We’ve all heard about how the cost of health care is rising. But there are many ways to save money on medical expenses without sacrificing you and your family’s health. I have listed the five main categories of savings, and highlighted the most important tips in each category.
Find the Best Plan
Many companies offer multiple health plan options for employees. Choosing a plan based on the premium amount is not always the best decision. If you are a young, relatively healthy, low-risk family, than an HMO with low to no OOP (out-of-pocket) expenses may be best for you. But if you have name-brand prescriptions (some HMOs only cover generic), have high-risk family members, or chronic illnesses, a higher premium PPO plan may end up costing you less OOP annually.
Before your company’s open enrollment period, take the time to track all OOP expenses for the prior year. If your plan denied numerous claims or you saw specialists out of their network, consider moving up to a PPO or no-network plan.
If your company offers a Flexible Spending Account—use it! I recently spoke with a young woman who was complaining about her company’s benefits. She mentioned that they just wanted to keep taking extra money out of her paycheck, and used the FSA as an example. She didn’t understand the benefit of pre-tax dollars. A Flexible Spending Account is money set aside by your employer; pre-tax, to be used for a qualifying expense. Most medical, dental, and vision expenses are eligible, as well as an abundance of other services, many of which would not be covered under your health plan. Basically, a FSA allows you to pay all of your OOP expenses pre-tax. That can add up to huge savings. Again, determining your annual OOP expenses and any expected future expenses will help you decide the correct amount to deduct.
Know Your Coverage
Having worked for a major medical insurance company, I cannot emphasize this point enough. It is standard procedure for most medical insurance companies to deny any claims over a certain dollar amount. The claims are only paid when and if the denial is appealed or the claim refiled. Never accept a claim denial as final. Ask your provider to refile the claim, write a letter of medical necessity, or attach supporting documents. Call your insurance company and try to find a sympathetic representative. Ask for his/her direct fax and have the rep process the claim directly.
In 2006, my husband’s company switched insurance mid-year. Our ID cards were sent with the wrong plan information, so we just paid for a monthly prescription OOP ($289). After six months of paying OOP (and numerous phone calls), we finally were given the right cards. When I submitted the claims with attached receipts, the claims were originally denied because the ID cards were not submitted at the time of service! Then they were denied because the prescription was not pre-authorized. They were denied a third time as being past the timely filing limit.
Finally, I called the insurance company and threatened to write a letter to the Insurance Commissioner in our state. I faxed the receipts and claim forms a fourth time, and they were paid, in full, within a week. We were only supposed to get 80 percent back!
Before you have any medical procedure done, be sure that it is covered under your plan. It is your responsibility to do so. Many providers rely on pre-loaded software to advise them of your plan’s benefits. They may not have fully accurate information, and you may be left with a larger OOP portion then expected.
Discuss Options with Your Doctor
Make sure you have a treatment plan in hand before any major medical or dental work is to be done. Discuss every proposed item to make sure you are getting the best treatment for your particular financial needs (this seems especially pertinent to dental care). If your insurance covers a lower-dosage prescription with less OOP, ask your doctor if he/she can adjust your prescription so that you take more of the lower-dosage. Ask for samples and always get a second opinion when in doubt or if you feel like you are getting fleeced.
Ask your provider if they provide a discount if you pay in full at the time of service or are paying in cash. The dental office I used to manage offered a 10 percent discount to all cash paying clients. Even if you have insurance, you can pay up front and file the claim yourself. Just be sure not to check the “Assignment of Benefits” box on the claim form!
Take Preventive Measures
Stop major health care issues before they start. Wash hands regularly. Make healthy eating and exercise part of your lifestyle. Play and ride safely (helmets, kneepads, etc). Wipe baby’s gums after breastfeeding or bottles and have your older children’s molars sealed as soon as they erupt.
When ever possible, take the generic option for prescriptions. Many health insurers’ have tiered co pays and generic drugs are usually the lowest co pay options.
Check your memberships (AAA, etc.) to see if they offer discounts on vision care. If you need glasses or contacts, check all your local stores to see who has the best deals. When my husband recently needed new glasses, we dragged four kids to three different stores, but ended up spending over $250 less for the exact same glasses.
Check with your local dental schools to see if they offer reduced prices on cleanings, fillings, and major work.