10 Smart Ways to Slash Your Health Care Bills

CO-PAYS. DEDUCTIBLES. OUT-OF-POCKET EXPENSES. It may feel like you need to empty your savings account to stay healthy. You're not alone: One in six Americans spends at least 10 percent of his or her annual income on prescriptions, premiums, and medical care. "Many women assume these costs are nonnegotiable," says Michelle Katz, author of 101 Health Insurance Tips. "But it's easy to save hundreds of dollars on your bills each year by speaking with your doctor or choosing another insurance plan." Here, learn why you're paying too much-and how you can put that money back in your pocket.

  • Choose a plan carefully When it comes time to re-enroll this year, don't blindly check the box next to your current policy. "Re-evaluate your plan annually to ensure it meets your current needs," says Kimberly Lankford, author of The Insurance Maze. The first question you should ask is whether you have a favorite doctor or a medical condition that requires a specialist's care. If you answered yes to either, your best bet may be one of the pricier preferredprovider organization (PPO) or pointof- service (POS) plans, which give you the freedom to visit any physician, says Lankford. Generally, an in-network doctor will charge $10 to $25 per visit; out-of-network M.D.'s bill you for 30 percent of their fees. But if you only see your physician a few times a year, a health-maintenance organization (HMO) may be a better fit. These offer a limited selection of doctors for cheaper premiums and co-pays.

    If you're self-employed or your employer doesn't offer medical insurance, check out Web sites like ehealthinsurance.com, which offers price and coverage comparisons by state. "Take into account your prescriptions, regular care needs, and mental health and vision expenses," says Lankford. "Also consider if you're planning on becoming pregnant within the year, because not all plans cover those costs." Once you've pinpointed all the services you'll require, crunch the numbers with an online calculator such as money-zine.com. "Don't be scared off by policies with high deductibles, the amount you have to pay out of pocket before insurance coverage kicks in," says Lankford. "Those plans have cheaper monthly premiums, so they may be worth it if your medical needs are minimal."

  • Question your tests "Doctors aren't necessarily aware of what screens and exams are covered by your insurance," says Katz. To avoid pricey surprises, bring a list of approved labs to your first appointment with a new physician. Also check with your insurance provider before you schedule any treatments or tests, such as X-rays, MRIs, and breast ultrasounds; you may need to get written or verbal approval beforehand. Write down everyone you talk to and the time and date you spoke," says Lankford. "A paper trail is crucial if there are any questions or disputes later on."
  • Bargain with your doctor If you're paying your bills out of pocket, don't be shy or embarrassed to ask your doctor for a discount. "Explain your situation," says Katz. "Say, 'You're not in my network, but I wouldn't trust anyone else to handle this. Is there any way you can adjust your fee for me?' " This tactic worked for Katz: As an uninsured graduate student, she asked a well-known local neurosurgeon to treat her injured back. "At my first appointment, I discussed my financial concerns with him," she says. Not only did he refer her to the least expensive hospital for her surgery, he also agreed to perform an operation for half his usual fee. What's more, he allowed her to pay off the cost on a monthly schedule, saving her a total of $14,000. "The key is establishing a personal relationship with your doctor and the staff," says Katz, who recommends arriving on time for your appointments and always expressing your appreciation.
  • Know what to do in an emergency When a crisis occurs, hospital and doctors' fees are probably the last thing you're thinking about. That's why it's crucial to review your policy in advance. "Check to see if you need preapproval before going to the emergency room and note which hospitals in your area are considered innetwork and what constitutes an emergency," says Lankford (you can find this information in your insurance policy booklet or on the company's Web site). You'll protect yourself from an unexpected bill: Health insurance companies deny 20 percent of all emergency care payment requests that require prior authorization, according to a recent study published in the Annals of Emergency Medicine.

    "If it's urgent, don't hesitate to call an ambulance," says Lankford. But for non-life-threatening situations, such as a broken bone or a fever below 103°F (unless you have stomach pain, which could signal appendicitis), ask a friend or family member to give you a ride to the hospital.

  • Review your hospital bill Most women scrutinize their credit card statements every month, yet very few even glance at their hospital invoices. But they should: Experts estimate up to 90 percent of hospital bills contain errors. Before you check out, request an itemized bill. "Each treatment you receive is assigned a numerical code," explains Katz. "So somebody accidentally typing in the wrong code could mean a difference of hundreds or even thousands of dollars." Before leaving, scan your bill for any unusual charges. Then, at your next appointment, ask your physician or someone on her staff to go over anything you don't recognize.
  • Pay with pretax dollars Less than 15 percent of Americans take advantage of a health savings account (HSA) or flexible spending arrangement (FSA), both of which are offered by employers. That means most of us are losing out on free money: These accounts allow you to pay for medical expenses with cash you set aside from your paycheck before taxes are taken out. The result: a savings of up to 30 percent on your health care costs. You can even use the accounts to pay for costs not covered by health insurance, such as doctor and prescription co-pays as well as hospital stays. Many plans also let you purchase contact lens solution, glasses, Band-Aids, and aspirin. Most employers offer only one type of account, either an HSA or FSA. The big difference between the two is that you can roll over your HSA contributions from year to year and from job to job. But with an FSA, you forfeit any money remaining in your account if you don't spend it by March 15 of the following year or if you switch companies.

    For an accurate estimate of your medical expenses, review your health-related spending over the past 12 months, then add on any additional expenses (new prescriptions, for instance) you expect to incur in the future. "But do keep in mind that you have to file claim forms to be reimbursed, so if you're horrible at paperwork or holding on to receipts, these types of accounts may not be for you," says Katz.

  • Be drugstore-savvy "You can save up to 30 percent on your prescription costs by going generic," says Steve Miller, M.D., chief medical officer for Express Scripts, a pharmacy benefit-management company based in St. Louis. Ask your doctor if there's a proven generic version of the medication she's prescribing. "They have the same quality and safety records as brand-name medicines," he says. If there's not one on the market yet, ask your M.D. if there's a less expensive but equally effective alternative to the drug she's prescribing. Even if your physician offers you free samples of a drug, still request the generic prescription: Once the complimentary packets run out, it's likely you'll have to fork over more money, says Miller. In fact, a study from the University of Chicago found that patients who received at least one free sample of a brand-name drug spent 40 percent more for medication over six months than those who didn't get them, possibly because they continued to buy the pricier pills.
  • Become a pill splitter "Some drugs cost the same in high and low dosages," says Hae Mi Choe, Pharm.D., a clinical assistant professor at the University of Michigan, Ann Arbor, School of Pharmacy. If you're on medication, such as one for high cholesterol, ask your doctor if she can write you a prescription for a highdose pill you can cut in half at home, says Choe. She recently conducted a study that found patients could save up to 50 percent on their drug costs by simply dividing their pills. But this doesn't apply to all drugs. "Some, such as capsules, coated pills, and time-release formulas, shouldn't be cut," says Choe. "So consult your doctor or pharmacist first." To ensure you always take an accurate dose, use a pill-splitting tool, available at drugstores.

  • Find a discount pharmacy Big chains like Target and Wal-Mart sell some generic drugs, such as antibiotics and cholesterol-lowering pills, for as little as $4 for a 30-day supply. Costco also fills prescriptions at a discount (you don't have to be a member to use their pharmacy). You might also ask your M.D. to write you a three-month prescription, then order it through an online pharmacy associated with your insurance plan or an independent one, such as walgreens.com , drugstore.com, or cvs.com. But be sure to comparison-shop: Researchers from the Creighton University School of Pharmacy found brand-name Rx's are cheaper when purchased by mail, but generic drugs can actually cost more.
  • Take advantage of hidden perks in your plan "Your health insurance policy may cover all sorts of nontraditional services for free or at a discount," says Lankford (a doctor in the network usually needs to give you authorization beforehand). Check to see if yours offers discounts on or pays for smoking-cessation programs, weight-loss or nutrition counseling, or gym memberships. A handful of insurance companies, including Aetna and Kaiser Permanente, are also starting to cover alternative treatments, such as acupuncture, massage therapy, and chiropractic care.
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