By Frank Lalli, AARP
Break through the bureaucratic maze and become an empowered consumer with these tips.
At the doctor’s office
Go prepared to your physical
- Call ahead and describe the services you want or nagging symptoms you have.
- Then write down your questions for your doctor.
- Be on guard against doctors pushing extra services or tests.
Don’t let your time be wasted
- The next time the doctor is running late, say that you can only wait until a specific time.
- Faced with a deadline, chances are the staff will fit you in.
Ask for a discount
- You are not obligated to use your insurance plan; you are free to pay less in cash.
- Tell the doctor face-to-face about your financial situation and perhaps show him a pay stub.
- Many have standing discount policies to cut their fees roughly in half — or to as little as 10 percent.
- Or they may simply charge their lower Medicare or Medicaid rates.
Get the right specialist
- Call your insurer for the names of board-certified specialists in your plan’s network, then talk it over with your primary doctor.
- Check a doctor’s credentials online through the American Board of Medical Specialties at certificationmatters.org.
At the pharmacy
Find the best fit for you
- If you are in a Medicare Part D plan, make sure you fill your prescriptions at a preferred pharmacy.
- Preferred pharmacies can save you up to 20 percent on drug costs compared with other drugstores in your network. Call your health plan for preferred stores near you.
- If insured at work, stick to your plan’s network pharmacies for the best rates.
Use deep discounts wisely
- Big-box stores and supermarkets lure customers with deep-discount prices of $4 or so for popular generics. But be careful.
- Some chains cover fewer than 100 specific generics.
- If your doctor writes a script for a different dosage or form, like a gel rather than a pill, you can get whacked.
- Ask for copies of your chains’ deep-discount lists of generics to show to your doctor before she writes a prescription.
Befriend your pharmacist
- Make a formal appointment to discuss your drugs and exact dosages.
- She may save you money by suggesting generic options or different dosages or by pointing you to coupons and assistance programs.
Hunt for generics
- The FDA will approve around 500 new generics next year.
- Each will have the same active ingredient, quality, safety and strength as its branded original.
- So keep asking your doctor or pharmacist if they’re hearing that a brand-name drug you are taking may soon get a generic option.
Ferret out freebies
- With more drug plans introducing or increasing deductibles, don’t overlook medicines that you can pick up for free.
Go to the manufacturer
- If you need an expensive specialty drug and your insurance company refuses to pay, don’t waste time fighting with the carrier.
- Instead, call the drugmaker.
- Virtually all drug companies selling wonder drugs that cost $1,000 to $20,000 a month have customer-assistance teams ready to supply their drugs to stricken families with household incomes up to $100,000.
At the Hospital
Negotiate your stay
- If you expect a hospital visit in 2017 for elective surgery or treatment for a chronic condition, negotiate your bill now.
- Sit down with the hospital’s ombudsman.
- Arrive with pay stubs and tax returns and work out a plan you can afford. Shop among competing hospitals.
Scrutinize your bills
- First, ask for a detailed bill; some hospitals send only summaries.
- Then look for obvious mistakes.
- You should get any honest mistakes dropped with one call to billing.
- If the situation drags on, you could hire a health care advocate—a fast-growing cottage industry.
- To find an advocate near you, check the Alliance of Claims Assistance Professionals at claims.org.
Dealing With Medicare/Insurance
Shop around every year
- When the open-enrollment period rolls around next Oct. 15, shop for a better Medicare plan. Just go to Medicare.gov/find-a-plan.
Get the best value
- Never shop for a health plan based on the premium alone.
- Instead, get the plan’s actuarial value (AV) from your company’s HR department or the carrier.
- That’s the percent of your estimated total medical costs that the carrier’s expert expects the company to cover; you pay the rest.