When it comes to the rising cost of medical care, Dr. Linda Girgis is quick to identify one of the most problematic symptoms: Patients who keep their mouths shut.
“When patients ask, I try to work with them," said the South River, New Jersey, family physician. "But many patients don't ask, and that’s the most important thing.”
Girgis offers a discount to patients who pay in full. Pre-treatment negotiation and identifying exorbitant charges on an itemized bill are other cost-cutting strategies. The biggest mistake consumers make is simply doing nothing and dutifully paying a bill they may not be entirely responsible for.
The cost of medical care is likely to continue to go up, according to expert projections.
According to the 2015 Milliman Medical Index — an actuarial analysis of the projected total cost of healthcare — the annual cost of covering a hypothetical family of four was $24,671. The analysis, which assumes an employer-sponsored preferred provider organization plan, was 6.3 percent higher than the previous year ($23,215). The report attributed increases primarily to growth in prescription drug costs.
Consumers end up bearing a sizeable chunk of that cost. Of the overall bill, $10,473 was paid by the insured — $6,408 through payroll deductions and $4,065 in out-of-pocket expenses.
Things aren’t likely to change: “The amount will almost certainly surpass $25,000 in 2016,” the report said.
Amid the anxiety health care costs bring, it’s easy to overlook an essential first step: Knowing what is a “reasonable” charge and what’s not. There are websites to help you untangle billing codes, price breakdowns and other boondoggles in answering that question, including Fair Health Consumer Cost Lookup, Healthcare Blue Book and Centers for Medicare & Medicaid Services.
Patients should ask in advance what a particular treatment or procedure will cost. In particular, dig into the breakdown between what you can expect to pay out of pocket and expenses covered by insurance.
“I advise patients not to pay anything unless they are sure it is really their responsibility,” Girgis said. “Sometimes, if the codes are changed, the insurance company pays it. So pursue all avenues with your health insurance coverage first.”
After identifying your costs, see what you can work out with your provider before receiving any treatment or undergoing a procedure.
“If possible, negotiate the fees prior to having the medical treatment,” said Adria Gross, founder of MedWise Insurance Advocacy. “Very often, providers will accept what is considered to be the usual, reasonable and customary medical fees. Any agreements should be in writing prior to the provider performing the medical services.”
An itemized bill can also prove a powerful tool in identifying and addressing unreasonable charges. Christopher Scully, author of “The Debt Survival Kit,” suggests targeting typically inexpensive materials used during treatment.
“Look for a common item such as a four-by-four gauze pad. This item sells for $8.93 for a box of 200. That's about 5 cents per pad,” he said. “I've seen bills where this item was billed at $4 per pad. … When I see things like that, I have no qualms about offering to settle the bill at 15 percent of whatever the total is.”
Know your insurance
Understanding what your insurance covers and what it doesn’t can help you better manage health care costs.
“The bottom line is becoming knowledgeable about your coverage and options, questioning insurance decisions that are unclear or inaccurate and responding to requests. These affect the outcome of how the claim is handled,” said Sunni Patterson, co-founder of Medical Bill and Claim Resolution, a medical bill patient advocate firm.
Patterson highlighted several points that can result in a rejected claim:
- Specifics of a medical network. For example, a medical group is covered under a network but a particular provider is not. Check this prior to receiving treatment.
- Changes in coverage plans. “When plan changes take place, termination errors can happen, resulting in denied claims,” Patterson said. “Also, some plans may have a suffix for each dependent under the plan. If the information on file is not accurate, the claim will be denied.”
- Inadequate patient response: “When an insurance company requests additional information from the consumer, and the consumer does not respond in a timely manner … this can result in the patient owing the entire balance when it could have been avoided.”
Help from other sourcesA medical charge is frequently justifiable and outside the purview of insurance coverage. That doesn’t mean patients are out of options to lower the out-of-pocket payout.
Hospitals and other providers often offer a variety of financial assistance options, ranging from formal payment programs to case-by-case price breaks.
“Some will allow some leniencies with any patient; others evaluate patient income-to-bill ratio to see if they qualify or not,” said Ashley Boynes-Shuck, a reporter for Healthline.com. “Additionally, it is worth noting that some patients who are on extremely expensive medications such as chemotherapy and biologic drugs can sometimes get rebates, coupons, discounts or payment plans directly from the pharmaceutical company or drug manufacturer.”
Other alternatives include independent organizations that help provide assistance for medical bills and pharmaceutical co-pays. Additionally, government-related programs such as Occupational Vocational Rehabilitation can help sick or disabled people earn more money through employment or even college scholarships as a way to help offset doctor bills and drug costs.