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.

NBC Interviews Michelle Katz on Her Cost Saving Tricks

Treating Health Like Car Can Save Money
Shopping Around, Making Deals Possible
Shiloh Woolman, Staff writer
UPDATED: 1:45 pm EDT July 29, 2008



Many people feel that, between their employer choosing their insurance provider and their insurer and doctor working out the price of care, they have no control over what it costs to stay healthy. But you can take control of your out-of-pocket expenses.
"People spend more time shopping for cars than they do for their health," said Michelle Katz, author of "Health Care For Less" and "101 Health Insurance Tips." Katz said health care costs aren't set in stone. People can negotiate for the best price their doctors can offer and shouldn't be afraid to shop around, she said. "I called a surgeon, he quoted one price. I asked for a deal. He was able to negotiate a lower price," Katz said, recounting her own experience with back surgery.
If you're uninsured, or have to pay a high deductible before insurance kicks in, consider offering cash. "Your best bet is to pick up the phone," Katz said. "Go to Medicare.gov and see what the rock-bottom prices are. If you are offering cash, offer the Medicare price up front and the doctor won't have to deal with insurance."

Get Right Care At Right Time
Wayne Sensor, the chief executive officer of Alegent Health, said emergency rooms are overused by people who don't need the highly specialized and most expensive care a hospital has to offer.
"(Ask any) ER physician, 'How many of the people you've seen in last 24 hours were there because they're in a truly emergent condition?' The figure would be 10 to 15 percent," he said.
People who aren't experiencing a true emergency have many other options for care, even after 5 p.m. or on weekends. Outpatient clinics, ambulatory care centers and clinics located in grocery stores are available. There are also 24-hour nursing hot lines that can help you make a decision about the right kind of care for your condition.

Alegent.com offers the My Cost calculator, which Sensor said allows consumers to research more than 500 procedures online and find their out-of-pocket expense before they schedule a procedure with one of the network's hospitals or clinics.

Do I Need That Procedure?
Katz said you can't expect your doctor to understand everything about your insurance plan. It is the physician's job to get you well, not save you money. "Doctors are now practicing defensive medicine," Katz said. The patient needs to be armed with what is covered, then challenge the doctor to make sure his recommendations are really necessary. These kinds of questions are likely to increase as more and more Americans sign up for health savings accounts, which offer consumer-driven health care options. Consumers generally pay a higher deductible and a lower premium. Since out-of-pocket expenses are higher, consumers shop around more. Sensor said 6 percent of all insured Americans are on a consumer-driven plan. The U.S. Treasury estimates that up to 45 million consumers will be in an HSA by 2010.

Pick Right Plan For You
Scrutinize your options each time you sign up for insurance, the experts said. Options change, and you want your plan to match your needs. If you have a favorite doctor or a chronic disease, choose the plan that covers them. "Some employees might like acupuncture," said Katz. "If you have, say, Crohn's disease, you want to designate your primary care physician as your specialist in your HMO, if you can." "Although employer coverage usually is still your best bet, you may do better on your own," wrote Kipplinger.com columnist Kimberly Lankford. "You can compare rates for individual policies at eHealthInsuance.com or find a broker at the National Association of Health Underwriters."

Don’t Get Sick
You can't avoid all illness or injury, but you can make the effort to avoid chronic disease.
Sensor said diabetes and heart disease are often the result of what we've done to ourselves by how we eat, live and exercise. A study published in the Archives of Internal Medicine shows that overweight study subjects spent 25 percent more on health care than people with a normal body-mass index, or BMI. Obese participants spent 44 percent more than those with a normal BMI. "Americans spend three hours a day, on average, watching TV," Sensor said. "Including sports, recreation and exercise, we average 30 minutes a day. Think what would happen if we spent half as much time taking care of our bodies as we do watching television. We'd be incredibly healthier and spend less on our health care."
Staying healthy also means learning your risk factors early. Preventative annual checkups and participation in screenings, such as mammograms and colonoscopy, can find health issues before they require major, expensive procedures.

Do The Right Drugs
The first place to save at the pharmacy is by getting the generic version of brand-name drugs when possible. "A prescription filled with a generic drug will cost, on average, $40 less per prescription," according to Blue Cross Blue Shield of Oklahoma.
Even if you pay a copay, many pharmacy benefit programs charge a lower or no copay for generics compared to brand names. A host of retailers, including Wal-Mart, Target and Costco, now offer flat fees for generic drugs. A study from Omaha's Creighton University found that not all mail-order drug programs are alike. Robert Garis said his research found that employers assume mail-order programs are better, so they encourage workers to get drugs by mail. But while some pharmacy benefit managers slash brand-name prices for mail-order drugs, they then mark up the cost of generics. "What pharmacy card companies' salespeople do is convince the employers that the brand drug discount is so much better and don't talk about generics. There is extra markup on generics," Garis said. It may not affect the employee's out-of-pocket expense on the drug, but it drives up overall health-care costs that make premiums higher. As such, it may be worth a chat with your human resources manager to make sure mail-order generics really are a better deal.

Scrutinize Your Bill
Whether it's a pharmacy, clinic or hospital, make sure your bill reflects the services you got. Katz said she went over a hospital bill for her husband and found an erroneous miscellaneous charge, a pharmacy charge and a wrong date. She had them corrected, and the bill was reduced.

Off to college....but what about health insurance?

You are sending your child off to college, but is he/she still covered under your health insurance? Many colleges/universities require health insurance coverage as a condition of enrollment. Most colleges/universities own student health plans that they provide to their students at a minimal cost to access doctors and hospitals near the school. However, if your child is attending college far away from home, and there is a lack of healthcare facilities at the school or close to the school, you may want to be sure they are still covered under your plan.

An example of this is if you and your child are currently covered by an HMO, and your child is going away to college in another state or region. You should check to make sure your child can access HMO providers in your network in the area your child is attending college. For example, if you are covered by an HMO in Maryland, and your child is going to college in California, your child may not be able to find a doctor or hospital in California that will accept the HMO’s coverage.

In addition, if your child is currently covered under your health policy as a dependent, check with the plan to be certain he/she can remain on the plan as a full-time student. Be sure to check with your policy how they define a “fulltime student.” Some insurers define it as an undergraduate with no less than nine credit hours, and other define it as no less than twelve. Other insurers have age limits - for example, with some plans, dependents over the age of 22 get booted off the plan, and others set the limit at 30 regardless of their student status.
Keep in mind, in order to get those “student health discounts” or even qualify for “continued coverage” under a parents’ health plan, some restrictions may apply. Here are some things you should check:

• Effective dates: most policies go into effect after you are a student for at least a period of 31 days and you can apply as soon as you enroll as an “eligible student” in the college.
• Exchange Student Coverage: if you plan on going abroad this semester or any other, be sure your child has is still covered under your policy or you may have to purchase an extended policy. Most policies cover this provided they are still considered an “eligible student” by definition of the policy.
• Extent of coverage: Are hospital fees, emergency room visits and medical tests covered? Do you prefer paying for the “smaller medical” expenses, or but need coverage for the “larger costs?”
• Types of services covered: Are eyeglasses covered, dental, or will you have to buy a separate policy?
• Exclusions and limitations, especially if there are pre-existing conditions
  Is there a maximum benefit amount?
• Is there flexibility regarding choice of health-care providers and specialists?
• What is the deductible and co-payment?

Don’t assume that your child is covered under your insurance. Read the fine print and inquire with your insurance company as to what is covered and what is not. You might find that purchasing supplement insurance is necessary. On the other hand, the school maybe the college/university provides adequate health insurance, in which case, your child does not have to be on your plan. Most college policies provide for payment of premiums on an annual basis or you can opt to pay every six months, or you can opt to keep them on your plan. Take the time to look around for the plan that is best for you and your child.

It's Tax Time! Do You Know What Medical Expenses You CAN Deduct? You May Be Surprised!

You may not be in as much medical debt as you think! If your medical expenses exceed 7.5 percent of your adjusted gross income, you can start deducting! The IRS defines these expenses as “the costs of diagnosis, cure, mitigation, treatment, or prevention of disease and the costs for treatments affecting any part or function of the body.” They may include costs, of equipment, supplies, and diagnostic devices needed for these purposes as well as dental expenses. So save those receipts and think back to what you think is a medical expense and double check with the IRS’s publication 502. You might be surprised at what made the list!

Traditionally, health expenses include doctors' visits, laboratory tests, prescription drugs, and even insurance premiums. But did you know that some alternative procedures such as acupuncture, Navajo healing ''sings,'' electric shock, whirlpool baths, hydrotherapy and heat treatments are also on the list? No, marijuana isn't deductible, even when prescribed by a doctor in a state permitting the prescription, but keep checking, it might be included in next year’s list!

Some less obvious deductions may include air conditioners for relief of allergies or breathing problems, contact lenses, Braille books, adapters for closed-caption service for the deaf, hearing aids, eyeglasses, orthopedic shoes, crutches, wheelchairs, wigs for those who've lost hair through disease, and legal fees for guardianship of a mentally ill spouse and let’s not forget those clarinet lessons for “little Jonny” because a dentist recommended them for treatment of his tooth defect.

If you participated in childbirth classes for expectant mothers, you may be able to deduct those too, but do not deduct your maternity clothes. You just might want to donate those to the Salvation Army or Goodwill if they are in at least “good” condition for the tax write-off. Don’t forget about those remedial reading expenses for your child if they are suffering from dyslexia and what about the cost of buying, training and maintaining a guide dog or “other animal” for that blind person.

Let's not forget any “home improvement” expenses you incurred while constructing an exit ramp, widening doorways, fire alarms, handrails, lead-based paint removal, special hardware on doors, lowering or modifying kitchen cabinets etc for the purpose of medical care for you or your dependent(s). And do you have dependents, like your parents, that rely on you to cover their medical expenses, or even part of their medical expenses?

For 2006, you can also deduct 18 cents per mile for travel expenses to and from your medical treatments. Next year it is expected to go up to 20 cents per mile and let’s not forget lodging and meals at a hospital or “similar institution.” As long as the principal reason for being there is to receive medical care, you are "in the clear," however, lodgeing cannot exceed $50 per person. For example, if a parent is traveling with a sick child, you can deduct up to $100 per night and that does not include meals.

In general, most medically necessary costs prescribed by a physician are deductible and so are some other things you may not even think of…so be sure you the IRS Publication 502, "Medical and Dental Expenses'' before filing your taxes this year. You don’t want to miss out on any of those deductions, especially with the rising costs of healthcare!!!!!

Read "Healthcare for Less" on other deductions and ways you can save on your healthcare.

The Healthcare-Debt Diet: 7 Ways To Avoid Going Into Medical Debt

Start your New Year more healthcare conscious in terms of your purse. Here are some tips to help keep you “medical debt free” this year:

1) REVIEW YOUR PLAN:
Whether you have a PPO, HMO, or HSA don't forget to review your plan for the new year! Did your policy change, were their new preventative measure added, or did your doctor drop your policy? Don’t assume your policy is still the same, even if simply renewed your same for the past few years. Small changes can mean big costs the next time you see your doctor.

2) TRY NEGOTIATING THIS YEAR AND PAY CASH:
Talk to your doctor and tell him/her you are trying to cut costs this year and if he or she can help. Offer to pay cash upfront or see if you can work out a payment plan for a discount.

3) SHOP AROUND:
Whether is for a hospital or a pharmacy, prices will vary. With a hospital, find out what is included in your stay. Tell the accounting office that you are scheduled for "name exact surgery" with "name doctor" on "date." When dealing with your pharmacy give them the name and quantity you need of your drug. Don’t forget about calling on those wholesale clubs, even if you do not have a membership! You may be surprised by how much you can save!

4) FIND OUT WHEN THE HEALTHCARE EXPOS ARE:
Get a free screening at a local healthcare expo. Save these results and bring them in to your next check up.

5) START EXERCISING AND EATING RIGHT:
Have you doctor help you find the right diet and exercise for you? Do you need to pay particular attention to your sodium intake, or does tomato sauce give you reflux? Do you have bad knees? What exercise is best for you? Set some goals this year.

6) SAVE YOUR RECEIPTS:
Whether it is over-the-counter medication or mileage to get to your doctor’s office, document it all!!!! The IRS allows you to deduct medical bills that exceed 7.5% of your gross income. That's a high bar, but the list of eligible expenses is extensive, including insurance premiums, dental X-rays, fertility treatments, prescribed weight-loss and stop-smoking programs and even LASIK eye surgery. See irs.gov/publications/p502 for the details.

7) CHECK AND DOUBLE CHECK:
Everyone makes mistakes, your insurance company, the hospital, the doctor’s office, the pharmacy and yes, even your doctor. We are all human, so be sure to ask questions, ask for an itemized bill and add the charges up yourself, etc. Don’t assume. Write down the answer, the person that gave that answer to you, the date and their contact information so you can go back to that person if there is a mistake. If you don’t ask, you are empowering someone else with you health, and that can cost thousands in the end!

9 Simple Ways to Ensure You Save on Your Next Hospital Procedure

Here are some simple and proven ways to save money on you next hospital procedure. Be sure to do the following at least one week before the surgery to reduce your final bill:

1) If you know you are going to have surgery, call each of the hospitals you are considering and ask their policies on discounts for payment in advance. Some hospitals give a percentage discount and some a flat fee. Flat fees are usually a better deal, and usually include the anesthesiology charge as well.

2) Select a surgeon who has privileges at the hospital, or find out if your surgeon is willing to seek courtesy privileges at that hospital.

3) Your doctor will identify the exact surgery he plans to do and place it on the operating schedule, approximately one week before the scheduled date. When you talk to you doctor or the surgeon's nurse who does the scheduling, ask to be scheduled first or second case on the date he proposes; this gives you more time to fool with the billing folks before they get busy, and gets you out of the hospital quicker.

4) Call the hospital accounting office as soon as you know the case has been scheduled. Tell them you want to discuss prepayment for a self-pay surgery. Tell them you are scheduled for "name exact surgery" with "name doctor" on "date".

5) Get the full name of the bookkeeping person you talk to. Ask if there is a set fee or discount if you pay in full, in advance on the day of the surgery. Write down the exact amount and the name of the person you talked to and ask them to make sure it is put on your record that you are eligible for the advance payment rate.

6) Ask what is included. For example, I wanted to go have my EKG and labs the day before (so I wouldn't have to get up so early), but the bookkeeper told me that these tests were included in the fee if I had them done the morning of surgery, but would be billed separately if I did them another day. For $400 bucks, I got up early!

7) Ask what is the discount for the additional fee if you have to stay overnight. Some hospitals do not discount this part. Most do.

8) Ask where the information about your prepayment arrangement is being recorded for the admitting clerk. Make sure that the fees quoted include the anesthesiology and pathology fees. Insist on including these as they can often end up costing as much as the procedure itself!

9) Ask if the hospital accepts Visa/Mastercard and if the same rate applies. The answer is usually yes, and you can really rack up the frequent flyer miles.

These are some simple ways I was able to save on my last hospital bill. They are listed in my book, "Healthcare for Less," along with some other great ways to save money in healthcare. "Healthcare for Less" can be found at Barnes and Noble, Olsson's, Borders, Politics and Pros and at www.amazon.com.

Saving on Perscription Drugs: Simple Tips mentioned on Channel 9

On today's show, I mentioned some simple tips on how you can save as much as 50% (and maybe more in some cases) on your perscription drugs. Just in case you missed the show, they were:

1. Talk to your doctor. Be upfront with your financial situation. Most physicians got into medicine because they like helping people. If the physician is aware of your financial situation, he may be able to prescribe a medication that is more economical for you.

2. Ask for the Generic Drugs. Ask your doctor if there is a generic equivalent or an over-the-counter medication that may meet your needs. Keep in mind that when a patent on a brand name drug expires, other pharmaceutical companies can make the drug, which creates competition and drives the prices down. These drugs are required to have the same active ingredient as the brand name; however, they are not required to have the same inactive ingredients.

3. Check you health insurance plan. Check to be sure you plan covers pharmaceuticals, the co-payments, and if their is a maximum amount the plan will pay per year for pharmaceuticals. Also, be sure you investigate what drugs are covered as well as the drugstores that accept this plan. If you need a prescription that is not covered, your physician may be able to request an exception by filling out a form. Unfortunetly, some HMOs may have you go through an appeal process.

4. Compare drug stores. Shop around for a pharmacy that offers the best price for your needs. You may be surprise to find your prescriptions prices vary from one pharmacy to another. Call a few pharmacies (wholesale and retail) ahead of time and ask them if they have the prescriptions available, compare the prices with and without your insurance, and check online. And do not let that "lack of membership card" from wholesale places stop you, because in some states, you do not need it to use the pharmacy! You might be surprised to find a drug store running a special promotion on a popular drug.

Simple cost saving tips like these and more can be located in "Healthcare for Less," which is available at all major bookstores and online at www.amazon.com.

"Healthcare for Less" Author, Michelle Katz, Featured Guest on WUSA TV's "Mind Over Money" Show

FOR IMMEDIATE RELEASE


Michelle Katz Offers Tips for Healthcare Consumers

Washington, DC. (August 11, 2006, 9:00am) – Healthcare for Less Author, Michelle Katz, will be one of the featured guests for WUSA Television’s weekly money segment, “Mind Over Money”. The segment examines some of the top financial stories and trends facing residents of the nation’s capital. This will be the second time Katz has been a live guest for the show.

“Many people do not realize how readily available some of these healthcare discounts are and where to begin. Healthcare for Less offers the reader some simple tools to help the reader become their own healthcare advocate,” said Katz. The Healthcare for Less Author offers some time-tested tips for dealing the high costs of healthcare with the free information that every American has access to, but may never take advantage of. Katz is a very popular news and talk show guest. Her background as a healthcare administrator, clinician and patient as well as the host and producer of Today’s Health and freelance medical reporter give her a unique perspective on a wide variety of healthcare issues.

About Healthcare for Less: Healthcare for Less, is the one of the first of its kind to teach the simple, cost-effective ways to get the coverage you need through choosing the right doctor, selecting the best healthcare plan for your needs, learning what resources are in your own backyard and more. Based in Washington, DC, Katz has devoted her life to helping others become more aware of these cost saving measures through her consulting firm, HCStrategies, LLC. We believe that becoming your own healthcare advocate is essential to navigate your way through today’s complicated healthcare system. Healthcare for Less is available at all major bookstores including Barnes and Noble, Borders, Politic and Pros, Olsson’s and Amazon. To find out more information on Healthcare for Less, go to www.healthcareforless.us.

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How can you ensure healthcare without breaking the bank?

It is possible, but it takes a conscientious consumer. So many times I have heard people say "I am not worried, my work covers my health insurance," and suddenly the person comes down with something that requires a treatment that the insurance company suddenly does not cover! This is happening more often, and I am urging you all to become advocates for your health before it is too late!

"Healthcare for Less" gives you the basic tools that take you step by step to becoming your own healthcare advocate. Whether you have insurance or not, you need to know when you are being taken advantage of and do something about it, before it is too late!

Our healthcare system is in a downward spiral! Start preparing now and go to www.healthcareforless.us in order to learn more about how you can save money!