34 Healthcare: Medical Services

In 2011, American households spent an average of $179 on physicians and $129 on hospitals. Obviously, some households were lucky enough to avoid any medical expenses, while others suffered catastrophic costs that dwarfed the national averages. Whenever you need a doctor or hospital, keep your expenses low with these strategies.

34.1  Make Insurers Pay

Once you have insurance, you need to make sure that the insurer doesn’t try to stick you with the bill—insurance companies excel at this. Follow these tactics.

   34.1.1  Confirm Coverage in Advance
For nonemergency procedures, confirm ahead of time that your policy provides coverage.

   34.1.2  Stay Within Your Network
Whether you join a PPO or HMO (see 32.2), you spend less if you visit doctors and hospitals within your plan’s network of providers. Confirm in advance of treatment that health care providers have registered with your insurance company.

   34.1.3  Exploit Wellness Programs
The more you avoid big medical expenses, the more insurers profit. So they dangle incentives to convince you to stay healthy: subsidized gym memberships, FREE screenings, stress management programs, nurse hotlines, informative websites, and more. Take advantage of all freebies. They deliver more value for your premiums, and they also help improve your health.

   34.1.4  Finesse Deductibles
As you near the limit of your annual deductible, accelerate any medical care you’re planning for next year into the current year so that the insurer picks up part of the bill.

   34.1.5  Challenge Coverage Denials
Don’t be cowed—MOOOOOO!!!—when insurers refuse to pay for treatment. Their denial isn’t the final word. Follow the procedures for appeal. If the process gets too complicated, and it easily might, use Appendix 2 to hire a local healthcare advocate.

34.2  Follow Preventive Medicine

   34.2.1  Pursue a Healthy Lifestyle
Adopt routines that save money and extend lifespans.

  • Smoking. Tobacco erodes away bodies and nest eggs.
  • Drinking. No more than two drinks per day for men and one drink per day for women.
  • Diet. A balanced diet keeps doctors away.
  • Exercise. Improves circulation and immunity from disease.
  • Mental Health. Cut your stress by spending less, for example.

   34.2.2  Monitor Metrics
Pay attention to body mass index (18.5-24.9 is good), blood pressure (120 systolic over 80 diastolic or lower is good), blood sugar (80-120 is good), and total cholesterol (≤ 200 is good).

34.3  Run Background Checks

When vetting doctors and hospitals, follow 8.3 and these tactics.

   34.3.1  Seek Quality
Your health comes first, so make sure that those responsible for it are well qualified. Don’t cut corners by hiring inferior caregivers.

   34.3.2  Check Hospital Safety Records
Use hospitals that have superior records for patient safety. Visit HospitalSafetyScore.org or LeapFrogGroup.org.

   34.3.3  Ask Around

Whenever you seek referrals, ask for details:

  • Bedside manner
  • Quality of service
  • Quality of communication
  • Willingness to haggle.

   34.3.4  Consult the Internet
Visit AngiesList.com, which collects reviews for a wide variety of practice areas and medical facilities. The site charges monthly fees for access. One frugal approach: join for one month, research any services you might need over the next few years, and then cancel.

34.4  Shop Around

   34.4.1  Visit Retail Chain Clinics
More than 1,350 clinics nationwide deliver non-emergency services for colds, flu, infections, and other maladies. Look for them at Walgreens, CVS, Walmart, Kroger, and Target. To find clinics near you, visit HealthCare311.com or CCAClinics.org.

   34.4.2  Seek Volume Discounts
If several household members require services at the same time, it provides an opportunity to negotiate. Another approach: band together with friends who need similar services and seek a group discount.

   34.4.3  Price Major Procedures Online
View the average costs for your zip code at FairHealthConsumer.org or HealthCareBlueBook.com.

   34.4.4  For Major Procedures, Seek Bids
Call around to doctors who scored high on your background checks and see which ones offer the lowest rates.

34.5  Haggle

Whenever you negotiate with doctors and hospitals, select from among these openers.

   34.5.1  “Do You Charge Insurers Less—Can I Get That Price?”

   34.5.2  “Dr. X Bid Lower—Can You Match His Price?”

   34.5.3  “Can You Match the Price at FairHealthConsumer.org?”

   34.5.4  “I’m a Longtime Patient, Is There a Loyalty Discount?”

   34.5.5  “Could I Speak With Your Supervisor, Please.”
General rule: the higher you climb the chain of command, the greater the bargaining authority.

34.6  Ask Your Doctor About Potential Savings

   34.6.1  Ask Whether the Procedure Is Discretionary
If something is fundamentally wrong, by all means fix it. But for purely discretionary or cosmetic work, do without.

   34.6.2  Ask for Cheaper Options
If you charm your doctor into talking things over, the conversation might uncover less costly alternatives.

   34.6.3  Seek Second Opinions
On big ticket procedures, two stethoscopes are better than one. Another physician might figure out a better or cheaper solution.

34.7  Save With Payment Methods

   34.7.1  Offer to Pay Before Services Are Provided
In exchange for a hefty discount, of course.

   34.7.2  Tap HSA and FSA Accounts
You save because you pay with pre-tax dollars.

   34.7.3  Take Tax Deductions
Time discretionary medical services for years in which you itemize and your overall medical costs exceed 10 percent of your adjusted gross income. Consult your tax advisor. Note: payments from HSAs and FSAs don’t qualify for deductions, because you already received a tax benefit when you first funded those accounts.

   34.7.4  Offer to Pay With Cash
Look for discounts that exceed the value of your card rewards.

   34.7.5  Seek Credit Card Rewards
If you don’t have an HSA or FSA, pay with plastic and at least rack up some rewards. And even if you do have one of these accounts, pay with plastic anyway: when you charge a $5,000 procedure to your three percent cash rewards card and reimburse yourself with a withdrawal from your HSA or FSA, you pocket an extra $150. Buy yourself some flowers.

   34.7.6  Avoid Interest
If you can’t immediately pay for the procedure, don’t use plastic—you’ll only stick yourself with heavy interest costs. Instead, ask for a no-interest payment plan that spreads your payments over several months. Doctors and hospitals make these arrangements often, so don’t be shy about asking.

34.8  Follow Up

   34.8.1  Insist on Itemized Bills
If you settle your bill based upon a summary that consists of a few lines only, errors go undetected and you overpay. Insist upon a copy of the line-by-line details.

   34.8.2  Watch for Billing Errors
Medical bills are complicated. Drill down into the minutia, because mistakes are common. Search each entry for duplicate charges, services you never received, and outlandish markups. If any charge seems too high, check it against online cost estimators (see 34.4.3).

   34.8.3  Don’t Pay for Medical Mistakes
If a mistake in care caused you to incur additional expenses, refuse to pay. Such costs should be borne by whoever erred, not by you.

   34.8.4  Hire Professional Bill Reviewers
They take a percentage of whatever amount they’re able to save you. To find expert bill reviewers near you, visit BillAdvocates.com or  Claims.org. Run all hires through Appendix 2.

   34.8.5  Build Relationships
If you like your doctor, refer friends. This might not trigger an immediate discount, but at a minimum, it builds goodwill.

   34.8.6  Retain Paperwork
Keep a file to document tax deductions or spending from tax-advantaged medical accounts.

CODA: MEDICAL TOURISM

In many foreign countries, treatment costs less than stateside—and also involves fewer delays. On the other hand, if complications occur, patients may lack effective recourse against doctors and hospitals. If despite these risks you’re still interested, investigate all specifics thoroughly before you travel. Several books cover this in exhaustive detail, so visit your library.

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