Make Smarter Mental- Health Decisions

Most health plans limit mental-health therapist coverage to 30 visits a year. If you're seeing a therapist every week, this can be very costly. If you go to a certified counselor or clinical social worker instead, you might be able to cut your bill in half (the average fee: $90 an hour) instead of a psychologist (around $120). Most studies find no difference in effectiveness.

See A Specialist

Sometimes an out-of-network specialist can save you more than the “in-network primary care doctor.” Generally, a specialist is far more experienced in performing certain procedures in their specialty thus that is why they are called specialists. They know what tests to order and what tests are a “waste of time and money.” If you have a condition, such as Crohn’s disease, and know a Gastroenterologist who specializes in Crohn’s disease, it's worth calling your insurer's pre-certification department to explain why using the out-of-network provider is essential and ask for coverage at in-network rates. In most cases, insurers would rather strike a deal up front than go through an expensive appeals process. Just be sure to get everything in writing as soon as the deal is made. The Kaiser Family Foundation at www.kff.org has a consumer guide explaining your rights to appeal disputes with health plans.

Follow The Rules Carefully

Don’t forget to read the fine print on your plan to find out your insurer's requirements for referrals and pre-certification. You are more than likely to need them for expensive procedures like MRIs and CT Scans which can cost you more than a thousand dollars if your insurer refuses to pick up the bill.

What Are The Extras?

Are you paying for acupuncture or chiropractic care and not using it? Do you really need the extras or can you substitute them for other forms of alternative medicine that you may use in the future? Check your insurer's website or call the help line to see if your plan covers alternative medicine treatments. Many also offer discounts on preventive measures like vitamins, bike helmets, and gym memberships. Others offer “healthy discounts” if you quit smoking, go for annual physicals, etc.

Health Insurance For People With Disabilities

If you think you are eligible for healthcare resources based on a disability, be sure you get an official determination from the social security administration. You can find the closest Social Security Office near you by going to www.ssa.gov or you can complete an application online at www.ssa.gov/applyforbenefits. The process of determining disability may be difficult and lengthy; however, the National Organization of Social Security Claimants’ Representatives (NOSSCR), which is an association of attorneys who are experts on the disability determination process, can help you out with this process and maybe even for free at www.nosscr.org. If you can prove that there is a likelihood that you will be determined to be disabled, such as a terminal illness, make sure to ask to for a presumptive disability application. This will speed up the process and the Social Security Administration can provide Social Security Insurance benefits for up to six months. If you are denied at first and appeal your case, you might eventually win, but it may take a few years and multiple levels of appeals.
In order to expedite the process be sure to document the following (clear documentation is a must):
• Disability onset date – give the earliest date that you became unable to work because of your medical condition.
• Obtain copies of you medial record from your physicians
• Keep a healthcare journal – record all medications you take, you medical symptoms, when you visit the doctor and the outcome of each visit to the doctor. Document dates of every time you feel sick, encounter other health problems, or feel depressed and how long each of these lasts.
• A complete Social Security Administration application
There are different types of disability plans, so be sure you do your research and find out exactly what is available in your state. The National Disability Rights Network at www.ndrn.org may be able to provide you with some of this information as well as inform you about the protection and advocacy programs in your state. This is a federally funded network that seeks to ensure that federal, state, and local laws are fully implemented to protect people with disabilities. Many of these programs also assist people with disabilities in accessing Medicaid.

Go To The Emergency Room (ER) For Emergencies Only

The ER is one of the most expensive places to get treatment due to the fact that you will be paying for the staff of specially trained physicians, nurses and other staff to handle health emergencies 24-hours a day, seven days a week, as well as the equipment and other emergency extras. Best to avoid the ER unless you have one of the following conditions:
• Severe bleeding
• Difficulty breathing
• Chest pain or pressure
• Broken bones
• Partial or total amputation of a limb
• Trauma or injury to the head
• Sudden dizziness or difficulty seeing
• Severe abdominal pain
If you have insurance, be sure to find out the guidelines on ER visits including what and who your plan will cover during your ER visit, and what your plan may not cover ahead of time. Your plan may also have guidelines similar to the conditions above that are/are not considered emergencies.

Buy Your Own Equipment

Hospitals charge a significant markup on equipment like crutches or braces, so you're almost always better off buying them on your own.

Before You Check In, Shop Around

Ask your doctor where he/she has privileges and shop around to those facilities and comparison shop. You may be surprised to find that facilities have varying rates. If you find that one facility is cheaper than another for the type of procedure you are having performed, recommend that facility to your doctor. Some doctors may also be familiar with the facilities rates, so be sure to let them know what you are doing, and they may be able to save you some legwork. Again, always double check with you insurance to be sure they cover that facility.

Can The Procedure Be Performed At An Outpatient Facility

Many times, routine procedures such as colonoscopies, can be performed at the physician’s office or outpatient facility. Be sure you inquire with your doctor because you may be able to save up to 50% on you medical bill.

Schedule The Procedure As Early As Possible

By scheduling your procedure early in the morning, you may be able to avoid back-ups in the operating room (OR) that will cause you to stay at the hospital overnight or even the next day. Also, try to schedule your procedures early in the week, so if there is a back up in the OR, you are not forced to stay over the weekend where staff is limited causing a delay in your discharge.

Have Your Lab Lab Work Done At A Separate Facility

Ask your doctor if you can have your lab work or other screenings such as an MRI, CT scan or X-Ray at a separate facility that may cost a fraction of the amount that it would cost at the hospital. Be sure you schedule these test/screenings well in advance of you procedure to avoid any delays.

Avoid Unnecessary Tests

Be sure you understand what tests your doctor recommends and why. Ask if every test is absolutely necessary. If your doctor is unable to give you a logical explanation, you may have to get a second opinion or seek another doctor.

Is An Appointment Necessary

Before you go in for something minor, call and speak to the doctor or nurse over the phone. Talk over your symptoms and see if you really need the visit. If you have a solid relationship with your doctor, and he is familiar with your health history, he may be able to call a prescription in for you over the phone rather than you coming in and paying for a visit. If you need to renew a prescription, best to ask the nurse if she can ask the doctor to call it in for you.
Medical bills
Discrepancies occur rather often and can be challenged only if you have documented exactly what really happened. This process can be painstaking and difficult to do but it can save you thousands of dollars. For some arrhythmia reason, hospitals typically take up to a year to send a final, itemized bill. By this time, you will have forgotten details of your hospital stay and may not recall what specifically should or should not appear on the bill. If this done on purpose, it is termed delayed price escalation, and is dependent on your poor memory.

Never Pay A Bill Before Leaving The Hospital

In order to review a bill carefully, you will have to take it home. So don’t pay in full when you are discharged, even if you have a small balance due.

Read Your Bill Carefully

Compare your bill to the log/journal you made along with the EOB and estimated costs you requested before you were admitted. Look for any discrepancies and bring them up the appropriate billing departments.

Duplication Of tests

Be sure to ask the doctor the kind and frequency of blood tests, x-rays, and medical procedures you have to undergo. Also, be sure to keep track if you did your “routine tests” earlier that week and were charge again during that hospital stay, or you were able to arrange to have these tests done cheaper at another facility and were accidentally charged on the day of your procedure. Unfortunately, records may get replaced or lost, especially if they are coming from an outside source, so be sure you are not charged for the replacements and try to avoid this by keeping copies with you or a loved one.

Number Of Days In Hospital

Check the dates of your admission and discharge. Were you charged for the discharge day? Most hospitals will charge for admission day, but not for the day of discharge.

Operating-Room Time

It's not uncommon for hospitals to bill for more time than you actually used. Compare the charge with your anesthesiologist's records. Often times the anesthesiologist, radiologists and other medical professionals you see while you are in the hospital will bill you separately. This is called the “professional bill.” For example, your anesthesia record will state the times when your surgery began and ended. Operating-room use is billed either hourly or by the half- or quarter-hour. Rates may vary from $500 to more than $2,000 per half-hour. If you compare these bills, you may find that you were billed for five hours for a procedure that actually took only four.