If the era of consumerism has finally arrived in American healthcare, as recent polls suggest, Americans may need to be ready to take charge of their health care finances.
But that role may be unfamiliar to many, especially considering that Most US health insurance through an employer or government,
Enter patient advocates – professionals who help consumers with the financial or clinical aspects of healthcare, either from internal organizations or as stand-alone physicians.
Sometimes, these advocates can help patients save huge amounts of money.
Ron Shinkman, a certified patient advocate based in Los Angeles, says he recently represented a client with a $67,000 bill for emergency services performed at a US military installation overseas. Although the client has both Medicare and Veterans Affairs benefits, she was billed $52,000. A collection agency then paid an additional $15,000 in fees because, according to Shinkman, “no one was stopping it from doing that.”
Shinkman discovered a minor glitch in the paperwork, contacted military representatives, and involved a major media outlet. The bill was waived.
Betty Long, president and CEO of Guardian Nurses Healthcare Advocates, has similar stories.
Long’s firm recently took on a client whose insurance refused to pay for a procedure to correct an abnormal heartbeat. The hospital billed for a permanent implant but actually used a device that is not permanent. This discrepancy came to light when a nurse reviewed the operative notes and the insurance company agreed to pay the entire bill.
long tip? “Like Winston Churchill said, ‘Never give up!’ “Keep calling, keep calling, and keep asking questions.”
Even if you don’t have a patient advocate fighting your health battles for you, here are six expert tips on how you can boost your health care dollars.
1. Know about your health insurance policy
Studying your health insurance materials may be less appealing than reading notices from the IRS, but experts say it’s necessary.
“I’m going to advise everyone to be intimate with their certificate of coverage for their health insurance policy. And if you don’t know how to read it, get an attorney to help,” says Nicole Broadhurst, Board- Certified Patient Advocate and lead Medical Billing Advocate at Tennessee Health Advocates. “The only way to plan for health care expenses is to really know what we are responsible for paying.”
Gail Trucco, a nurse advocate and founder of Medical Bill 911, also urges people to learn about their coverage.
Read and understand your insurance policy [its] Limitations, out-of-network and in-network terms,” Trucco said. “Insurance has limits and it’s your responsibility to plan.”
When you know your policy, you can get additional benefits that you are entitled to.
New York City-based patient caregiver, Saira Patel, recommends using benefits such as discounts or allowances for medical or pharmacy visits and over-the-counter medications and vitamins. These benefits are especially common in Medicare Advantage plans.
2. Read the Medical Bill Carefully
Shinkman urged consumers to read medical bills closely and with a dose of skepticism.
He followed his advice after undergoing a surgical procedure in 2019. His bill showed the charge of an anesthesiologist, even though a nurse anesthetist had given him anesthesia. When he asked about it, Shinkman was told that the doctor had come to visit him when he was unconscious. Shinkman filed a complaint with his state’s insurance regulator and the provider agreed to cancel the fee.
“Patients should understand that they will never get such an easy victory, and the provider will never fully admit wrongdoing, but they will reverse course if you confront them with accurate information and a polite tone. , while also suggesting that you will never back down,” said Shinkman. “There’s not nearly enough coming from patients, and it’s time to change.”
3. Ask for the Cash Price
Especially when it comes to prescription drug costs, many Americans are paying more by using their insurance, according to Mary Shoman, author and thyroid and hormone health activist.
“Always ask the pharmacist which is the lower price: your insurance copy or the cash value without insurance,” Shomon said.
She says the cash price is often low.
4. Go Digital
Telemedicine can save you money, according to Dr. Rajinder Chahal, a California-based endocrinologist and cofounder of WhitecoatRemote.com, a job board for remote healthcare workers.
For example, says Chahal, a video consultation with an at-home sleep test can cost hundreds of dollars and replace an overnight sleep study that costs in the thousands.
“Not all patients are eligible, but for those who are, the telemedicine option for personalized treatment for a variety of conditions can be a huge money saver,” Chahal said.
5. If You Don’t Have Insurance, Ask for Help
If you’re struggling with bills, Trucco suggests asking about drug company patient assistance programs to obtain low-cost prescription drugs and tapping into charitable funds.
If you don’t have insurance but need care, ask for services “in kind” or try to negotiate an upfront payment for a lower rate, says Dr. David Nayak, a board-certified allergy and immunology specialist. and recommend the founder. Strength to Love Foundation, a free asthma and allergy clinic for patients without insurance.
“If you lack medical insurance, don’t take ‘no’ or ‘we don’t provide services for uninsured people’ as an answer to the people you seek care from,” Nayak said.
Some providers offer free services. Control National Association of Free and Charitable Clinics For free clinics in your area.
6. It’s your money. Give it a Thumbs Up.
When it comes to out-of-pocket health care costs—which can be as high $5,000 to approximately $20,000 per yearAmericans should start practicing “fearless autonomy,” says Shinkman.
“Doctors are mostly curious about cost, often to a fault,” he said.
So, it’s up to you to ask about costs and speak up if something doesn’t seem right.