Time to do some "Health Insurance Spring Cleaning"

Some helpful tips to get you through the "initial layer" of getting the health insurance you need without all the fat!

US Teens and Marijuana

Recent piece that aired on the increased usage of marijuana among US Teens: PressTV

The Salahis and Dealing with Multiple Sclerosis

There are 9 + types of Multiple Sclerosis, some more severe than others that the public is unaware of. I had the opportunity to interview the Salahis on Today's Health in DC and find out how Michaele dealt with her flare-ups while in the spot light. I also had the opportunity to ask her some of the questions that no one in the media has dared to ask......see how they answered on this episode of Today's Health.

Don't Eat My Wallet (or my face)!!!!

It is that time of year and you can see the stress on everyone’s face and what better solution than to get a facial! There are so many places right here in the nation’s capital, how does one choose? Personally, I am always looking for the best deal, but the best deal may come with a price….medical professionals call it Erysipelas, which is a skin infection caused by streptococcal bacteria, I call it "an expensive reason why I don’t go to spas.” This is not the gift I want for myself or my friends and family during the holidays!

All it takes is a simple cut and all of those streptococci come rushing in. You may have heard of the “flesh-eating bacteria?” This is otherwise know to the medical community as necrotizing fasciitis, a much more serious, but on the rare occasion, one can acquire it, and many times your body can fight it off. It tends appear more commonly on the arms, legs, and your abdominal. The symptoms generally include a combination of redness, swelling, pain, blisters, fever within the first 24 hours of exposure of this bacteria to your muscle and fat. Many of these cases are rare and the smaller ones usually go unreported since the consumer assumes they are just coming down with a cold and that “acne” is just a “normal reaction” to a “first time facial” and will go away in a few days. (Stay tuned for that story while a friend of mine recovers from this.) That is not what I want to be included in my facial!

No, I don’t mean to scare you, but if I did, I have your attention. Through my "local research", I have found there are some estheticians and nail therapists that are not inclined to follow proper hygiene protocol according to the owner of Patsy’s Nail Bar. Why? Maybe it is cheaper for them, maybe the Occupational Safety and Health Administration (O.S.H.A.) as well as the Washington, DC health regulations are not as thorough as they could be at following up on “Standards of practice,” or maybe we as consumers don’t know the standards and are not as educated in what they should be. So Patsy, from Patsy’s Nail Bar in DC was kind enough to take the time out to explain the “standards” that her spa follows and talk me into a facial with “no added and unwanted bacteria.” Here are some tips she gave me regarding what to look for when assessing “right spa” for me (or for that holiday gift):

• Is the therapist's license valid and posted in the spa?

• Did you see the technician sanitize their hands before starting your treatment?

• Is the technician wearing protective gloves during the treatment?

• Are you lying on clean, freshly laundered sheets during your facial?

• Is the technician using waxing sticks one time only? Double dipping in wax is an easy way to spread bacteria to the next client, or you!

• Are all containers used during your treatment properly marked? You may not be able to pronounce the words on the bottle, but it is safe to ask the technician, “What is that you are putting on me?” You have a right to know and I hope you want to know!

• During nail treatments, are the technicians using the same files and buffers multiple times on clients?

• Are the pedicure chair bowls sanitized for 10 minutes with water and an EPA registered product after each use?

• Did the therapist use a razor on your skin during your pedicure? This is illegal in DC as well as many other states!

• Are the nail files, buffers, and implements being stored in a "box" for the next time you return? Will they be sanitized and cleaned before your next visit and how?

These are just a few tips that I am going to ask the next time I visit a spa or get that “holiday spa gift” for a friend since I love extra surprises, but not the types that can cost you your health in the end! It’s time we become more educated consumers…who knew a day at the spa could accomplish that!

Shortened version available on: WUSA9

Save Your Boobs and Your Wallet

Here is an article that might save you a couple hundred on your next "wellness visit;" more specifically, on your mammography! BEWARE!

http://herndon.wusa9.com/content/how-save-your-breasts-and-your-wallet-october-2nd

Tip Number 1 from "101 Health Insurance Tips"

Be sure your insurance plan has integrity.....

Is this possible? The words "insurance plan" and "integrity" in the same sentence, or maybe there is a different definition out there as guided by the health insurance plans? In any case, be sure you do your research BEFORE committing to a plan, especially if you are the CEO of a larger company!!!!!! Believe it or not, the larger the company, the bigger the influence on the industry.

A good place to start is by doing a background check through the National Association of Insurance Commissioners. That may not be enough, so be sure to talk to your friends, family, and other business owners. Ask questions like: "how quick was XYZ insurance company on paying claims" or "did XYZ insurance company even honor certain claims at all."

Another "attack" is to ask the physicians themselves. The simple question of: "which insurance company was the easiest to get answers from" and "how quickly did they solve any claim disputes your patient may have encountered?" And my favorite: "Did you actually get paid from XYZ health insurance company" and "was the payment in a 'timely matter' and the amount you expected?"

With these simple questions in mind, you may find out a LOT about how an insurance company handles certain situations. This may be a sure indicator on how you and your company may be treated later.

Since larger companies have more power, it might be best for the human resources department to get more creative when signing these "healthcare plans." Maybe take a walk down to the legal department and add a clause to the agreement such as "if claim disputes are not resolved within a 48 hour period, XYZ company has the right to drop the health insurance plan and be refunded XYZ" or "...the claim disputed will be adjusted according to APR rate of the set time to be disputed and deducted from the set premium." If the insurance company "barks" at that, start networking with a group of healthcare providers; propose a discount plan in which employees from your set organization get a discount on services rendered at time of service. Depending on the size of your organization, you might start seeing the health insurance company asking for a second look at your proposed contract.

Remember, for most health insurance companies, it is about keeping their shareholders happy, not your employees healthy!

The "New" Health Care Bill: What does it all mean?

If you are confused, like most of the country, below is a little something to get you scatching your head, and asking some more questions:

The new "healthcare reform" is said to cost us about $940 billion over ten years. The most recent CBO estimates that this plan will reduce the deficit by about $143 billion over the first ten years and would total $1.2 billion dollars in the following ten years.

The new "healthcare reform" is said to cover more than 32 million Americans who are currently uninsured. Under the new healthcare reform, the uninsured and self-employed will be allowed to purchase insurance through state-based exchanges. Subsidies will also be available for individuals and families with income between the 133 percent and 400 percent of poverty level. By 2014, separate exchanges will be created for small businesses to purchase coverage. Additional funding will be available to states to establish exchanges within one year of enactment and until January 1, 2015.

Those individuals and families making between 100 percent – 400 percent of the Federal Poverty Level (FPL) SHOULD be eligible for subsidies, which for a family of four is $22, 050, and individualized health insurance should also be available at a decent price (so we are told). These "beneficiaries" cannot be covered by an employer and cannot be eligable for Medicare or Medicaid. Those eligible will receive premium credits (what they are is still a mystery). The good thing is, there will be some sort of cap on how much they have to contribute to their premiums on a sliding scale, which may be VERY "slippery".


Starting in 2012, the Medicare Payroll Tax will be expanded to include unearned income. This means that there will be a 3.8 percent tax on investment income for families making more than $250,000 per year ($200,000 for individuals).

Beginning in 2018, insurance companies will pay a 40 percent "excise tax" on so-called “Cadillac” high-end insurance plans worth over $27,500 for families ($10,200 for individuals). Dental and vision plans are exempt and will not be counted in the total cost of a family’s plan.

And for all you tanners, there will also be a 10 percent excise tax on indoor tanning services. There are more of these surprises in the "reform plan;" too many to go over in one blog!

The Medicare prescription drug “donut hole” will be closed by 2020, so we are told, and those seniors that hit the donut hole by 2010 will receive a $250 rebate. Where is that money coming from and will one actually get it? Your guess is as good as mine! In 2011, seniors in the gap will receive a 50 percent discount on brand name drugs. There will also be $500 billion in Medicare cuts over the next decade, so watch out for changes!!!! That may mean some benefits being cut over the next few years or MANY doctors dropping Medicare patients due to cuts in reimbursement rates.

Medicaid will expand to include 133 percent of federal poverty level which is $29,327 for a family of four. By 2014, states will be require to include "childless adults."
The Federal Government will pay 100 percent of costs for covering newly eligible individuals through 2016 and illegal immigrants will NOT be eligible for Medicaid.

Around September 23, 2010, insurance companies will no longer be allowed to deny children coverage based on a preexisting condition and by 2014, insurance companies will not be able to deny coverage to anyone with preexisting conditions. In addition, insurance companies must allow children to stay on their parent’s insurance plans through the age of 26.

Those individuals seeking an abortion would have to pay for their coverage by making two separate payments, private funds would have to be kept in a separate account from federal and taxpayer funds and no health care plan would be required to offer abortion coverage. States could pass legislation choosing to opt out of offering abortion coverage through the exchange. However, federal funds can be used to pay for abortions except in the case of rape, incest or health of the mother.

By 2014, everyone will have to purchase health insurance or be faced with a $695 annual fine with no exceptions for low-income people.

Generally, there is no employer mandate except employers with more than 50 employees will be asked to provide health insurance or they will be forced to pay a fine of $2000 per worker each year if any worker receives federal subsidies to purchase health insurance. This may, in some cases, be cheaper than actually paying for health insurance for some companies, so be prepared. Fines will be applied to entire number of employees minus some allowances.

Illegal immigrants will not be allowed to buy health insurance in the exchanges — even if they pay completely with their own money.

Can we say, "moving target"......well get your best gear together! I don't even think a "customized patriot missile" can hit this one!

6 Tips On Negotiating with Your Provider More Effectively

Can one actually negotiate with a provider? Believe it or not, you may be able to negotiate 10% - 50% or more off your bill; in most cases, all you have to do is ask! Here are some tips to help you become a more effective "healthcare negotiator":

1. Ask the right person: Many people tend to ask the person who send the bill; and many times, this is a collection agency or a person who is just that; the person collecting the money. Keep in mind that this person may be commissioned on the amount they collect, so why would they want to collect less (it means less for them?) Find out who is the decision maker and is instructing that person (i.e. who is reviewing their performance). Is it the doctor that took care of you, is it the director or manager of the billing department?

2. Be polite: There can be a big difference in the discount you ask for based on the way you ask. Don't expect, don't beg, and don't bribe. Just ask as you would the President for a Pardon or the officer when he pulls you over for speeding. The worst the doctor can say is no, but if you ask politely, you may be surprised.

3. Be consise and more proactive: Your provider is busy, and trust me, in this economy, everyone is stressed. If you foresee a big "lay-off" happening, give your provider a heads up, but don't be long winded. If you predict the next few weeks may be your last at work, send you doctor an email (no longer than a few sentences) explaining your concerns, or schedule to have a "consultation" (no more than 10 minutes) to go over a game plan BEFORE you are let go. Maybe your provider can work out a payment plan for your next few visits, cut down on tests, ask the pharmaceutical representatives for samples or your particular medication when they visit, etc.

4. Don't stress: So you got "let go yesterday" and you are not feeling well today. DO NOT call up your providers office screaming at the front staff because there are no appointments available for 2 months and that is when your company health insurance will expire. Take a deep breath, make the call, and be patient. Even if you are waiting on the line for what feels like hours or you get disconnected, be friendly, but concise. Smile when you talk (smiling does effect your tone) and get to know the person by asking for their name and ask how they are, BUT KEEP IT SHORT. Even if this person is in a bad mood, remain calm and always say thank you at the end of the conversation and maybe even compliment them. This person may be so taken by your calm demeanor, that they might find a spot for you that week, or even that day! You might get a reputation as the "nice patient", thus that will be relayed to the provider, making your negotiation process easier.

5. Be flexible: Again, if there are no appointments available when you need one, be patient, but also flexible. Ask the scheduler if there is a list that you can be on that just in case there is a cancellation to call you. Let them know how long it can take you to get there as well as give them a number, such as a cell that they can reach you immediately. This also works if the doctor is running late for your appointment. Don't get upset, be understanding and acknowledge that your doctor may have a=had a tough day and is falling behind, but in a way that does not scold him/her. Again, this will make asking for a discount a little easier...a little patience goes a long way!

6. Say "thank you": This is something many people do not say to their providers anymore. In fact, only 1 in 22 patients that I observed at a doctors office actually says "thank you." Maybe it is because the patient is not feeling well and their mind is clogged, but a "thank you" can go a long way......all the way to a discount on your next bill. So if you forget to say thank you, send a card, bake some brownies for the staff, etc. a little kindness goes a long way, especially for someone who only hears complaints all day!

22 Ways to Save on Health Care (Mary Hunt from Woman's Day interviews Michelle Katz)

You don’t need me to tell you that the cost of health care in America is skyrocketing. I know this all too well, having just been hit with an 18.96% increase in my health insurance premium. Yikes! When I found out, I sat there in shock for a few minutes, then decided to do the only reasonable thing: cancel the policy and just take my chances.

But eventually I came to my senses and called Michelle Katz, MSN, author of Healthcare for Less: Getting the Care You Need—Without Breaking the Bank. Michelle gave me what I needed—sound advice for my problem, and a lot more ways we can all cut the cost of medical expenses.

Health insurance

Evaluate annually If you get health insurance through an employer, review your options each year during the open-enrollment season. Last year’s plan may not suit you this year. Did you get married? Divorced? Perhaps it’s cheaper to opt out of your plan and add yourself to your spouse’s plan. Here’s your chance to switch without losing benefits.

Seek the best deal If you’re unemployed and uninsured, you may qualify for group health insurance through a professional or trade association, like your college alumni association. Group plans are generally cheaper than individual coverage. If you’re self-employed, consider joining a group like the National Association for the Self-Employed ($120–$480 a year), which includes the opportunity to buy reduced-rate health insurance.

If you’re looking for individual insurance, make a list of the top five things that are important to you (paid prescriptions? best doctors included on plan?), then call several companies for quotes. You may be able to save if you can take a higher deductible or higher copay.

Find a broker The National Association of Health Underwriters (nahu.org) can put you in touch with a reputable health insurance broker. Brokers are paid by insurance companies, so you don’t pay a fee. Make sure the broker has a “big book,” meaning he or she represents a lot of insurance companies, not just two or three—you want to be able to compare several quotes.

Add flexibility Sign up for your company’s flexible spending account. You deposit pre-tax dollars (anywhere between $120 and $5,000) into your FSA to use for copays, deductibles and other out-of-pocket expenses not covered by your insurance. It’s a great way to save: If you’re in the 28% tax bracket, for each $1,000 you put in your FSA, you’ll cut your taxes by about $280. But keep in mind, it’s a use-it-or-lose-it account, so estimate wisely and don’t deposit more than you’ll need during the year.

Doctor’s Office

Ask for a discount Everything in health care is negotiable, according to Consumer Watchdog, especially if you’re underinsured (you have to pay for the procedure out of pocket) or have a high deductible that you never reach. For $7.95 you can get a medical costs report from HealthGrades.com. Click on “Health Manager” to find the going rate in your area for more than 50 different procedures. Armed with the facts, you’ll be in a better position to negotiate. Or call your insurer’s customer service number and ask about the rates it pays physicians in your area. These rates are typically lower than the sticker price set by providers. Ask your doctor if she’ll accept a similar amount.

Find it for free If you have a health condition for which new treatments and cures are being developed, you may be able to get free medical attention. Check the National Institutes of Health (NIH) website (clinicaltrials.gov) or ask your doctor to call 800-411-1222 to find out if your condition is currently being studied.

Spread out appointments Conventional wisdom dictates an annual physical. But to cut costs on other needed appointments, such as test follow-ups, find out if you can wait 10 weeks instead of six, or request a follow-up over the phone.

Dental Care

Start flossing Daily brushing and flossing is the best way to prevent periodontal disease. Multiply the cost of treatment (from $200 for minor problems to $2,000 or more to replace a tooth if the disease is advanced) by the number of people in your family to see what a little toothpaste and a few dollars’ worth of floss can mean to your wallet.

Ask to prioritize Faced with an overwhelming treatment plan? Ask the dentist to prioritize your care, then spread out the work over a period of time.

Finance it If the work can’t be delayed and you don’t have the money, ask for a payment plan. Many dentists will work out something or will suggest a financing plan such as CareCredit (CareCredit.com), a company that lets patients make payments over 90 days without interest.

Find a dental school Try going to a clinic at a major dental school; it will be staffed by closely supervised students in their final years of training. The cost is about 50% less than for dentists in private practice. To find a school, go to ada.org and search under the “Dental Professionals” section.

Hospital

Use outpatient services Many procedures, even simple surgeries and invasive tests, can be done without being admitted as an inpatient, so talk to your doctor. Schedule your procedure for first thing in the morning, and be home by evening.

Avoid weekends Unless it’s an emergency, don’t check into the hospital on a Friday. Most labs don’t work weekends, so your tests will likely wait until Monday.

Go to a walk-in clinic For routine issues like an earache or sore throat, visit a clinic (even retail stores like Walmart have them). Some take insurance, but if they don’t or you don’t have coverage, the cost will typically be affordable. Plus, no appointment is necessary.

Negotiate the cost If your insurance doesn’t cover your entire medical procedure, call the hospital’s billing department and negotiate the amount you’ll have to pay out of pocket. (Do this before the procedure, not after.)

Prescriptions

Get samples When your doctor prescribes a new medication, first ask if there are generics or OTC medications that could do the same job. If the brand name is a must, ask the doctor for samples to get you started. Go to CRBestBuyDrugs.org for reports on the most inexpensive and effective drugs, which you can print out and take to your next doctor’s appointment.

Be a splitter High-dose pills are generally priced the same as their low-dose counterparts, so ask your doctor if you can safely split a higher-dosage pill in half. Twice as many dosages for the same amount of money—or 50% off.

Find help If you have no prescription-drug insurance coverage, you may qualify for a public or private assistance program that will help you pay for the medications you need. Pharmaceutical companies run patient-assistance programs; many states and other programs can help, too.

The Partnership for Prescription Assistance offers a site (pparx.org) developed by major pharmaceutical companies and patient advocacy groups. If you’re eligible, you can enroll in programs through this site. NeedyMeds.com also offers prescription assistance programs.

Buy by mail If your prescription plan has a mail-order option, take advantage of it. When you order a 90-day supply of medication, most plans will waive one of the three deductibles. Michelle says it’s possible to save 15% to 35% on your monthly copayments, or nearly $90 a year on the average prescription.

As for my insurance problem, I followed Michelle’s advice, and so far I’ve received seven quotes from different companies, each offering coverage equal to our current plan—and six of them hundreds of dollars less each month than our newly increased rate. Whew! Saved by a phone call.

The Cost of Saving a Life

My husband had sudden cardiac arrest a few months ago and luckily I performed CPR on him that inevitably saved his life. Fortunately, I have written many books about saving money in healthcare and this was no different. Many people get "lost in the emotion" while the bills pile up. I put my rules to practice once again, and proved that you can save, even in an emergency situation of a loved one.

1. Make sure you have a Power of Attorney: This is the designation of someone to act as the sole decision maker in your absence. In my husband's case, he was unable to make any decisions while he was unconscious for three days and could not deal with the stress of bills during his recovery. By having a Power of Attorney, I was able to make medical decisions on behalf of my husband as well as get copies of our bills to review and question all mistakes in a timely matter...and there were plenty of mistakes! This is not automatic when you are married!!!! Be sure to keep a copy at your local hospitals, with your insurance company, as well as at your home and office. You may also opt to file an Advanced Directive which contains both a Power of Attorney for health care and a Living Will. You can get these form free online and have them notarized at you bank. Some health insurance companies have their own forms that you can simply sign and fax in.
2. Does the provider have the correct health insurance information: Have your card and a copy of your spouses card on you at all times. One slight mistake, even if it seems obvious, is cause for your insurance company to reject your claim. During our emergency, one of the providers switched my husband's first name with his middle name. This caused some major reimbursement problems for us until I discovered that on some of the medical records being submitted to the insurance company, my husband's middle name was being treated as his first. At another point, someone submitted his "membership number" incorrectly. By having a copy of the card I was able to point out the errors before the billing got out of control and provide the medical facilities with a copy for their records. It may seem obvious, but mistakes happen, especially in a rushed situation.
3. Ask for an itemized bill BEFORE you leave the hospital: You may not get it immediately, but you should get this before you get your bill summary when you will be on a deadline to pay. At that time you, can double check for mistakes on your bill. I found many mistakes including double charges that are not necessarily obvious on the billing summary.
4. Keep you own records: It is extremely difficult to keep track of anything when you are an emotional wreck, but this is where an itemized bill may jog your memory on procedures that were done, medications that were administered or were not. The first night we were in the hospital, a friend of mine brought me a journal to jot down my feelings as a form of "therapy" when I was alone during those hours of silence and could not sleep. I actually used this journal to write down questions I had for the nurses and cardiologists on my husband's condition as well as keep track of dates and people that came to visit my husband. This came in very useful when we received our bill a few weeks later only to find we were charged for items and procedures never performed as well as a whole day before we actually checked into the hospital. (The bill stated procedures were performed on the 9^th when he did not have the arrest until the 10th)
5. Make friends with the right people: Many hospitals have patient advocates which are people you can turn to for most of your billing questions. Since most hospitals outsource lab work as well as different physician groups, it is very helpful to get to know this person. In our case, we were dealing with many billing agencies which became overwhelming. One of the patient advocates not only helped me locate the correct contacts at the billing departments, but assisted me in getting the correct insurance information to those billing departments that were submitting it incorrectly. In my husband's case, he was brought to the Emergency Room of one hospital and transferred to one with a "more equip" cardiac care unit. The patient advocate from one hospital supplied me with the contact information for his equivalent at the other hospital.
6. Ask questions and ask for the supervisor: Three hours in the emergency room cost us over $11,000, and it looked as though the claim was submitted. When I called the billing department initially, I was told that my insurance did not cover that particular emergency room. Thinking I was going crazy, I double checked with my health insurance and they informed me that that particular emergency room may not have been covered, which was possible, but I chose my health insurance of the emergency rooms in my area being covered. At that point, I politely asked for the supervisor and she gave me the correct codes that the hospital should have submitted as well as explained that the hospital may have been delayed in their submission. Still unsatisfied, I called the manager of the billing department only to find the codes were incorrectly filed and they would resubmit the bill immediately. Again, I documented everything and have not had a problem since. Always ask for the person in charge if you are not satisfied with the answer. I found out the person I was dealing with at first was new to the job, thus I was given misinformation.
7. Ask for financial assistance: Even if your insurance covers most of your bill, a high deductible can be detrimental to your bank account. Don't be afraid to ask for financial assistance. Write a letter immediately describing your financial need and ask your patient advocate who to submit it to. Some hospitals offer discount for paying bills in a timely matter, others may write it off. My husband has done so much volunteer work at one hospital that they wrote off their bill, the other offered a 20% discount for his volunteer work over the past 13 years and an additional 10% discount for paying the balance in full within 30 days!
8. Ask for everything in writing: Avoid any miscommunication by getting everything in writing. The hospital that wrote off the balance of my husband's bill sent a balance a few weeks later. Luckily, I had the name of the person I spoke with, her contact information and a 0 balance on the itemized bill she sent me previously. When I contacted her about the bill, she said it was an accident and she would forward the 0 balance document she had sent me previously to the billing department and a copy to me.

My husband is currently alive with a second lease on life. The CPR I happened to performed was with compressions only, no breaths. Ironically, I was too busy screaming for help for over a documented 16 minutes and cracked three ribs in four places. This inevitably saved his life. Today, we are able to enjoy life without the stress of his medical bills.

How to Get the Health Care You Need

Interview with Michelle from the Wyoming Valley Health Care System

When health care is not an emergency, you have more time—time to do a little investigative work and make sure you’re getting the right treatment for your needs.
“This is the kind of research you should do before making any important purchase,” says Michelle Katz, M.S.N., author of Healthcare for Less: Getting the Care You Need—Without Breaking the Bank. “No purchase is more important than medical care, yet people spend more time shopping for houses and cars than they do for their own health care.”
From her training as a nurse and her experience as a professional health care consultant, a doctor’s wife, and a patient, Katz has seen all sides of the health system. Here’s her advice for obtaining the care that’s right for you.

Begin by choosing the right health care provider. This person will coordinate all your care for years to come, become familiar with your medical history and any ongoing health concerns, and act as your partner in every treatment decision.

Pick the right provider
To reduce your costs substantially, choose a provider who is in your insurance plan’s preferred provider network. “It’s so important to find a doctor who’s good for you. Not every doctor is good for every patient,” Katz says. She notes that if you have a chronic illness, you may fare better with a specialist as your primary care doctor—for example, a gastroenterologist for chronic digestive problems, or an endocrinologist for diabetes. A specialist often can more quickly hone in on problems related to your illness and thus avoid unnecessary medical tests.
After you’ve found the best doctor for your needs, look at your health care plan. Your plan should meet these needs:
Cover doctor services.
Cover treatment in your doctor’s hospital.
Cover the specific treatments you’re most likely to need.
“The best plan for you may be a little more expensive than what you want to pay, but in the end, paying more up front can save a lot of money later,” Katz says. “Make sure the plan has the tools you need to help your doctor give you the care you need.”

Do your homework
Look closely at your coverage. Your doctor doesn’t know everything that’s in your health plan—it’s up to you to read the plan booklet or to call the health plan’s customer service office to confirm that any proposed treatment will be covered.

Use your insurance sooner, not later. Don't delay necessary, appropriate health care to save money out of pocket, Katz says. That's a sure way to miss out on getting the best care for your needs. This rule applies to both preventive screenings and to treatment for existing problems.

Take pains to befriend your doctor and clearly communicate what you need. The more your doctor gets to know you, the more likely you are to receive the knowledgeable, personalized treatment you need. “If you say you have a cough, the doctor is going to treat the cough and that’s it,” Katz says. “If you forget to add that you’ve also been having stomach pains, your doctor can’t make the right diagnosis.” This can lead to treatments that address the symptoms but not the cause, and therefore to more office visits and more treatments.
To prevent this from occurring, take the time to write down your symptoms and concerns before you visit the doctor. Take along a list of any medications and alternative remedies you’re taking, the names of any specialists you’re seeing, and your medical records from previous doctors. Then, speak up.

Second opinions
Consider getting a second opinion, especially when a recommended treatment is risky or expensive. This can make a world of difference in ensuring you understand all your options and are choosing the right treatment. According to Katz, if your doctor makes a treatment recommendation using words such as “almost,” “possible,” “probably,” “maybe,” “chances,” or “unlikely,” that’s a good cue to get a second opinion from another health care provider.

Most important, always be your own advocate in health care.
“Don’t rely on anyone but yourself to ensure things are done the way you want them done,” Katz says. “Your doctor is your first mate, but you’re the captain of your ship. It’s up to you to figure out how to steer your course toward the best treatment for your needs.”

Shape Interviews Michelle on her Top 10

10 Smart Ways to Slash Your Health Care Bills

Before you fill that prescription or enroll in an insurance plan, read this guide on how you can trim thousands from your medical costs—without compromising your care.
by Anne Marie O'Connor

CO-PAYS. DEDUCTIBLES. OUT-OF-POCKET EXPENSES.
It may feel like you need to empty your savings account to stay healthy. You're not alone: One in six Americans spends at least 10 percent of his or her annual income on prescriptions, premiums, and medical care. "Many women assume these costs are nonnegotiable," says Michelle Katz, author of 101 Health Insurance Tips. "But it's easy to save hundreds of dollars on your bills each year by speaking with your doctor or choosing another insurance plan." Here, learn why you're paying too much—and how you can put that money back in your pocket.

Choose a plan carefully
When it comes time to re-enroll this year, don't blindly check the box next to your current policy. "Re-evaluate your plan annually to ensure it meets your current needs," says Kimberly Lankford, author of The Insurance Maze. The first question you should ask is whether you have a favorite doctor or a medical condition that requires a specialist's care. If you answered yes to either, your best bet may be one of the pricier preferredprovider organization (PPO) or pointof- service (POS) plans, which give you the freedom to visit any physician, says Lankford. Generally, an in-network doctor will charge $10 to $25 per visit; out-of-network M.D.'s bill you for 30 percent of their fees. But if you only see your physician a few times a year, a health-maintenance organization (HMO) may be a better fit. These offer a limited selection of doctors for cheaper premiums and co-pays.

If you're self-employed or your employer doesn't offer medical insurance, check out Web sites like ehealthinsurance.com, which offers price and coverage comparisons by state. "Take into account your prescriptions, regular care needs, and mental health and vision expenses," says Lankford. "Also consider if you're planning on becoming pregnant within the year, because not all plans cover those costs." Once you've pinpointed all the services you'll require, crunch the numbers with an online calculator such as money-zine.com. "Don't be scared off by policies with high deductibles, the amount you have to pay out of pocket before insurance coverage kicks in," says Lankford. "Those plans have cheaper monthly premiums, so they may be worth it if your medical needs are minimal."

Question your tests
"Doctors aren't necessarily aware of what screens and exams are covered by your insurance," says Katz. To avoid pricey surprises, bring a list of approved labs to your first appointment with a new physician. Also check with your insurance provider before you schedule any treatments or tests, such as X-rays, MRIs, and breast ultrasounds; you may need to get written or verbal approval beforehand. Write down everyone you talk to and the time and date you spoke," says Lankford. "A paper trail is crucial if there are any questions or disputes later on."

Bargain with your doctor
If you're paying your bills out of pocket, don't be shy or embarrassed to ask your doctor for a discount. "Explain your situation," says Katz. "Say, 'You're not in my network, but I wouldn't trust anyone else to handle this. Is there any way you can adjust your fee for me?' " This tactic worked for Katz: As an uninsured graduate student, she asked a well-known local neurosurgeon to treat her injured back. "At my first appointment, I discussed my financial concerns with him," she says. Not only did he refer her to the least expensive hospital for her surgery, he also agreed to perform an operation for half his usual fee. What's more, he allowed her to pay off the cost on a monthly schedule, saving her a total of $14,000. "The key is establishing a personal relationship with your doctor and the staff," says Katz, who recommends arriving on time for your appointments and always expressing your appreciation.

Know what to do in an emergency
When a crisis occurs, hospital and doctors' fees are probably the last thing you're thinking about. That's why it's crucial to review your policy in advance. "Check to see if you need preapproval before going to the emergency room and note which hospitals in your area are considered innetwork and what constitutes an emergency," says Lankford (you can find this information in your insurance policy booklet or on the company's Web site). You'll protect yourself from an unexpected bill: Health insurance companies deny 20 percent of all emergency care payment requests that require prior authorization, according to a recent study published in the Annals of Emergency Medicine.

"If it's urgent, don't hesitate to call an ambulance," says Lankford. But for non-life-threatening situations, such as a broken bone or a fever below 103°F (unless you have stomach pain, which could signal appendicitis), ask a friend or family member to give you a ride to the hospital.

Review your hospital bill
Most women scrutinize their credit card statements every month, yet very few even glance at their hospital invoices. But they should: Experts estimate up to 90 percent of hospital bills contain errors. Before you check out, request an itemized bill. "Each treatment you receive is assigned a numerical code," explains Katz. "So somebody accidentally typing in the wrong code could mean a difference of hundreds or even thousands of dollars." Before leaving, scan your bill for any unusual charges. Then, at your next appointment, ask your physician or someone on her staff to go over anything you don't recognize.

Pay with pretax dollars
Less than 15 percent of Americans take advantage of a health savings account (HSA) or flexible spending arrangement (FSA), both of which are offered by employers. That means most of us are losing out on free money: These accounts allow you to pay for medical expenses with cash you set aside from your paycheck before taxes are taken out. The result: a savings of up to 30 percent on your health care costs. You can even use the accounts to pay for costs not covered by health insurance, such as doctor and prescription co-pays as well as hospital stays. Many plans also let you purchase contact lens solution, glasses, Band-Aids, and aspirin. Most employers offer only one type of account, either an HSA or FSA. The big difference between the two is that you can roll over your HSA contributions from year to year and from job to job. But with an FSA, you forfeit any money remaining in your account if you don't spend it by March 15 of the following year or if you switch companies.

For an accurate estimate of your medical expenses, review your health-related spending over the past 12 months, then add on any additional expenses (new prescriptions, for instance) you expect to incur in the future. "But do keep in mind that you have to file claim forms to be reimbursed, so if you're horrible at paperwork or holding on to receipts, these types of accounts may not be for you," says Katz.

Be drugstore-savvy
"You can save up to 30 percent on your prescription costs by going generic," says Steve Miller, M.D., chief medical officer for Express Scripts, a pharmacy benefit-management company based in St. Louis. Ask your doctor if there's a proven generic version of the medication she's prescribing. "They have the same quality and safety records as brand-name medicines," he says. If there's not one on the market yet, ask your M.D. if there's a less expensive but equally effective alternative to the drug she's prescribing. Even if your physician offers you free samples of a drug, still request the generic prescription: Once the complimentary packets run out, it's likely you'll have to fork over more money, says Miller. In fact, a study from the University of Chicago found that patients who received at least one free sample of a brand-name drug spent 40 percent more for medication over six months than those who didn't get them, possibly because they continued to buy the pricier pills.

Become a pill splitter
"Some drugs cost the same in high and low dosages," says Hae Mi Choe, Pharm.D., a clinical assistant professor at the University of Michigan, Ann Arbor, School of Pharmacy. If you're on medication, such as one for high cholesterol, ask your doctor if she can write you a prescription for a highdose pill you can cut in half at home, says Choe. She recently conducted a study that found patients could save up to 50 percent on their drug costs by simply dividing their pills. But this doesn't apply to all drugs. "Some, such as capsules, coated pills, and time-release formulas, shouldn't be cut," says Choe. "So consult your doctor or pharmacist first." To ensure you always take an accurate dose, use a pill-splitting tool, available at drugstores.

Find a discount pharmacy
Big chains like Target and Wal-Mart sell some generic drugs, such as antibiotics and cholesterol-lowering pills, for as little as $4 for a 30-day supply. Costco also fills prescriptions at a discount (you don't have to be a member to use their pharmacy). You might also ask your M.D. to write you a three-month prescription, then order it through an online pharmacy associated with your insurance plan or an independent one, such as walgreens.com , drugstore.com, or cvs.com. But be sure to comparison-shop: Researchers from the Creighton University School of Pharmacy found brand-name Rx's are cheaper when purchased by mail, but generic drugs can actually cost more.

Take advantage of hidden perks in your plan
"Your health insurance policy may cover all sorts of nontraditional services for free or at a discount," says Lankford (a doctor in the network usually needs to give you authorization beforehand). Check to see if yours offers discounts on or pays for smoking-cessation programs, weight-loss or nutrition counseling, or gym memberships. A handful of insurance companies, including Aetna and Kaiser Permanente, are also starting to cover alternative treatments, such as acupuncture, massage therapy, and chiropractic care.