Effectively Seek Medical Care in a Way that Makes Sense for Your Insurance
The level of responsibility being imposed on patients is increasing. We must all begin to view obtaining medical services and healthcare through the lens of the informed consumer rather than the dutiful patient. We should seek out doctors who wish to embark on a collaborative approach to care to help us navigate this new medical landscape.
The rise in popularity of high deductible health plans has begun to shed light on the way healthcare is typically provided in the United States and the cost associated with that care. We have adopted a fee-for-service model that conditions patients and doctors to believe that more is better – more tests, more medications, more visits. Coupled with malpractice concerns, quality care measures and the opportunity for hospitals to charge more for the same procedures than independent doctors, the cost of service can rise rapidly. More and more patients will be required to cover these costs under high deductible health plans.
“Are You in My Network?”
When making an appointment with your doctor do not ask “Are you covered under my plan?” Typically, doctors will accept many health plans in order to be able to see a wide variety of patients. Instead, ask “Are you in my network?” Being in-network means that the doctor has entered into a fee arrangement with your insurance provider and that the cost of your care should be lower than an out of network provider. Be sure to document who you have spoken with.
Prior to going to the doctor, take the time to write down how you are doing, what your current symptoms are, any medications you are currently taking, a description of your overall diet, and any questions you would like answered during your visit. Make three copies of this document. Send one into the doctor’s office a few days prior to your scheduled visit. If you have a complicated issue, request a longer appointment. Give the second copy to the receptionist at check-in and request that it be given to the doctor prior to being seen. Bring the third copy with you and hand it to the doctor before your appointment begins. At the conclusion of the appointment be sure all of your questions have been answered in laymen’s terms, not medical jargon, and that you understand what the next steps are.
If you are referred to a facility for testing, be sure to ask “Is the testing facility in my network? Are the doctors evaluating the results of my tests in my network?” Again, document who answers your questions. Be sure to ask the doctor what he or she hopes to learn from the test that is being ordered. As a follow-up, ask how the results of the test may impact your course of treatment. If the doctor cannot provide a clear or compelling answer to the second question, you need to ask if the test is truly necessary.
If you are given a prescription, ask “Is this drug covered under my plan?” Even if it is, ask if there is a cheaper/generic version of the same medication. When filing the prescription at the pharmacy, ask for the cash price of the medication without insurance. Sometimes the cash price for prescription drugs can be less than the out of pocket cost via your insurance. Be sure to understand the benefits and risks of taking the medication, how long you are expected to continue using it, and if there are any alternatives to the medication being prescribed. Often an improved diet or increased exercise can ameliorate conditions, as opposed to prolonged medication usage.
Emergency Medical Care
In an emergency, most, but not all, employer-sponsored health plans will cover out of network care. It is worth trying to understand the coverage your insurance provides during a medical emergency before such an incident occurs. Interestingly, while a hospital may be considered in-network, many of the doctors working inside of it may not be. A hospitalization is the most likely time you will be faced with a balanced billing issue, which occurs when a patient is billed from the difference between health insurance reimbursement and what the provider is choosing to charge. This is normally the story when a patient goes in for surgery, but later finds out the anesthesiologist was an out of network doctor and receives a bill for $50,000. Some states, but not all, have passed laws against this practice. On all hospital paperwork be sure to write that you will only allow in-network care, and obtain copies of all documents. These steps can prevent an unexpected expense from arising during a routine or emergency medical procedure.*
As medical care becomes more complex and difficult to navigate, there are still tactics that patients can deploy to make sure that their care makes sense under their current insurance plan. While these suggestions are not coming from a medical professional, as a financial planner, we hope our clients see that proper planning can make the most of any important expense.