Medical expenses are the number one cause of bankruptcy in America. America’s Healthcare System is a for-profit institution that benefits from your inability to advocate for yourself by keeping billing complex, resources hidden, and patient’s ignorant of their responsibilities. This year, America has put into place the “No Surprise Billing” act for Medicare beneficiaries. However, this bill is still very limited and does not reduce the patient’s costs. I’ve worked for insurance companies, CT’s insurance marketplace, and currently for a major health organization. In this article, we will review three ways to reduce medical expenses and help you navigate the system effectively.
Knowing your benefits
When shopping for a good healthcare plan, you should educate yourself on your cost-share (out-of-pocket cost) responsibilities. Your insurance plan determines your out-of-pocket cost when receiving care. There are three different types of cost-share responsibilities you are subjected to:
Co-pays are the flat rate fee you pay for a service.
Co-insurance is the percentage you pay for a service.
A deductible is an amount you have to pay out-of-pocket before coverage applies.
*you can meet your deductible and still be responsible for co-pays and co-insurance. It is when you meet your OOP maximum that you are absolved of the co-pays and co-insurance
Knowing your out-of-pocket or cost-share responsibilities will help you detect discrepancies in processing and billing errors. High premiums do not mean good coverage and low premiums do not mean affordable coverage. Multiple coverages do not absolve out-of-pocket costs . However if you choose a plan that picks up where the other plan is lacking in coverage. , this will drastically reduce healthcare costs. Some questions you should ask yourself is:
How often are you at the provider’s office or receiving treatment?
What is the cost-share for services you have performed regularly?
This should be budgeted with your monthly premium. Make sure to review your insurance EOB booklets in-depth to calculate your estimated cost for regular services (such as office visits, labs,and etc).
What does your network look like?
Find out If your provider is in or out of network prior to service by getting your provider’s NPI number (National provider Identifier Number) from the office. Also, prioritize providers in tier 1 or 2 if you have a tiered plan.
Applying for resources and discounts
We are so conditioned to believe that paying bills is equivalent to good morality. I urge you to release that standpoint, it will save you money. I come in contact with people who are financially strained looking to set up payment plans to afford the unaffordable. Before you pay anything ask these questions
1. Do you have Financial assistance & Hardship programs?
Most healthcare institutions have income-based financial assistance programs and many of us qualify for them even if we don’t qualify for Medicaid. Oftentimes these programs apply even with insurance and can cut costs dramatically -if not altogether- with no limitations to services besides cosmetic procedures. Apply first, Budget later!
2. Call and request a discount. Know your worth. Do not take the first offer. If they offer you a 10% discount, request a review for a higher discount with the billing supervisor. When they ask why, advise them that you are experiencing hardship and this bill was unexpected. Then, shoot for 20%.
The importance of questioning, requesting reviews, and language
This is where the play on ignorance is at an all-time high. The shift in the language you use will provide better answers and trigger better reviews.
Language changes with cost estimates
DO ASK: What is my cost-share responsibility for *insert service* with *providers name and location*?
This provides you with a more accurate quote specific to your plan and network.
DON’T ASK: How much does an office visit cost?
It’s too general and you may be misled. The person may quote you the total cost of the service
*office visits are billed by providers time
It is best to contact the pricing & estimates department of your health organization when getting quotes.
When contesting/disputing services
DO: Question the validity of the charges.
Ex. The office visit was 10 minutes long, why am I being billed for 30 minutes?
DON’T : Begin the dispute with a complaint of the cost of the services. Aim for the validity of the charges! Sad to say, most health services are overpriced. If you want to dispute the cost of services, make sure you highlight the lack of transparency on the cost and state this is a Suprise Bill
Another way to catch discrepancies is to request itemized bills of your account frequently. This will help you get a clear understanding of what you are being billed for and may help you catch changes in your insurance processing. Sometimes, insurance companies may pay for services inconsistently. Get comfortable with calling member services and asking why they paid or did not pay for a service. Your insurance company is supposed to advocate for you. So, if you are uncomfortable calling billing, request that the representative calls on your behalf .
The last and most important tip is to be kind! You may feel intimidated and defensive about being a number to a system, but build a relationship with the people you speak with. The representatives spend all day delivering hard truths for a system they did not create. Speak calmly and remember they are human. I can say I’ve advocated for the kindest patients’ medical expenses to be reduced drastically and led them to the right places to get the resources. No one can help someone who is defensive. Get comfortable saying to people “This is unaffordable for me, but I need these services”.
