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christian counseling today
Vol. 20 no. 4
S
afety, tolerability and effective-
ness have been the hallmarks of
good healthcare interventions in
the past. Increasing costs, how-
ever, have propelled affordability into
a fourth variable that payers, providers
and patients use to evaluate interven-
tions. Thus, it is necessary for patients
to have guidance about how to finan-
cially navigate through the healthcare
“system.” The following is a collection
of strategies across several domains that
will assist patients in receiving the best
arrangements for care that are safe, well-
tolerated, effective
and
affordable.
Hospitalization/Procedures/
Physician Visits
n
Negotiate for a price discount on
hospital fees or expensive proce-
dures if you are paying a substantial
portion out-of-pocket due to high
deductibles or lack of coverage.
Insurance companies do not pay
“sticker prices” and neither should
the cash-paying patient. For
example, I have seen psychiatric
hospitals give patients 20-30%
discounts on cash rates when asked.
n
Always question the medical neces-
sity of an intervention by asking the
very succinct question—“Would
you recommend this to a member
of your family with the same clinical
condition?
n
Obtain second (and even third)
opinions if significant doubts remain
about the course of treatment.
n
Always analyze your hospital bills for
duplicate charges and/or errors in
billing, such as charging for a medi-
cation that was not received.
n
Always ask questions of your
provider regarding the proposed
length of therapy, duration of
medications (if needed), and any
interventions that may speed up the
process (e.g., lifestyle changes such
as diet, supplements, exercise, etc.).
Medications
n
Use generics when appropriate.
Most will work as well as branded
products, but may vary between
brands… so identify the generic
“brand” (the company that makes
it) that is effective and well-tolerated
and stay with it. Your pharmacy
may need to special order the
prescription.
n
If a branded product is more appro-
priate, maximize your insurance
coverage by getting prior autho-
rizations and formulary (list of
medications) exclusions from your
insurance company. Your physician
will need to complete paperwork to
receive this, so try to get as much
done with your insurer before
involving the doctor. Some offices
charge a fee for this service.
n
If the insurance coverage had a very
low reimbursement on submitted
charges, identify if this was due to
a deductible that needed to be met.
In this case, one would expect the
insurance coverage to improve after
meeting the deductible.
n
Obtain 90-day supplies if your
insurer permits. Usually an indi-
vidual would only then pay two
months of co-payments and receive
three months of medication (33%
savings).
n
If you do not have insurance (or
have high deductibles), compare
prices between pharmacies using
«
Michael R . Lyles , M .D.
shrink notes
Let’s Make a Deal on Healthcare
