How To Navigate Unexpected Healthcare Costs
How To Navigate Unexpected Healthcare Costs
With the rise of Western medicine comes unexpected costs. This seems to be more of a first world problem but many wonder how to navigate unexpected healthcare costs. Let’s explore some tools available at your disposal to reduce some of the stress that inevitably comes with aging and the cost of your health.
Preventative Care
There are many things that are covered under preventative care. This can range from cancer screenings to immunizations. These services are covered by most health insurance plans at no cost to you. Here is a full list of preventative care services offered based on age and gender.
Ultimately, these will fall under what CPT code the provider ends up billing to your insurance but if you set clear expectations for what your appointment is for, many services can be covered.
Price Estimate Tools
Unlike healthcare in other parts of the world, price transparency is not really advertised or promoted within the American healthcare system. But the good news is that you can request a good faith estimate before a procedure or appointment.
A good faith estimate should include expected charges for scheduled services including all fees from the provider and facility. This estimate will include an itemized list of expected charges. There is some fine print regarding how early you need to request this estimate but if it all falls within 3 business days or more you are entitled to one. This way you will have an idea of what an expected procedure will cost you. If you need to dispute a bill discrepancy at a later point, you will need this itemized list.
There is also a No Surprises Act. This is a federal law that protects you from unexpected medical bills. It applies towards most health insurance plans and it protects you from paying certain expected out-of-network bills. It is important to do your research and understand your rights so that you can advocate for yourself financially.
Medical debt is a big issue in the United States. With more tools at your disposal regarding cost transparency you will face fewer surprises. Keep in mind that these tools also cover dental and vision.
Discounts
Depending on the type of medication you need, some manufacturers offer digital coupons. Many coupons can be combined with insurance. This can be based on the total cost of the medication or it can be income based.
GoodRx is a free website used to track prescription drug prices and provide discount coupons. You can either use a digital coupon or request a physical prescription savings card.
Also, to save money on medications consider the generic version versus the name brand if all things are equal. And you can also consider higher quantities if you can afford it, such as a 3 month supply instead of a month’s supply.
Reimbursements
This is specifically for those who have a health savings account (HSA) or a flexible spending account (FSA). If you pay for anything that is eligible to be reimbursed as a medical expensive, you can do so with HSA/FSA funds. Whether you use the debit card issued to you or you pay out of pocket and reimburse yourself later, this is your money to use for qualified medical expenses.
Sometimes paying out of pocket may be cheaper than going through insurance (as sad as that seems). If you do pay out of pocket, you may be able to submit a manual claim to your insurance for reimbursement or for it to apply towards your deductible if you have not already met it. You will need to determine what best fits your needs and price tolerance.
Telemedicine
Many healthcare plans now offer reduced costs associated with utilizing telemedicine. This cuts down on a physical office visit for less urgent and serious conditions. A few popular platforms are Teladoc, MD Live, and Telehealth by SimplePractice to name a few. These can range from straight medical care to behavioral visits – which I believe is still healthcare. Your brain is part of your body after all.
Many of these services are much cheaper than an in-office visit. And depending on your healthcare plan it may be free. This can also serve a benefit if you are traveling to reduce out-of-network visits. Contact your benefits administrator or healthcare administrator to find out what your specific plan covers.
Insurance Authorizations
Insurance authorizations are decisions made by your insurance company to determine if a medical service, treatment, or medication is necessary. This allows your insurance company to control costs that they are paying out to cover your service. This is also necessary to prevent unnecessry treatments and exposure.
This prior authorization is usually obtained before a service is needed, although there are emergency circumstances. Needing a prior authorization is common for things like an imaging test with a CT scan.
Financial Assistance Programs
If you need assistance with medical bills or prescriptions, help is available. There is financial assistance in place for those struggling to pay medical bills. These previsions are made available by medical care providers, government programs, nonprofit organizations, and advocacy groups. There are a few discounts provided for hardship, the uninsured, and underinsured.
There are stipulations on eligibility requirements, but it is available if you need it. The discount percentage amount (which can be up to 100%) is based on your income, family size, employment status, and more. All patients eligible for financial assistance will not be charged more for medical care than the amounts generally billed to patients who have insurance.
Financial assistance requires the cooperation of the patient in providing health insurance information, applying for available government programs, completing a financial assistance application, and providing any requested supporting documentation. Given the sensitive nature of these requests, all communications with the patient or family members will be handled with strict confidentiality and compassion.
Documentation
As with anything relating to business, get as much as you can documented. Word of mouth is never really explicit evidence. Never underestimate their ability to overcharge you. Whether it is an email or physical copy of a document. Try to have tangible proof of communication and estimates. If you do ever need to dispute a charge, having proof will serve to your advantage. At the end of the day, it is your word against theirs. After all, it’s just business.
Many healthcare companies also utilize MyChart. This is a popular patient portal that allows you to access digital health records, schedule appointments, request refills, and send messages to your physician. There are also many other features. If you are interested in using this feature, contact your healthcare provider’s office to see how you can enroll.
In conclusion, resources are available for you. You should be aware of the resources at your disposal but also the assistance available if you need it. This will better help you with advocating for your health and your finances while also holding the healthcare field responsbile for being more transparent.