How To Be a Smart Health Care Consumer
While we do everything we can at KIG to work with insurance carriers to keep the cost of your health insurance down, we encourage you to do your part, too. Come on, throw us a bone here!
There are steps you can take to save on out-of-pocket costs, but there are also ways you can reduce the cost to your company’s insurance plan, which — whether you know it or not — saves you money in the long run. After all, if an insurance company raises the cost of the group plan, the increase will most likely get passed on to you in the form of a higher deductible or copay.
Understand your health insurance
Before you can be a smart consumer (of anything, really), you first have to be educated, right? Knowing some of the basic terminology will help guide you, and there are four key concepts you should be familiar with. On a health care 101 level, these concepts are:
Copay: A fixed amount you pay for a covered health care service after you’ve paid your deductible.
Deductible: The amount you pay for covered health care services before your insurance plan starts to pay.
Maximum out-of-pocket: The limit on what you have to pay for covered services in a plan year.
Premium: The amount you pay for your health insurance every month.
OK, now that we’ve gotten that out of the way ...
When you get a bill at a restaurant, it’s customary to look it over to make sure you weren’t charged for an extra appetizer or, worse, a third glass of wine, even when you had the restraint to stop at two. Scrutinizing your medical bills should be no different, especially because a medical procedure is considerably more expensive than a bottle of Merlot (unless you have very expensive taste.)
Taking this analogy a step further, you may be inclined to check your credit card statement later to make sure the incorrect charges did not end up on your bill. It’s a good idea to compare the explanation of benefits (EOB) to the actual bill to make sure they square up. An EOB, incidentally, is a statement from your health insurance company detailing the breakdown of the charges and who is responsible for those amounts.
But what if you spot a mistake on your bill? Good question. We answer that here.
Choose a PCP
With any luck, you’re so healthy that you’ll never have to deal with a medical bill. One way you can stay healthy is to pick a primary care physician. And you don’t want to wait until you’re sick. It’s a much better idea to establish a relationship with the doctor before that happens. That way, you can schedule an initial checkup and make sure he or she is familiar with your medical history.
It is very important from an insurance standpoint that the PCP is in network, as opposed to out of network. Using a doctor who has signed a contract to be in an insurance’s network is always cheaper than one who is out of network. Think of it as a membership of sorts.
Say you slip and fall (you klutz!), and you go to an in-network doctor and the total charge is $250. A $75 discount is applied to that amount for the negotiated rate with the doctor. Insurance pays $140. You’ll have to pay the remainder, which is $35. Now let’s say you go to a doctor who is out of network. No discount is applied to the total charge. The insurance may still pay the $140, but you’ll be responsible for the remainder of $110.
And, like with anything you buy, you naturally want to know how much something will cost. Medical care is no different. It’s OK to ask a physician how much a procedure may cost, says Stephanie Rosenberger, client services manager at KIG. For that matter, she says, don’t be shy about asking whether a prescribed test is necessary or just a recommendation.
It can be hard to know when to seek medical treatment. Do you really need to get the oil changed at exactly 3,000 miles? Probably not, but if you wait too long, chances are the neglect will lead to serious damage. The same is true with your health. Your car has to be inspected once a year — and you should, too. At an annual checkup, it’s a good idea to prepare questions you may have and to bring a list of medications so you can paint a complete picture of your health.
Recommended screenings like a mammogram or colonoscopy (everyone's favorites) and immunizations (such as an annual flu shot) are other ways you can take charge of your health.
Lastly, if your health plan offers certain perks or incentives, take advantage of them. They are often designed to save you money directly, or to save money for the group as a whole. These can include smoking cessation classes or a wellness program.
Click here for a good resource on preventive health care.
ER, urgent care, virtual visits
If, despite all your best efforts, you do require medical care, where you go is an important consideration. While your instinct may be to head to the hospital, if your condition is not serious or life-threatening, you have less expensive options. In other words, says Stephanie, if it’s not a matter of “life or limb,” you’re probably better off going to an urgent care facility. The average cost of a trip to the ER is far higher than than a visit to an urgent care clinic. Plus, a deductible for an ER visit can be several times higher. One disadvantage that should be noted, though, is that urgent care clinics are not usually open 24/7 like a hospital ER.
Another option that has become more popular during the COVID-19 pandemic is telemedicine, or virtual medical visits. Because they are done over the phone or a computer, you don’t have to leave home, meaning you don’t have to be around any sick people, and it’s often offered 24 hours a day. Virtual visits often cost $50 or less, and as an incentive, some insurance plans offer this service for free.
To help you decide which is the best option, check here.
OK, so the doc says you need a prescription (or two) to make you better. You can save money here, too. Find out if a generic drug is available and appropriate, which can save big money over a name brand. And don’t assume the cost is the same at every pharmacy; shop around to find the lowest price.
Being a smart consumer of health care can help lower costs for both you and your employer, which, in turn, benefits you as well. If you have questions on how you can keep your health care costs to a minimum, call us at (724) 349-1919.
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Read more: I'm sick. What Should I Know About My Insurance Plan?