Saving at the Doctor's Office

When most people think of how they can save money on healthcare, they often consider two factors: how to lower their health insurance premiums, and how to not have to use as much medical care as a patient.

Healthcare consumers cannot be faulted for trying to find ways of saving on health insurance costs. Keeping recurring premium costs down, and getting ahead of the game by saving for healthcare in HSAs or FSAs is much of what this website is devoted to. And everyone could benefit from thinking about how to use less medical care, especially if it is done by staying in better shape and practicing wellness and prevention.

A part of responsible healthcare is getting the regularly scheduled maintenance that you need. So what about those times when the best thing for you or a family member is to make that trip to the doctor, dentist, clinic, or hospital? When you are already going to be interacting with the healthcare system, how can you save money? Many tend to assume that once you step foot in the door of the healthcare practicioner, you've given over all of your leverage to them. As we also example in other colums such as Ways to Manage Pediatrician Costs, in the age of savvy, educated patients, being assertive and informed is your right.

Here are four ways that you, as a consumer of healthcare, can reduce your costs at the medical office, clinic, or hospital.

1) Price Shop. Upon first blush, one may assume that price shopping is meant for cars and electronics. Sure, and also healthcare. One of the most noticeable, early benefits of the healthcare consumerism movement is that our healthcare providers, the doctors, dentists, clinics, and hospitals, are gradually getting better at providing prices of their services up front. They know that in an age where the patient controls more of expenditure, they need to be able to provide quotes when you ask.

In our research and experience, those services that have traditionally been largely patient-funded are the most advanced in giving firm bids - LASIK, plastic surgery, dental cleanings, etc. However, more and more practicioners are stepping up to the plate and providing firm quotes on common procedures. Even when they don't have a "menu" of services with associated prices, many will provide a price quote to you if they know that it could mean the difference between getting your business or not. Typically, the more direct involvement that the physician or dentist has with the operation, the more they will be willing to provide price quotes. Additionally, a cottage industry is arising that provides information to patients on which hospitals and doctors provide the best-priced service based on public information. This could really change the landscape of healthcare.

Most practicioners will provide quotes with the caveat that the price will increase if unforeseen circumstances arise. For example, if you get a quote of $1,500 for a knee scope, and as they are doing the procedure you happen to have a more complicated case that requires a day of hospitalization, the hospitalization cost will typically be considered a separate event.

One important note -- price shopping is probably best done for specific procedures or one-time services. When it comes to creating a long-term relationship with a reliable family practice physician, there is no substitute for asking around and finding someone who you trust and click with.

2) Negotiate like the managed care companies. Do you ever look at those Explanation of Benefits forms that you receive from your insurance company and wonder what the "provider discount" or vague "adjustment" on your charges is? The ones that bring a $1,000 charge down to $800, $600, or even $400 in one simple line item? Those are the discounts that managed care companies have built in to their contracts with healthcare providers. The discounts might be flat - 20% to 50% across the board, or they can be based on the procedure (i.e. I don't care what you are going to charge me, but I'll only pay you $400 for X procedure).

As a patient, you have every right to negotiate the same, or better, deals with the providers. And while they have every right to refuse negotiation, you'll be surprised how open they are to it. You can use two methods. The first, armed with the information you received by price shopping, will enable you to go to your favorite doctor and say "I know that Dr. Benson charges $295 for this procedure. You charge $350. Will you match Benson's price?" Another method would be to take the managed care approach, which would be something like this. "I'm ready to come in for my procedure and will pay promptly through my HSA. But like Blue Cross, I'd like a 25% discount."

Of course, they can say no. But in an age where a doctor knows that receiving 75% of his total posted charge might be pretty good, it is definitely worth a try.

Another thing to consider is a prepaid "cash package". You may request that all elements of your routine labor and delivery cost you no more than, say, $3,500. The hospital may agree as long as you prepay in advance. If you are self-funded or funded through a high deductible plan, this can often be a win-win for the provider and the patient, but you must negotiate in advance, when you still have the leverage to take your business elsewhere. If you do this, make sure it is done in a way that will not prolong the process of meeting your deductible -- the allowable amount should apply toward your deductible, regardless of how much you agree to pay to the provider.

Keep in mind that the "allowable" amount is what should count toward satisfying your yearly deductible. Any price negotiation would likely be a discount after that allowable has accounted for, or else you may end up setting yourself back in your effort to meet your annual deductible.

3) Inspect your bill. Have you ever wondered how all of those charges are placed on your hospital bill? Manual entry. Every time a doctor or nurse does something, they enter a note which triggers a charge on your bill. So you are in the hospital for a hernia surgery, and the nurse gives you a shot. You're in pain, so you get another shot. Three weeks later, you get your bill, and you've been charged for six of those shots.

Certainly, when you are a patient in a healthcare setting, the last thing you are doing is counting the number of shots you receive or the number of pills you take. But an inspection of your bill upon receiving it will often identify errors. Most large health systems have an audit function which serves as a liaison for patients who believe their bill is incorrect, and smaller doctor or dentists offices usually have at least one person on staff considered the billing expert who can answer your questions.

The bill you receive probably has many charges rolled-up into a vague line or two. Virtually every healthcare information system has the ability to generate an itemized bill with every last charge on it. If you are skeptical that your bill is correct, ask for the itemized and go over it with a fine-toothed comb.

4) Pay your bill on time. Much like with a credit card or house payment, paying your bill on time will avoid the late fees and surcharges that providers have the right to charge. If your bill is extremely late, providers have access to the same collection agencies that other business do, and a tardy payment could potentially hurt your credit report.

Doctors, dentists, hospitals and their staffs provide a very valuable service and in most cases excellent care. As a consumer, our end of the bargain is to not expect them to finance the work that they are doing for us.