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Health Insurance and Health Care
The health insurance industry and our nation's employers are setting themselves up squarely in opposition to the vast fast food, entertainment, tobacco, and many other industries that want us to keep right on living the sedentary lifestyles that most Americans do. After all, the health care industry wants to remain profitable too. In addition, generations of consumers have been taught that doctors are trained specialists (and authority figures) who know better than they what treatment is best and which remedy costs what. Do you know how to "shop" for the best value in an appendectomy in the 12 hours you have before your emergency operation? Do you feel qualified to suggest to your health care provider that a CT scan might cost less when he or she has just ordered an MRI?
Being a savvy consumer in the health care and health insurance arena means first, understanding the term, "consumer-driven health care" and the hype that surrounds it. If you are not noticing any difference between the policing that is going on by your health insurance coverage plan today and the oldstyle HMOs, then you are sensing - correctly - that you are really not in the "driver's seat" at all and therefore cannot be driving your own care. What may be changing for you dramatically, however - and perhaps forever in the U.S. unless our politicians can be persuaded to go to bat for consumers - is your share of the costs for health insurance coverage and care.
Health Insurance You Can Control
Because the remedies available in the USA are still among the best in the world, let's now concentrate on what you can control to change the odds in your direction as a savvy health insurance consumer. If you have health insurance coverage, you are somewhat limited by the benefits spelled out in your policy. However, you can exert control over your health care costs at many points. These five steps can save you significant money:
- Plan ahead to devote pre-tax income to health care and health insurance.
- Choose your health insurance providers prudently.
- Negotiate fees for health insurance when necessary.
- Direct the discussion yourself when visiting a health insurance provider.
- Be proactive about your prescriptions.
First, before anyone gets sick or injured, study the benefits package provided by your employer to see whether you are offered a flexible spending plan. If so, you will want to take advantage of this opportunity to set aside pre-tax dollars from your paycheck to fund medical expenses over the next year. You will have to decide in advance how much you want withheld for the total year; guesstimate this on the basis of your out-ofpocket expenses from recent years. Look carefully at exactly which procedures are covered by your health insurance, and then be sure to file the appropriate paperwork (with receipts) to withdraw funds from this account. In this way you are still paying out-of-pocket expenses, but you are avoiding taxes on that money. Every little bit helps.
When it does become necessary to seek health care, stay within your health insurance provider's network. In fact, familiarize yourself in advance with the list of available doctors, hospitals, and other providers. Be aware that many services initiated in the office of your primary caregiver are outsourced. Try to ensure that your films are read by a radiologist within the network, your lab results are studied by a member pathologist, and your anesthesia is administered by a network specialist, or the fees for each service provided beyond the network might well be denied by your health insurance company.
When you simply have to go beyond your health insurance network, negotiate the fees. Don't feel at all uncomfortable inquiring of the health insurance company the total coverage for the service you need. Then tell your out-of-network provider what that limit is and ask them to honor it. If the business manager gives you a flat refusal, speak directly to the doctor about it at your next opportunity. Doctors routinely "write off" or "adjust" charges not covered by health insurance.
And speaking of discussions with your doctor, form the habit of being proactive about that too. Direct the conversation in the examining room. In most cases, health care providers are delighted to care for patients who report their symptoms willingly and come prepared with a list of relevant questions and concerns. Ask burning questions early on, while you have the provider's full attention, and do not excuse the medical professional until you know everything you need to know. Do your part, of course, by preparing a list of all your medications, including dosages. On that same paper, list worrisome symptoms and questions you want answered. Far from taking up too much of the doctor's valuable time, you will find that the entire process is more focused and purposeful and actually saves time.
Once your physician has sent you on your way with a few prescriptions, you have a further opportunity to control your health insurance and health care costs: Be smart about your prescriptions. Pharmacies do not all charge the same price for the same drugs. Find a reputable licensed pharmacy that offers a lower drug price in general. While all medications have a generic name, the generic version is not readily available in all cases.When it is, your out-of-pocket cost can be a fraction of the price for a brand name drug. Frequent a pharmacy that readily offers generic drugs, and remind the pharmacist that the lower-priced alternative is your preference.
When You Don't Have Health Insurance
It is a disturbing fact that, in our advanced and wealthy country, great numbers of families and individuals remain totally uninsured or under-insured. Health insurance costs rose 87% from 2000 to 2006, putting health insurance benefits beyond the reach of some employers, especially small companies. Families unable to bear the full financial burden of health insurance find themselves without coverage. Ironically, hospitals, clinics and pharmacies generally charge the uninsured more than those with health insurance coverage - sometimes four or five times as much as they charge health insurance companies! All is not lost, though. You still have some control.
Tell the hospital or health care provider that you are uninsured and ask for a discounted price. If it is not forthcoming, try to find a health care provider who will offer a discount. Meanwhile, research your options for free health screenings by your local health department or nonprofit agencies like the American Heart Association or the American Cancer Society. The Veterans Health Administration offers free or reducedprice services to military veterans. You might qualify for Medicaid, even if only temporarily. Call your local public health or social services agency to inquire about your eligibility, or research the topic online at http://cms.hhs.gov/medicaid. If you require a prescription you cannot afford, ask the pharmacist how you can contact the pharmaceutical company directly to request a price break. You might be surprised at the assistance extended to you. When you do find yourself confronting a medical bill simply beyond your means, do not panic, and do not automatically reach for a credit card. Ask the health care provider to help you establish a long-term payment plan. Even if the provider charges some interest, it will be well below the rates your credit card company would have imposed.
Making sound purchasing decisions involves how you pay for your purchases. Besides the credit limits imposed on you by others, think about what else you need to consider before you absent-mindedly just say, "charge it." Becoming engaged and active in your financial affairs is about taking control and practicing personal accountability as you navigate your way through the number of choices that are available to you as a consumer. By spending wisely and staying in tune with your Life Values, you will be rewarded with more money in your pocket, and you will have become an aware, savvy, and engaged consumer.