Health care is an unavoidable aspect of being human, and even with stellar medical coverage, it deserves a line item in your budget. According to the latest News and Numbers report from the Agency for Healthcare Research and Quality, the average visit to a doctor’s office costs $199—but you’ll shell out $1,275, on average, for an outpatient hospital visit.
While you can’t control all forms of disease and illness, there are proactive steps that you can take to maximize your healthcare budget, and it starts by getting the most out of the care you receive in the doctor’s office. Here’s how:
Ask about policies first.
Medical offices vary in their appointment policies and the services they’ll charge for and perform. Before you set the appointment, ask about the practice’s policies, including penalty charges for missed or cancelled appointments and fees associated with certain paperwork processing, like required short-term disability forms if you have a condition or procedure that causes you to miss work temporarily.
You should also inquire about the medical office’s policy for treating multiple needs in the same visit (for example, writing a new prescription for a recurring condition at a “sick” appointment). Some will require you to schedule separate visits for each medical need and pay a separate co-pay each time.
Gather pricing information from medical providers just as you would estimates for home repair or auto repair. If you don’t like their payment policies, find a provider that offers the service you expect.
Research your insurance coverage.
Medical offices vary in how diligently they research your health insurance and prescription drug coverage before recommending treatment. Ultimately, you are responsible for paying for the care you accept.
Always confirm that a doctor is covered under your plan, and if you anticipate a certain procedure, like lab samples, X-rays, blood work or annual tests, confirm what is covered with your insurance provider before you accept treatment. Some plans require that you pay a certain amount out of pocket (which “resets” annually), before the plan pays anything.
With this information, you can strategize the timing of your medical care to get the most coverage possible.
Healthcare is a rare industry: costs of goods are known to be high, yet customers rarely question the goods and services they are told to buy. While it is your doctor’s job to recommend a sound treatment plan, it’s not his or her duty to consider your financial situation. Never assume that he or she has given thought to costs.
When your doctor recommends tests or treatment plans, engage in a conversation to understand what function each performs and whether it’s the only option. Consumer advocate Dr. Holly Lucille, ND, RN, recommends asking the doctor about lifestyle changes that might minimize the severity of a current condition, inquiring about non-prescription alternatives to the recommended treatment, and researching preventative measures you can take to boost your own body’s defenses.
Bring your prescription formulary with you to every doctor visit (access it online from your health insurance provider, or call and request a copy). Show it to the doctor before he or she writes the prescription so you know that you’re getting the best coverage you can for the recommended treatment.
Inquire whether there are older varieties of the same medicine that may be less expensive, but are simply not “top of mind” for the doctor. Ask for samples of new prescriptions to confirm that a formula works with your body and condition before paying for the full-sized option.
If you take a prescription regularly for an ongoing condition, shop prices by calling both brick and mortar pharmacies and using prescription price comparison sites.
Check your explanation of benefits, and final paperwork.
The Medical Billing Advocates of America (MBAA) estimate that 8 out of 10 medical bills contain an error. A few weeks after you receive care that was submitted to your health insurance provider, you’ll receive an explanation of benefits (EOB) letter in the mail. (Often it will say “this is not a bill” at the top).
Make sure your basic contact information and the numbers on your insurance card are accurately shown on the statement. One wrong digit may actually identify a different plan that has different coverage than your own.
The earlier you catch the issue, the easier it will be to resolve. Review the statement details to confirm that the services on it accurately reflect what you approved to be performed and completed at the doctor visit.
If there is too much much jargon, or vague terms like “kits” and “trays,” that leave you unsure as to what you’re actually paying for, contact the biller for clarity, and to ensure that you are not being charged twice for the same item or for tests that didn’t actually happen.
Under the American Hospital Association’s Patient’s Bill of Rights, medical billing departments must send you a free detailed bill upon request.
Stephanie Taylor Christensen is a former financial services marketer based in Columbus, OH. The founder of Wellness On Less, she also writes on small business, consumer interest, wellness, career and personal finance topics.