself healthy

·         Stay in network when selecting providers (hospitals, doctors)

 

I have a tip for the health insurer --  why not keep health care costs down by eliminating expensive advertising!  I wonder how much this full-page ad cost Aetna.   With the rise in health care costs, including insurance premiums, cost of service, and administrative fees, I find it disconcerting that health insurers spent so much money on this ad.  If I had my choice, I would prefer my health insurer save me money and reduce my monthly premiums, rather than spend extravagant amounts of money on unnecessary advertising. No offense Aetna, but with health care costs spiraling out of control, consumers are more interested in reducing their out-of-pocket costs.   I’m not sure this ad keeps my wallet healthy.

 

 

Happy New Year!  Spending wisely for health care services is definitely a priority in 2009 and with a little knowledge; you can easily save hundreds –even thousands of dollars.   To get you started, here are some excellent tips on how you can save money on routine health care services. 

 

Affordable Medical Care Services

 

Federally-funded by the Health Resources and Services Administration (HRSA), there are thousands of health centers around the U.S. that provide low-cost health care to people based on financial need. You pay what you can afford, based on your income. For more information visit www.findahealthcenter.hrsa.gov, or you can call (888) 275-4772.

 

Hill-Burton facilities: There are around 200 Hill-Burton health care facilities around the country that offer free or reduced-cost health care for people that cannot afford to pay for services.  To locate a facility or to see if you qualify, visit www.hrsa.gov/hillburton or call 800-638-0742.

 

Free clinics: These are privately funded, non-profit, community-based clinics that typically provide care for common illnesses and injuries to those in need, at little or no cost. There are around 1,000 free clinics nationwide. To locate one in your area, call your local hospital or visit www.freemedicalcamps.com for more information.

 

Indian Health Service (IHS): A government agency within the Department of Health and Human Service, IHS provides free medical care to American Indians and Alaska Natives in 35 states. Visit www.ihs.gov for more information.

 

Remote Area Medical: A non-profit, charitable organization that provides free health, dental and eye care to uninsured or underinsured people in remote areas of Tennessee, Kentucky and Virginia but may be expanding to other states in the future. Visit www.ramusa.org or call (865) 579-1530.

 

Affordable Eye Care/Vision Services

 

To locate free or discounted eye care or eye glasses programs in your area, you should contact your local Lions Club. Call 800-747-4448 to get the number to your state Lions Club office, which can refer you to your community representative, or visit www.lionsclubs.org. There are also a variety of national eye care programs that can help you too including:

 

EyeCare America is a public service foundation of the American Academy of Ophthalmology that provides free eye health educational materials and access to medical eye care.  Visit www.eyecareamerica.org or call (800) 222-3937. 

 

Vision USA offers free vision care services to uninsured and low-income workers and their families.  Visit www.aoa.org or call (800) 766-4466.

 

Mission Cataract USA provides free cataract surgery to people who don't have Medicare, Medicaid, private insurance and are low-income. Visit www.missioncataractusa.org or call (800) 343-7265.

 

New Eyes for the Needy is an eyeglass program that accepts donations of used prescription eyeglasses and distributes them to people with limited incomes. Visit www.neweyesfortheneedy.org or call (973) 376-4903.

 

Affordable Dental Care

 

Many people with health insurance do not have dental insurance.  Here are some affordable options, depending on where you live.  Call your state dental association, or local dental society (visit www.ada.org/ada/organizations) to find out if there are any state or local programs, or clinics, that offer discounted dental care to those with limited income. Other sources you should checkout:

 

Health centers: In addition to low-cost health care, many HRSA health centers also offer dental care too. Visit www.findahealthcenter.hrsa.gov or call (888) 275-4772.

 

Dental schools: If you don't mind letting a dental student work on your teeth, dental schools are another source that may offer discounted dental care. Visit www.ada.org - click on “Dental Schools” for a U.S. directory and contact information. 

 

National Foundation of Dentistry for the Handicapped is a service that provides free dental care for elderly and disabled people who can't afford to pay. To learn more or to apply for care in your state, visit www.nfdh.org or call 303-534-5360.

 

Are You Eligible for Medicaid or Assistance Programs?

 

To find out if you're eligible for Medicaid, prescription drug assistance programs, visit www.benefitscheckup.org. Also, see www.needymeds.com, a top resource for finding affordable medicine.

 

Source: These tips were provided by Jim Miller, contributor to the NBC Today show and author of “The Savvy Senior” book.

 

 

Affordable Lab Tests

 

If you need to have blood tests done, you have several options on where you can go to get affordable lab tests. 

 

If you are looking for preventive testing, consider attending health fairs at schools and churches. A company called Life Line Screening offers finger stick blood tests for glucose and lipid panel (total cholesterol, LDL, HDL, triglycerides) for $60. Results are provided on the spot. Go to lifelinescreening.com or call 800-697-9721 to find out when the next local screening is scheduled. 

 

Also be sure to contact community centers, library, and YMCA or village hall.  These organizations often schedule affordable blood screening fairs once or twice a year.  Check with the health services department of your village or township to get more information.

 

If the need for additional tests comes up during a regular checkup, you can start by asking your doctor to cut the cost—to cost. Ask whether you can get involved in a clinical study; that way the blood work might be done for free.

Non-profit hospitals and most other teaching and community hospitals offer a sliding fee scale of discounts for people with no health benefits or insurance, but you have to ask. Call the hospital's financial services office and tell them your situation. Or, offer to pay in cash-- you just might get you a discount.

 

The ambulatory clinics are another option, but you have to make an appointment to see a doctor first. You'll be billed for the tests, but the hospital will help connect you with services you might be eligible for. Also check out community health centers. 

Finally, while it might be hard to discuss, tell the doctor—or office manager—your financial situation and see what he or she recommends.

 

Be sure to check out some of the online lab ordering websites including DirectLabs, LabSafe, MedLabUSA, MyMedLab and PrivateMDLabs. These lab sites offer large discounts and have drawing centers located in many different neighborhoods.

 

Source: These tips were provided by Julie Deardorff in her Health column in the Chicago Tribune.

 

 

Wishing you a happy, healthy New Year!

 

Mona

 

 

You might have noticed that a lot of prices are missing from our OutofPocket.com directory.  OutofPocket is currently under construction and we appreciate your patience.  We are making some enhancements to the site and in this process; the majority of our price data is temporarily not searchable.  During the construction phase, what you will see when searching for prices on OutofPocket is a link to websites that publish health care prices.  Please be patient and check back in a few weeks.  In the meantime, I would like to encourage as many consumers as possible to post/share prices you paid for actual services, contact us about a great site to add to the directory or link to, or if you are a provider – send us your prices so we can include them in the directory.

Making Sense Out of Existing Data

Did you know that health care price data exists today --it's just not available to the public. I am passionate about bringing consumerism to health care, and dedicated to promoting price transparency.  My goal is to make sense of the existing price data to help consumers make informed choices. 

For CONSUMERS

• Hunting down true out-of-pocket expenses for health care services – in advance, can be frustrating.  Unless you are an experienced data minter, this type of hunting can be intimidating and time-consuming.  If you are uninsured, under-insured, looking for an out-of-network provider, or have a high-deductible health plan, you are probably trying to make cost-effective choices before purchasing health care services.  And you are probably interested in knowing your true out of pocket cost for the services BEFORE you visit the provider.    That’s just being a good consumer.  You need useful and relevant tools to help you make good choices.

For INSURERS

• You are the keeper of all the claims data for your members.  You know exactly the negotiated (contracted) price for every provider, for every service, for every different insurance plan you offer.  You also know how much of a member’s deductible has been met.  You have databases of prices paid for every service for every member and could make life a lot easier for your members and possibly change health care if you agreed to share this data to make it publically available.  Yet you insist on keeping this data a secret. 

For OUTOFPOCKET.COM

• I am inviting consumers to post/share prices they paid in the directory.   Everyone wants to look up prices, but very few are willing to take a minute to post/share their prices.  We could wait years for legislation to pass, insurers to agree to make prices public, or we could do something today.  Consumers are invited (and encouraged!) to collaborate and share prices they paid on OutofPocket.com.  If enough consumers participate and share prices, consumers collectively will create a very powerful directory of true out-of-pocket prices.

For PROVIDERS

• You have an opportunity to transform health care as we know it today.  You can help promote transparency by publishing your prices for services.   Why not let consumers know up front what your services will cost them?  OutofPocket.com invites you to include your prices/services in the directory - free of charge.  This not only promotes your practice, but also helps consumers understand what they will be required to pay for services at your facility.

Imagine how easy it would be to comparison shop for health care services if relevant data was available. If consumers had access to true healthcare price data, comparison shopping for health care services could be a lot like your experience shopping for a book on Amazon.com, booking a vacation on Travelocity.com or purchasing an item on eBay.com. 

Tell a friend about OutofPocket.com and be sure to add prices you paid for health care services to this directory.   Not only will you be sharing data, but you will be contributing to a powerful directory of prices that will help promote more affordable health care services.