It’s no huge secret that healthcare is expensive. Between premiums and bills for healthcare services and prescriptions, it’s enough to deter anyone from seeking care. Of course, no one wants you to neglect your overall well-being so I’ve put together 10 ways to save on your healthcare costs.
Always use an in-network provider
Before setting up your appointment always make sure the provider is in your network. Although a provider may advise that they ‘accept’ your insurance, that does not guarantee that they will be in-network. If your network is PPO, ensure your provider of choice is PPO as well.
When a provider is in your network, insurance’s reimbursement is higher and the deductible (if you have one) is lower. An example of this is an 80/20 plan with a 500 deductible. Once the 500 deductible is met then insurance reimburses at 80% and you have 20% as member responsibility. If out-of-network, your plan’s reimbursement may only be 50/50 with a 1000 deductible, therefore, costing you more.
In-network providers are contracted to accept an allowance for your services. For example, let’s say you go in to get an MRI. The facility bills your MRI to your insurance company with a price of $2000, but the contracted allowance is only $500. If in-network the facility must accept the pricing of $500, and write off the difference of $1500. Now you are only responsible for $500. If out-of-network, they do not have to accept the allowance, therefore, they may balance bill. Balance billing is when a provider bills you for the difference between what they billed and insurance’s allowance (the $1500). Now, you may be responsible for the whole $2000.
For help locating in-network providers, contact your insurance company or use your health insurance’s provider locator. If you cannot find an in-network provider in your area, inquire about a network exception. This is when you get services done by an out-of-network provider but insurance reimburses at the in-network level of coverage.
Verify your benefits before services are rendered
It’s frustrating when your health plan denies your services. Then you’re stuck asking yourself what the point of having insurance is out of anger. Many of us have been there, and don’t want to be back in that spot.
If you are not positive that an upcoming service will be covered then don’t hesitate to contact your insurance carrier to verify benefits. This way you’ll know beforehand if the services are eligible and how the benefits will apply.
Utilize providers with their own practice and verify what place-of-service will be billed
OK, so some plans have deductibles that are ridiculously high. If you’re someone that doesn’t go to the doctor’s office often it can feel like your left paying for everything without the help of your insurance company. Most outpatient services are subject to the deductible, meaning that you have to meet the deductible first before insurance pays their share.
What is the point of a deductible? To help keep the cost of insurance premiums down and to limit the number of unnecessary doctor visits.
If your plan has copays for office services, this most often means that insurance will make payments regardless of if your deductible is met or not. So instead of a $200 office service rolling over to an unmet deductible, which is member responsibility, you will just pay a copay upfront and insurance will pick up the rest.
A provider with their own practice will have a clinic separate from a facility. These providers are more likely to bill with an office setting thus just collecting a copay.
If you’re wanting to know if you must meet the dreaded deductible first or if you will need to pay a copay upfront, ask your provider what place-of-service they will be filing. Remember, although you went into the doctor’s office that doesn’t guarantee your claim will be filed with an office setting, especially if the doctor’s office is located within a facility.
Save the ambulance ride for emergencies only
I’ve seen how expensive an ambulance ride can be and I will be one cough away from meeting Jesus before I get in one.
Most ambulances are not able to be contracted, and because of this insurance policies opt to reimburse at the in-network level of coverage. Although they are reimbursed as in-network, they are still not bound to a contract so you can be balance billed!
Let’s say you’ve already met your deductible and out-of-pocket for the year (*out-of-pocket: the maximum amount you have to pay for covered services. Your health plan takes 100% after this is met for all covered services). You decide to ride in an ambulance, and they bill $1800 to your health plan. Although reimbursing as in-network, insurance only pays up to an allowance of $1000. The ambulance company decides that they aren’t going to accept insurance’s payment as payment-in-full (some will) so guess who’s going to get billed $800? You!
But I met my out-of-pocket?! Sorry, Charlie.
IF you are able to get to a nearby hospital safely with a non-life threatening condition, consider skipping the ambulance ride.
Ensure that all services and prescriptions are necessary
Many people seek inadequate or unnecessary care due to not knowing what services are needed for their symptoms. Consultation after consultation quickly adds up, even if you’re just paying a copay.
Never be afraid to ask if all medications and services are necessary. There are a few providers that will perform extra services for more money, especially after learning the deductible and out-of-pocket have been met, or to limit legal liability.
Utilize care management and self-care programs
Take full advantage of the free programs offered to help you manage your overall care. Self-care programs and care management help to educate you on how to distinguish if your injuries or illness is minor or needs medical attention, how to treat minor symptoms on your own, coordinate care, find assistance for healthcare costs, and much more.
By utilizing these programs the use of healthcare is lowered and unnecessary visits are limited. Self-care information can be found in a variety of ways including online portals, newsletters, and designated phone numbers.
Use your preventive services
Many health plans have opted to pay for preventive (routine) services, such as annual physicals and bloodwork, with no cost to their members. These services are designed to keep you healthy thus reducing the need for pharmaceuticals, diagnostic services, and hospital care.
Make it clear that your visit is routine
Have you ever gone in for what you thought was a routine visit, but find out that something wasn’t billed as routine? You aren’t alone.
If you are going in for a routine service then be sure to make it clear to your doctor that is the main reason for your visit. Often times we can get chatty and mention a symptom which can prompt extra services to be performed. Politely inform your doctor’s office that you only want routine services performed and billed.
Remember that if something is found during your routine visit that may prompt the provider to submit your claim as medical. If you are experiencing symptoms that you want to discuss with your doctor then feel free to do so, but remember there is a chance that something will fall on member responsibility.
Consider going to an urgent care instead of an emergency room
If you’re needing medical attention and it isn’t technically an ‘emergency’, consider going to an urgent care. Emergency rooms are undoubtedly crazy expensive, and a sprained ankle could wind up costing you thousands. The hospital will file a claim for the use of the facility, the individual doctor will file a claim for the services he/she performed, if labs were drawn the lab will file a claim, if imaging was done and sent to be read the radiologist will file a claim, shall I go on?
With an urgent care, typically only one claim is filed and your health plan may only require a small copay for the services performed.
Check the allowance
The million dollar question everyone wants to know: “How much will this service cost me?”
Unfortunately, the answer is not so black and white. A good way to find out how much a service will cost you is to inquire about the allowance. If the provider is in-network, the allowance will be the amount they are able to bill you for a service. For example, if your doctor says they bill $1500 for an MRI the allowance may only be $800. If your deductible is already met for the year and you have an 80/20 plan, then insurance will pay the first 80%. The amount you are responsible for is $160.
If the provider is not able to give you the contracted allowance, request the procedure codes and see if your health plan can look it up for you.
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