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Ways to Save on Health Care & Pharmacy Costs
Health Cost Strategies; Ways to save you money on your Health Care Costs
Most consumers are aware that by utilizing " In Network Providers" with your Insurance Company you will have higher coverages and lower out of pockets costs. But there are so many ways to maximize your Insurance benefits coverages while decreasing your Out Of Pocket costs. By Being an educated consumer and yes sometimes having to take extra steps or making calls can in the end, save you money. Firstly, create a folder at home for matching up your Physicians billing with that of your EOB (Explanation of Benefits) claims processing receipt to ensure your providers office has not overbilled you. If you use a "Contracted/In Network Provider" they are locked into a contract for pricing. What does this mean? If your Doctor charged $100 for the exam and your EOB/Claim states their contracted price for reimbursement is only $50.00; you do not owe the $50.00 difference. They may bill you, but if they are In-Network aka Contracted, you do not owe the difference. SO before you cut the check to them, call your Insurance company and speak to a representative. Often times, they have provider and member Advocates who can resolve this with your providers billing (ask as they may not just offer this service until you ask). Secondly, if your Doctors mentions you need; a blood pressure monitor, a hospital bed, oxygen, a walker, a wheelchair etc. This is called Durable Medical Equipment or DME for short. Before you run out and pick it up from your local vendor, verify with your Insurance company who their local providers are (quick service and supporting the little guy) as well ask if the have National Contracted Providers. It can be time consuming but by calling the vendors and asking their pricing can often vary by hundreds if not thousands of dollars. This can ultimately affect your pocketbook and overall expenses and works for Prescription Medications as well. Thirdly, Follow up on your Physicians billing. Over the past few years, Physician offices have become create with their billing to try and maximize their income. Under Medicare and most insurances we are allowed 100% coverage for a 1 time in 12 months "Annual Wellness Examinations." This is covered under Part B of Medicare (Outpatient Physician Services). Whether you have Medicare or Insurance they process the same in claims. If you receive a bill and you owe MORE, you need to check the providers billing information and coding. They may have coded it incorrectly (follow up exam vs an Annual Wellness) or when you asked about the weather, that aching hip you have or any other medical questions; they can add that and "pad their bill." Again, often you have to be your own Advocate, question the bill, question the office billing staff and reach out to your Insurance claims department for accuracy prior to paying their bill. Finally, being a smart consumer takes patience & time but again, in the end can save you money.
Strategies for budgeting your upcoming Health Care Costs
Preparing for upcoming procedures can be stressful. But preparing for your financial responsibilities before, during and after your procedure is essential for your budget. If you are using an "In-Network" contracted provider, you can ask the provider #1 the billing code they will be using and their usual fee then ask your insurance company their "Usual and Customary fee schedule" for that specific billing code. Remember to call your Insurance carrier to verify if a "Pre-Certification" process for notification is required. For many diagnoses and surgeries, certain criteria must be met for "Pre-Approval or Certification" of your upcoming procedure. This may help avoid any Denial of Services or a delay in your procedure because it was not Pre-Certified. Be your own advocate and make the call to verify their rules, it is usually helpful to keep a log and track whom you spoke with for resolving any future issues.
The below Medicare link can give you a rough estimate of the cost. Please be aware, Medicare's reimbursement is significantly less than that of Insurance contracts for providers; often by multiplying by 1.5 or doubling Medicare's rate you will be in the Insurances ballpark of cost expectations.
Strategies for saving on Prescription Drugs
Whether you are on a daily prescription medication, an expensive cancer medication, anti-rejection medications or a short term prescription of antibiotic. There are strategies for cost savings as some can be thousands of dollars a month. #1 use a Network or contracted provider. #2 for long term prescription medications, verify if your Insurance has a Mail in program. Sometimes buying in a 90 day bulk can save you money and you also have the ability of door to door delivery. Many local retailers are now offering "member savings" or discount programs with a Member Saving Card. For very expensive medication or specialty drugs, your Insurance may require you to meet certain criteria for coverage vs decide not to pay if that criteria is not met. They often will require you to do "Step therapy" requiring you to "try" other less expensive medications first and/or their Specialty Pharmacy Program as a gate keeper for their Cost Containment. Recently, a Bill was signed by President Trump to cut out high kickbacks to the middle man for prescription drug fees and sending the savings back to We The People. There soon will be more to come on that and the trickle down effect to us the consumer vs Pharmaceutical companies. And finally, if you are prescribed by your provider an expensive medication, most pharmaceutical companies offer a Medication Assistance Program. Reaching out to your pharmacist on how to apply if your Physician does not offer it to you can often provide you substantial savings. Not taking your prescribed medications, should not be the option because you cannot afford them. Reaching out to Social Workers locally or calling your pharmacist or the Pharmaceutical company can certainly offer resources to help you get the medications you need at a price you can better afford.
Call your Insurance Provider
Check with your Insurance FIRST then decide what works BEST for YOU
**Free Power Of Attorney for Health Care Forms by State. No Lawyers Needed
Palliative/Comfort Care & Hospice Care.. National Institute of Aging
Whatever your health care needs, remember you need to be your own best Advocate; this is about you or your loved one. Reach out and call the number on your Insurance card for your plan benefits; ask for your deductible (percentage you are responsible for), your Out of Pocket maximum (usually annual maximum you are required to pay on your own), Network differences (if you use an in-network provider vs Out of Network). When you are Out of Network usually there is not a contract for guaranteeing you the Doctor has agreed to a certain fee.. (aka..be careful), and how much of those out of pocket costs you have met for the year (0% in January vs 100% by July??) for anticipating your upcoming expenses. You can verify if your Insurance company has a Case Manager to help provide you or your family resources for your current situation; often Travel & lodging is available to seek a 2nd Medical opinion or if care is needed for you to travel > 50 or 100 miles for specialized Physician care. Some Companies offer incentives for Healthy Living/Weight loss programs and specialized Nurse Case Managers, Doctors and Social Workers to help members manage Kidney disease, Bariatric (obese population), Maternity, Congenital Heart (babies with heart defects), Joint Replacement (hips, knees etc.) and provide additional resources free to you for being under their Insurance and you may even have access to "Centers of Excellence." This is often access to top World renowned facilities and physicians across the country for more rare disease and conditions. Again, it is better to have the resource information and not need it later vs never knowing it existed and not using your hard working benefits to help you in your time of need
Palliative/Comfort Care & Hospice Care.. National Institute of Aging
**Free Power Of Attorney for Health Care Forms by State. No Lawyers Needed
Palliative/Comfort Care & Hospice Care.. National Institute of Aging
Both Palliative Care and Hospice Care focus on your Medical Care to ensure your comfortable. You do not need to be at the End of Life for a Palliative Care Team visit. Palliative Care consultations can be completed on anyone in a hospital; ensuring all aspects of you being comfortable are being best managed. Hospice Care is End of Life Care for the terminally Ill patient; they are usually expected to live 6 months or less (yes many do live longer). At the time of diagnosis or due to their condition or disease status, life is anticipated to be shorter. Both services have a multi-disciplinary team of Doctors, Nurses, Social Workers, Physical, Occupational & Speech Therapists, Respiratory Therapists, Pastoral Care (Priest, Pastors or a Lay Person) and dieticians to discuss together with you and often your family; your wishes, your concerns and develop a plan together to ensure all of your needs are being met. Medicare and most Insurances cover Hospice Services, but not always ongoing Palliative care. It is certainly best and recommended to call your Insurance Carrier regarding coverages and or limitations or not under your plan. Home Hospice Services under Medicare pays for intermittent staffing to care for patients at home but doesn't provide coverage for 24/7 in person care. Medical Equipment and most prescription medications related to the treatment of your End of Life care needs are covered under hospice vs none of these are covered under Palliative Care. Hospice usually provides emotional support for you, your family and that continued family support remains for up to 1 yr after death as needed.
**Free Power Of Attorney for Health Care Forms by State. No Lawyers Needed
**Free Power Of Attorney for Health Care Forms by State. No Lawyers Needed
**Free Power Of Attorney for Health Care Forms by State. No Lawyers Needed
No one ever wants to think about or discuss the end of Life, but we are all born and eventually we will all pass away. Advanced Care Planning, puts you in control of your death and what measures you would like or not like when your time of death is near. When you complete the forms, it can be the most powerful gift to your loved ones. They now will know your End of Life Care wishes regarding; Life Support, Breathing and Feeding Tubes, Nursing Homes, Organ Donation and so much more. Hopefully you will not need these for many years to come, but when you do they will be completed and your wishes known.