Effective Health Care Consumerism

Don’t be embarrassed. A significant obstacle for many people in reducing medical costs is embarrassment to admit they can’t afford it. So they quietly pay bills they can’t afford, or ignore the bills until a collection agency comes around…. or worse, avoid getting needed care until their health becomes a crisis. Inability to pay medical bills is a systemic social and political problem, not a personal failing. Do not allow your feelings to rule your financial health.

• Research
  • Read books about how to stretch your health care dollar.
  • Read books about your specific condition and its possible treatments, so that you know what you need and can then ask for the least expensive way to obtain it. The more you know, the more direct your path to health may be.
  • Especially, read books written by people with the same chronic health condition as you, who have overcome the condition. Such books are often written by ordinary people (not by doctors). They know what works in the real world, and can sometimes provide excellent information on how to heal yourself.
  • Use medical guides, online or in print. Medical guides can sometimes help you diagnose your symptoms and often alleviate needless worry. They can save you time and money when you really don’t need to see a doctor, and they can save your life when you really are in need of care.
  • Obtain the above books free from the library, free from paperback swap websites, and at a low cost by buying used books from online bookstores.
  • Research online at websites, bulletin boards, and blogs. There are many places to find out what others have successfully done to improve their health problems. Be sure to use care in selecting what advice to follow. Some is very helpful, some needs to be weeded out.
  • Get a second opinion. If a doctor is recommending extra tests or procedures, get a second opinion to see if these are necessary.

• Community Health Resources
  • Health fairs in your community usually offer free or low-cost screenings. Health fairs are often repeated annually, so if you find one, you might go every year. Until there is a national resource promoting health fairs, to find them, we suggest you do a search on the internet that includes your state and the words “health fairs.”
  • Practitioner training schools often have student clinics offering services with reduced fees. Chiropractic colleges, dental schools, optometry schools, massage schools, medical schools, and acupuncture schools come to mind — there may be others. Some schools conduct research studies, so if you qualify, you may be able to receive treatment for free. To locate schools, look online or in the phone book for the state society or association for that modality or treatment. Note that this care will likely be more time consuming than regular practitioners.

• Negotiate with your Providers
  • Do you really need that health care service? Ask your providers lots of questions and make sure the services recommended to you are really necessary. You may be able to undergo a less expensive, less invasive procedure or avoid it altogether.
  • Call several naturopaths, doctors, dentists, therapists, physical therapists, acupuncturists, massage therapists, chiropractors, etc. and find out the prices before selecting a practitioner. Their office staff will tell you their fees over the phone. You might be amazed at the range of prices, and a low price
    does not necessarily mean poor service. Some of the best help can come from the lowest priced practitioners.
  • Make sure your doctor or health care practitioners know you
    do not have insurance. Many kind-hearted professionals lower
    their fees for the uninsured.
  • Some treatment centers have financial assistance programs.
    If you need medical help, don’t assume the treatment center
    you would like to go to is out of your reach — ask them if
    they offer financial assistance.
  • Barter. Some practitioners are open to bartering for services, particularly if you have a useful service or item to trade. Also ask if the practitioner has a financial assistance program or introductory special.
  • Ask if there are discounts for pre-paying for a package of several sessions.
  • Avoid unnecessary visits to doctors and other practitioners. Save visits where possible by calling in your question and asking the practitioner or staff member to call you back with the answer. This works especially where you have seen the practitioner recently and don’t need to be seen again. For example, if you’ve been seen for repetitive stress injuries, and then learn that massage might be helpful, just call the doctor’s office for a prescription. Also, sometimes if you call your doctor’s office and let them know that you can’t really afford a doctors visit but are suffering from specific symptoms, the nurse will let you know if your symptoms warrant you coming in for a visit. Also, ask if a follow up visit is really necessary.
  • Read bills carefully. Doctor or hospital bills may contain mistakes that end up costing you money. Something as simple as an incorrect billing code could prompt an incorrect fee (or your insurance to pay less than expected or even reject your claim). If you haven’t gotten an itemized bill, request one, then look for the diagnostic (CPT or EOB) codes. Check online for what the codes represent. Make sure the code matches the service listed.
  • Use appropriate services. How serious is your medical need? The emergency room is usually the most expensive way of receiving treatment; urgent care is second; and your primary care physician costs less. Especially, do not use the emergency room as a substitute for a doctor’s visit. You’ll pay much more, probably wait longer to be seen, and if not an emergency, your condition may not be addressed. However, if you do need immediate attention, don’t risk your life by waiting for your doctor to be available.
  • A nurse practitioner usually charges less than a doctor. Independent nurse practitioners may have private offices or work in clinics at large pharmacies or large discount stores.
  • Explore other countries. Look into having surgery outside the United States. In some countries (we’ve heard Thailand and India), US-trained physicians provide safe services for less. Research these options thoroughly by checking credentials and getting referrals.

• Mental Health
  • Sliding Scales. Some providers may have sliding-scale fees based on your income, and the provider will reduce his or her fees. Call around and ask for prices.
  • Look for unlicensed psychotherapists or pastoral counseling programs. Some states have a category of providers called unlicensed (registered) psychotherapists (or who practice under other names such as coaching), who often provide therapy or counseling on a sliding scale. Your church or synagogue can put you in touch with a pastoral counseling program. Certified pastoral counselors, who are ministers in a recognized religious body, have advanced degrees in pastoral counseling, as well as professional counseling experience. Pastoral counseling is often provided on a sliding-scale fee.
  • Use support groups. See the info in the support group section. Here is an online reference for many self-help groups for mental health issues: http://mentalhelp.net/selfhelp/. (checked 3/09)
  • Negotiate practitioner fees. See the section about negotiation.

• Rehabilitation
  • Sliding scales. Look for physical therapists, massage therapists, or other professionals that offer sliding scales. Call around and ask for prices.
  • Negotiate practitioner fees. See the section about negotiation.
  • Commit to recovery. If you’re recovering from surgery and facing rehab, follow the recovery regimen diligently. Get your physical therapist to maximize your home routine to save on visits.

• Prescriptions and Medications
  • Do you really need that prescription? Be sure to ask your doctor if your prescription is really necessary.
  • Check out your drug company’s website. Sometimes coupons or free samples are offered.
  • Use generics. If you need a prescription, you may be able to ask for a less expensive generic version rather than a more expensive brand name product. As your doctor or pharmacist for the names. You may also consult the PDR (Physician’s Desk Reference) or current “pill books” (non-technical versions of the PDR) at your local library. All of these books contain names of generics, side effects, and more information about any medications you may be taking.
  • Free samples. Doctors often have free samples of medications, just ask for them. Also your doctor might be aware of discount plans that pertain to the particular drugs s/he is prescribing.
  • Be honest with your doctor if you can’t afford a prescription. The doctor may be able to prescribe a less expensive medicine.
  • Ordering at online pharmacies is a popular way to lower the cost of medication. Save time by using websites that compare prices on online pharmacies provide several prices simultaneously.
  • Call around to local discount pharmacies and ask for their prices, too.
  • Buy in bulk, purchasing a larger amount to save money if it is a prescription that works for you and you’ll be on it for a while. No point buying a lot to later find out it doesn’t work, or you only need it for a short while and have a lot left.
  • Pill splitting. An article in the September 1999 issue of Clinical Psychiatry News reports that you may be able to purchase a higher dose pill at a cost only slightly more than the dose you’re currently on and split them in half. In a presentation to the APA, it was reported that patients can save an average of 37% off their current medication costs by pill splitting. A list of the medications surveyed included popular antidepressants. Be aware, though, that some medications cannot be split, such as “time-release” or “long-acting” pills. Ask your pharmacist to be sure.
  • Use over-the-counter or natural alternatives. Use non-prescription or natural alternatives to prescription drugs when possible. For example, there are several herbals and nutraceuticals on the market that are reputed to work well as antidepressants and anti-anxiety treatments. They are inexpensive and do not require a prescription. Do a search for “natural treatments for [your condition]” or consult a natural practitioner such as a naturopathic physician. Clerks in health food stores are often very knowledgeable about taking supplements to help different conditions, and will offer helpful suggestions about what products might help you.

• Medical Labs and Lab Tests
  • Keep good medical records to avoid unnecessary tests. If you’re seeing a lot of specialists, you may have the same test repeated unless you keep copies of your records. Avoid duplication by keeping track of EKGs, X-rays, and blood work. Ask for copies of lab results and carry them with you when you see specialists.
  • Avoid costly and unnecessary tests with a therapeutic trial. Some tests meant to tell you if you need a certain treatment can be avoided. Instead, you may find out if the treatment would be helpful, inexpensively, by simply doing a “therapeutic trial” of that treatment. You just try that treatment for a short while, and see if it helps.
  • Call around. When you do need to have a test done, call a few different testing facilities to compare prices. You might find considerable savings.
  • Some medical testing labs will perform lab tests without needing a doctor, by direct patient request. You can find online labs by doing a search for medical laboratories using these keywords: “direct,” “online,” and “no doctor.”
  • Look into home medical tests. You can buy tests for blood sugar levels, pregnancy and venereal disease, urinary tract infections and other conditions at most pharmacies. If the tests are positive, you know it is time to get professional help.
  • Check for health fairs and other offerings. Look in the newspaper and online for free routine screenings for blood pressure, blood sugar levels, or other testing at health fairs, pharmacies, non-profit organizations, and other places.
  • Work out a payment plan. Laboratories and imaging centers may work out payment plans or even waive fees for tests and procedures if you let them know you’re unable to pay the full fee.

• Support Groups
  • Find on-line support groups. Yahoo groups seems to have an online group for just about every disorder, illness, disease, syndrome, mental illness, and interest. Also, do an online search for “12-step groups” to find support groups based on that model.
  • Find local support groups. There are many groups for a variety of conditions. Look in your phone book or check your newspaper for support groups in your area.
  • For mental health support groups, see the mental health section.

• Medical or Therapeutic Supplies
  • Free used crutches, canes, walkers, medical supplies, or other health items (no medicines, though) may be requested via your local freecycle community. The main organization’s website at www.freecycle.org can guide you to find your local freecycle group. You can post a message requesting the item that you need. Freecycle might also help you find other resources to help make ends meet. Yahoo groups has many similar re-use/re-cycle groups. Try searching there under your community name.
  • To borrow used canes, walkers, and crutches, try local senior citizen’s centers.
  • Ask for discounts and coupons. At pharmacies or other stores selling therapeutic supplies, before you check out and pay, ask if there are any coupons available, or coupons that you could print out online, or any discounts.

• Hospital visits
  • Avoid the Hospital Emergency Room. How serious is your medical need? For conditions that aren’t life-threatening, you may be able to use a local urgent care facility instead. The emergency room is usually the most expensive way of receiving treatment; urgent care is second; and your primary care physician costs less. Especially, do not use the emergency room as a substitute for a doctor’s visit. You’ll pay much more, probably wait longer to be seen, and if not an emergency, your condition may not be addressed. However, if you do need immediate attention, don’t risk your life by waiting for your doctor to be available.
  • Shop around before undergoing surgery or other procedures. Surgery or treatments done a specialist centers often have lower prices than hospitals. It might be worth the cost of driving a little farther.
  • Negotiate the cost of your hospital visit. Here are a few tips:
    • Ask your referring doctor about which hospitals are best for providing lower out-of-pocket costs for patients.
    • Get the CPT code for your procedure and call the billing department of several medical centers to check the exact costs for the services you need.
    • Negotiate by paying cash. Try for a 20% discount for paying with cash or a credit card on the spot. Tie it to a hardship story to increase your chances.
    • Try negotiating by asking for a prompt payment discount, or if you need, negotiate a more protracted payment arrangement without extra cost.
    • Ask the medical center what the Medicare rates are, and then try to negotiate your cost closer to this rate. Ask to speak to the chief financial officer of the hospital. You won’t likely reach that person, but ask for the highest level official and say, “I’m willing to pay a little bit more than what Medicare pays.” You might get a substantial discount, such as 30% or more.
    • Ask for financial aid. If you have to go to the hospital without health insurance, ask to speak to someone in the financial department and ask if they have financial aid applications for uninsured people.
    • It’s important that you get the payment plan agreement from the hospital’s administrator in writing.
  • Try to get an itemized quote in advance and check for any small additional costs that might not be necessary (toiletries, for example) – these small costs add up.
  • Take your own. Bring your own over-the-counter medications and regular prescription medications to the hospital. Bring them in their original bottles and be sure to tell your nurse what you are taking. Double check your hospital and doctor’s bills to make sure you weren’t charged for the medication anyway.
  • For a sudden illness or accident, negotiate after your recovery. For a sudden illness or accident, it’s not too late to negotiate fees after your recovery. You can offer to match your payment to the level of Medicare payments if you don’t have insurance. It’s important that you get the payment plan agreement from the hospital’s administrator in writing.
  • Watch for billing errors. We’ve seen estimates that 80% of hospital bills have errors. Keep track of every procedure and medication, and check it against the bill. If you don’t understand soemthing, ask the billing department to explain it.
  • Contact the consumer protection office. If you are held responsible for charges you think are erroneous, contact the consumer protection office of the state attorney general’s office for help. Visit the website of the National Association of Attorneys General at http://www.naag.org/attorneys_general.php (checked 4/09) to find the phone number for the attorney general’s office in your state.
  • For what you must pay, find low-cost ways to finance. If you need to take out a loan to pay for a hospital visit, try finding a way to join a credit union, as their interest rates for loans are usually less. Another source of funds, if you have a good credit score (around 750 or higher), try a home equity loan. You may also be able to deduct the interest on your income tax. However, make sure you have a secure financial picture, for if you are unable to pay off the loan, you may lose your house. Another option is a reverse mortgage.

• Nutritional Supplements
  • Many stores selling nutritional supplements take returns on bottles that are opened or unopened, within a reasonable time frame, if you have had a reaction to the products or if you cannot use the items. Those are good stores to buy from. Ask about the return policy BEFORE you purchase the item!
  • Buy supplements online. Some vitamin stores online offer low prices and free shipping. Many will not charge sales tax in your state, which can be another source of savings.

• Eye Care
  • Check prices at different optical stores. Some stores charge much lower fees than others. Discount and warehouse club store optical departments, etc. sometimes offer very low prices for glasses or contacts. However, the least expensive frames are usually not the best frames. Ask whether options such as scratch-proof coating, plastic rather than glass lenses, or UV protection can be included in the price of better frames instead of buying cheaper frames.
  • Negotiate for better quality products. If you prefer the higher quality frames sold at doctors’ offices or boutiques, negotiate or ask about coupons or seasonal sales. The markup on frames is usually very high, so if you ask for 20% off the price of a second pair of glasses, you may get it.
  • Check prices for contact lenses online.
  • Negotiate with practitioners. See the section about negotiation.

• Dental Care
  • Keep current with checkups and teeth cleanings. Preventive care is expensive, but is much less compared to how much surgeries will cost you.
  • Visit dental school clinics. Another possible source of lower-cost dental care is a dental school clinic. Generally, dental costs in school clinics are reduced and may charge only for the cost of materials and equipment. Your state dental society can tell you if there is a dental school clinic in your area. Note that this care will likely be more time-consuming than going to a regular practitioner.
  • Negotiate with practitioners. See the section about negotiation.

• Other
  • Do-It-Yourself. If you can’t afford certain treatments, find self-help books at the library and do it yourself, find a family member to help you, or trade with a friend. For example, there are books on trigger point therapy, self-massage instructions, acupressure, herbs, aromatherapy, nutrition, and reflexology.
  • Try alternative treatments. Especially if you have a chronic ailment, try alternative treatments. Alternatives are very often less expensive than conventional treatments, and some can be done at home for very little cost.
  • Keep good records. Save time and money by keeping a medical profile with you with information such as your blood type, allergies, medications you’re taking, and contact information for your practitioners. Also, obtain copies of your records from your practitioners in your file so you can look back to find results of tests (and avoid duplicating tests), etc.
  • Save on income tax. If you itemize deductions, keep receipts for parking fees associated with health care. Write down starting mileage and ending milage for each trip to a health care provider or support group.
  • Use free services. For example, most pharmacies have blood pressure testing machines.

We feel certain that there are many more resources out there! Please let us know if you know of any other helpful resources available to all, or money-saving tips on health care costs. E-mail info@stollfoundation.org.