Better Care at Lower Costs

Overview

Should you talk about cost with your doctor?

A doctor's main focus is to help you get better, not to save you money. But if you speak up, your doctor may be able to help with both.

Don't expect your doctor to know the exact cost of a drug or test or treatment. There are so many things that determine the cost of care. These include your health plan's arrangement with your doctor, how your plan bills for care, where you get the care, and others. But your doctor can give you an idea of how the cost of one choice compares to another.

How can you lower health care costs by taking charge of your health?

Here are some things you can do to take charge of your health and lower your health care costs.

• Protect your health with a healthy lifestyle.
  • Eat a healthy, balanced diet.
  • Get active.
  • Get immunized.
  • Don't smoke.
  • Make safety a priority.
  • Manage stress.
• Tell your doctor that you care about how much your treatment, medicines, or medical tests cost. Your doctor may be able to help you find ways to get great care at lower costs.
• Get health care when you need it. Ignoring problems can lead to expensive complications.
• If you have health insurance, find out if your plan will pay more for your health care costs when you go to their preferred list of providers.
• Review your health care bills. Ask questions about what you don't understand.
• If your employer offers a wellness program, you may be able to lower your insurance costs and at the same time do things that are good for your health.

Asking About the Cost of Treatment

Each part of your treatment may have a cost. For example, if you have surgery, in addition to the cost of the surgery itself you may have separate charges for things like anesthesia and the time you spend at the hospital after the surgery.

Doctors aren't likely to know how much a procedure or course of treatment will cost on your insurance plan. But they can usually direct you to the people who can get the information, such as:

• A staff person in their office.
• The hospital billing department.

Ask your doctor about any hidden costs involved in the procedure or treatment (follow-up visits, anesthesiologist fees).

• Is there anything you can do to reduce the cost?
• Are there any less expensive options?

Review your health plan.

• Will your medical insurance cover the cost of treatment?
• Do you need a second opinion or preapproval before this treatment will be covered?

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Asking If a Medical Test Is Needed

Make sure you understand how any medical test will help you before you agree to it. For instance, ask your doctor if the test results would change how your health problem needs to be managed. Think about your willingness to have treatment or make lifestyle changes if you tested positive for a health problem. The only good reason to do a test is because the benefits to you outweigh the risks and costs. No test can be done without your consent.

Medical tests are expensive. If you need a test, do your part to make sure that you do not have to repeat it. The tips below can make a big difference:

Follow instructions about how to prepare.

Are you supposed to stop eating the night before? Not drink alcohol? Stop taking medicines, or take a special medicine? Get written instructions from your doctor or nurse, and follow them. This reduces the chance of error and the need to repeat the test, which saves you money.

Keep a copy of all your results.

Get a copy of the full test results, even if they are normal. You may get a printed copy, or you may be able to see your test results online. Do not assume that no news is good news. If you do not hear from your doctor, call to get your test results. This helps in these ways:

• It makes sure you have the results if you later need to compare them to past or future tests.
• You have a backup record in case you see a different doctor who does not get your test results from your previous doctor. If you can provide a copy, the new doctor may not have to repeat the test.
• Having the results helps you better understand what's going on with your health.

Don't have tests more often than you need to.

If you have a health problem that requires frequent tests and you are worried about the cost, tell your doctor. Maybe you can go a little longer between tests. Maybe you can have a less costly test some of the time and the more expensive one less often.

Ask about options, and shop around.

The cost of some testing can vary widely without any difference in how reliable the results are. For expensive tests, it may pay to compare the costs of your best options.

Asking About Saving Money on Medicines

There are many things you can do to save money on your medicines.

• Ask for medicines that cost less but that work just as well.
• Ask your doctor for free samples if you are trying a new medicine.
• Find out if there are generic versions of the medicines you take.
• Shop around for the best deal on medicines. Costs can vary from drugstore to drugstore.
• Find out about discount and patient-assistance programs. To learn more about these programs, look online at RxAssist (www.rxassist.org) or at the Partnership for Prescription Assistance (www.pparx.org).
• Ask your doctor or pharmacist about pill splitting. In some cases, buying pills at double the dosage costs the same or nearly the same as the lower dose. By splitting the larger dose in half, you can get two doses for the price of one.
• See if the drug company that makes your medicine offers coupons or discounts.

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Knowing When to Go to the Emergency Room

Hospital emergency rooms (ERs) are set up to focus on medical emergencies. They are not set up to focus on routine health care. If you go to the ER for a problem that is not an emergency:

• It will cost a lot more than it would at your doctor's office or a walk-in clinic. A trip to the ER for an earache, for example, may cost three to four times as much as it would at your doctor's office.
• You will probably spend a lot more time there than you would at a walk-in clinic or doctor's office.
• You will get care from a doctor who has probably never seen you before. It can be helpful to get care from a doctor who knows and understands you and your medical history.

Go to the ER if you think you are having a medical emergency. That's what the ER is for. Otherwise, call your doctor's office first, or go to a walk-in clinic. It will save you money and time.

Knowing when it's an emergency

There are few clear rules about what is an emergency and what isn't. Most doctors would agree on a short list of problems that should always be treated as emergencies. This includes heart attack symptoms, not being able to breathe, severe and uncontrolled bleeding, stroke symptoms, severe pain, and a few others.

Most health problems are not emergencies. You may want to take care of the problem right away because you feel sick or uncomfortable, but nothing bad is going to happen to you if you wait a bit. Then again, you don't always know that for sure. Some problems that seem minor can become serious if you ignore them. And it may be even harder to know what to do when a child is sick.

One good question to ask yourself is, "Am I thinking about going to the ER because it's convenient or because it's necessary?" If you are choosing the ER because you can get in without an appointment, keep in mind the high price you will pay for that convenience. You may also have to wait a long time before you are seen by a doctor. And you may have other options. You can always call your doctor's office or a nurse line for help.

Getting care at night or on the weekend

If you think you are having a medical emergency, call 911 or other emergency services immediately or go to the emergency room (ER).

If you don't think the problem is an emergency:

• Call your doctor's office.

  If it is closed, there may be a number to call for after-hours service.

• Call a nurse line for advice.

  The nurse can help you decide whether you need to get help now or whether it is safe to wait.

• Go to a walk-in clinic (if one is open).
• Go to the ER.

  If you feel the problem cannot wait until your doctor's office or a walk-in clinic is open, you can go to the ER.

Walk-in clinics

Walk-in clinics are often called "minor emergency," "urgent care," or "immediate care" centers. They deal with all kinds of health problems and are often open in the evenings and on weekends. You do not need an appointment.

These types of clinics can be a great option when:

• You can't or don't want to wait for an appointment at your doctor's office.
• You don't need the level of care an ER provides.

Care at a walk-in clinic costs a lot less than care for the same problem at an ER.

If it turns out you are having a true medical emergency, a walk-in clinic will send you to the ER.

Unless you have a walk-in clinic in your neighborhood or already know where one is, it may be hard to find one when you need it. So at your next doctor visit, ask your doctor to recommend one. Check with your health plan to see if it offers better coverage at some clinics than others.

Knowing When to See a Specialist

Specialists are doctors who have in-depth training and experience in a particular area of medicine. For example, a cardiologist has years of special training in dealing with heart problems. A visit to a specialist often costs more than a visit to your regular doctor, and the tests and treatments that you receive may be more expensive and invasive. Of course, specialists often provide the information you need to help you decide what to do about a major health problem and can perform certain procedures not available through your primary care doctor.

If you think you need to see a specialist but you have not been referred to one, discuss your concerns with your primary care doctor. When you do have a referral to see a specialist, a little preparation and good communication can help you get the most out of your visit. Before you go see a specialist:

• Know your diagnosis or expected diagnosis.
• Learn about your basic treatment options.
• Make sure that any test results or records on your case are sent to the specialist.
• Know what your primary care doctor would like the specialist to do (for example, take over the case, confirm the diagnosis, conduct tests).
• Ask your primary care doctor to remain involved in your care. Ask the specialist to send new test results or recommendations to both you and your regular doctor.

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