Tips to Cut Your Health Care Costs

I recently had an experience that opened my eyes to the healthcare system. I have been fortunate to have good insurance coverage for the last 30 years. I am like many others, when the cost of care doesn't impact my pocketbook; I am not a wise a consumer as I should be.

We recently have had changes in our insurance coverage, as many of you have experienced too. We have had some hefty out-of-pocket costs that has set me on a journey to be a wiser consumer.

I found a report by Kiplinger "50 Ways to Cut Your Health Care Costs." I will share a few of the tips here. I have added it as a link on the website under resources. You may explore it further. I will hit the high points. Some you will know and others I hope you will find new and useful.

Stay in Your Network

Insurers have negotiated pricing with providers. You see those prices with providers in the network. You may also have a higher co-pay or co-insurance for providers out of the network, and also a higher deductible and a higher annual limit.

Save at Stand-Alone Radiology Centers

The average outpatient hospital cost for MRI and CAT scans is $1,384 to $1,668. But the average radiology center costs $445 to $725. (Information from Cigna) There can be a huge range between the highest and lowest costs in your area. [Most insurers have tools to help you compare the costs of x-rays and tests at different types of facilities in your area.] Check your insurer's website.

Ask Your Doctor about Cheaper Facilities

Most doctors have privileges at several hospitals or outpatient surgery centers. The doctor's costs will be the same. However, the facility fees can vary by thousands of dollars. This was an "A-Ha moment" for me. I learned after the fact, the doctor's clinic would cost 1/3 the fees as the hospital. I think that is one reason why so many of these clinics and surgery centers are sprouting up.

Avoid the Emergency Room if You Can

You may not always be able to avoid an emergency care visit. However, you may be able to go to a much less expensive urgent care center or convenience care clinic. Cigna suggests using these facilities for minor cuts, burns, sprains, joint or lower back pains, and urinary infections. The average cost nationwide for an emergency room visit is $1,553 compared with $135 for an urgent care center and $58 for a convenience care clinic.

Determine ahead of time, who is in your network. You don't want to be fumbling around when you have an emergency.

Sometimes you can't avoid a trip to the emergency room, but you can still manage the costs as best as you can. You may be in the ER, but you are still the consumer. The triage protocols have employees following certain procedures. You need to be vocal about what you believe is needed.

I had something stuck in my esophagus. I called my doctor's office to ask for assistance. I was told I needed to have my esophagus scoped; go to the ER. Because I presented with heart burn, - after all I had something stuck for hours in my throat - they followed procedures and were going to do an EKG. I was vocal and refused the procedure. Next they wanted to do some blood work. I also put a hold on that procedure. I did finally receive the services I came for and a bill of $4,500. I can't imagine the cost if I had let them proceed unfettered.

Sign Up For Special Health Programs

You may get extra cash or discounts on your premiums for taking a health risk assessment or participating in a tobacco-cessation program. Employers are moving towards motivating employees to be healthier. Kaiser Family Foundation surveyed employers and found more than half offer special disease management programs others may provide a work-out room within their building or pay a set amount towards a gym membership.

A healthy employee is an asset to an employer. They miss fewer days and can be more productive on the job. Costs of insurance are determined by claims. Individuals behavior can make a difference in some health costs. Employers are trying to incentivize them.

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Choosing A Health Plan For 2015

Health coverage is typically confusing. Most of us pick a plan and forget about it until we need it. The Affordable Care Act (ACA) has made it easier to choose a plan. But we have to get past the emotional aspect of change. Once we do, there should less surprises at claim time.

Easier said than done...

Why? Emotions distorts logic and forces you to make impulse decisions.

Some people pick coverage based on what their perception of health insurance coverage should be. This could lead you into financial trouble. Some will pick with their emotions and will find themselves with a very unaffordable plan, health insurance tax credit subsidies or not. Then you will lose your coverage by not being able to afford the payments.

Price is important, but not the only thing. We have to find a balance between coverage and cost. Lets set a reasonable expectation.

Choosing a health plan is more of a math problem than a benefits problem.

In a perfect world, with money not being an issue, you would choose the lowest out-of-pocket. But this could be a very expensive option. Then for others, having a $6,000 deductible could be very scary. But so is not having insurance.

How do you make a good informed decision when choosing your health insurance?

Here are a few things that you can do during your review:

    Review your medical expenses and usage in the past 24 months.
    Review any anticipated expenses that you are aware of. This could be current or foreseeable treatment; a birth of a child; etc.
    Analyze if it is worth the premium difference to add coverage, i.e. co-pays for doctor visits and the prescription drugs card.

If you are single, it may cost about $50.00 - $100.00 more per month to have doctor visit co-pay with a co-pay drug card. To have this kind of first dollar benefit of co-pays at the doctor's office and pharmacy adds value to the plan, hence the premium increase. Does the $100.00 per month justifiable for what you would be using?

    If yes, then it is worth adding the coverage.
    If no, then take the savings and put it into a Health Savings Account, or to better use. Just keep in mind you are saving money per month when you do use services and the service fees are applied to your deductible.
    Yes - it is insurance. Some may want to pay the difference in premium just for the likelihood they may need the coverage. If that is the case, then add it. It is worth it to you.

Another area to analyze is the choice of networks. Some insurance companies charge less per month to go to their smaller network of doctors and hospitals.

Some policyholders will absolutely require they have certain hospitals or doctors. If you are unwilling to move or review other choices, then you will pay the higher fee for the bigger/different network.

Being a little flexible on doctor choices could save you thousands of dollars per year. After all, a true emergency is covered out-of-network, but only for the emergency. As soon as you are stable you have to get out of dodge and move to an in-network facility. The savings could be beneficial to you and your family.

In some cases, you could be spending about $2,000 more per year just to keep your doctor. This is, of course, before you even use your benefits. Ask yourself, "is it worth it?". If it is, then go with it. If it is not, remain flexible and the savings will come.

Choosing a health plan for 2015 can be easy, if you remove the emotion out of it. If you can do that, you can save thousands per year on your new health plan.

Arthur "Butch" Zemar is a 2014 Broker of the Year Finalist, an insurance specialist, author and President at Elite Benefits of America. Butch Zemar is actively developing informative resources, such as articles and videos that deliver vital information on healthcare reform and employer options. Elite Benefits of America has consultative packages for employers, as well as insurance solutions, to keep employers compliant with healthcare reform and keep skyrocketing premiums under control.

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