Read these 47 Health Insurance Tips tips to make your life smarter, better, faster and wiser. Each tip is approved by our Editors and created by expert writers so great we call them Gurus. LifeTips is the place to go when you need to know about Health Insurance tips and hundreds of other topics.
Conditions do not manifest themselves in our bodies overnight, it takes time. By going to the doctor and getting an annual physical, your doctor and yourself can reestablish you relationship by discussing any changes that may be occurring in your live that may or may not be contributing to any symptoms you may be experiencing. Your doctor can then look over your family history and evaluate whether it is something serious or not or whether at a certain age you need to start becoming more aware of certain physical conditions that may start effecting you and adjust your diet, exercise, or even levels of stress at that point in your life.
Check your car insurance policy—there is often a medical component. If you are ever in a car accident and need medical help, often times your car insurance will supplement what your regular insurance does not. If you do not have health insurance, the car insurance may cover a portion of your medical fees related to the car accident.
The IRS allows you to deduct medical bills that exceed 7.5% of your gross income. That's a high bar, but the list of eligible expenses is extensive, including insurance premiums, dental X-rays, fertility treatments, prescribed weight-loss and stop-smoking programs and even LASIK eye surgery. See irs.gov/publications/p502 for the details.
According to the Merck Manual of Medical Information, about half of all patients don't follow instructions about taking medicine, which results in 10% of hospital visits a year. These incidents could have been avoided by listening to your doctor and following instructions. If you find that you do not like you doctor, or worse, do not trust your doctor, start searching for a new one immediately. Many medical mistakes can be avoided if there was more effective communication between a doctor and his/her patient.
You could spend thousands a year on cutting-edge medical tests, which usually aren't covered by insurance. Or you could hold on to that cash by sticking mostly with the baseline tests recommended by the U.S. Preventive Services Task Force (PSTF) www.ahrq.gov/clinic/uspstfix.htm, which makes recommendations for patients based on recent research. So if your doc insists you need a whole body CT scan that may not be covered my your insurance and can be very expensive, check the PSTF website as soon as you get home, and don't proceed until you get a second opinion.
It's the best way to prevent periodontal disease and keep your teeth white (cost of treatment: from $200 for minor problems to $2,000 or more to replace a tooth). Dentists recommend at least twice a day, once in the morning and once before you go to bed. Be sure you have the best toothbrush for you (firmness, angle etc) and replace you toothbrush every few weeks.
Home accidents rank among the top reasons for visits to the emergency room. Some easy ways to make your home safer and avoid a trip to the ER: Install handrails along both sides of the stairs, use nightlights, put nonslick strips in tubs, check smoke alarm batteries every month and keep candles at least three feet from anything that can burn. Go to www.homesafetycouncil.org for more tips.
Americans pay hundreds on flu treatments and countless more for colds but routinely neglect the best preventive treatment: soap and water. So get into the habit of scrubbing your hands for about 20 seconds, especially around the nails, before eating or handling food and after contact with any potential contaminants.
Americans spend billions a year on bottled water, sports bars and nutritional supplements. Unfortunately, most of that stuff has very little, proven benefit. So ditch the drink from the tap and be sure to get that fluoride and tote around fresh fruits and vegetables, or just carry eat a simple banana on your way to the gym.
Smoking is not cheap ($4.35 a pack on average or more than $1,500 a year if you smoke a pack a day) and it can be even more expensive you are diagnosed with a lung disease that was cause by your smoking as well as dental bills. Some healthcare plans offer incentives to stop smoking including free cesation programs. By 2008, 25% of companies expect to impose penalties for bad health behavior, such as higher deductibles and premiums for smokers. And you may soon be paying more for health insurance at work too.
More than half of doctor visits stem from stress-related factors. Peoples' bodies react differently to different levels of stress. It is important that once you determine how your body reacts to stress, that you figure ways to reduce your stress level whether it is taking a yoga class (which some insurance companies with reimburse for), listen to music and exercising.
Recent studies have show that the flavonoids in grape juice, like those in wine, prevent the oxidation of the “bad cholesterol” or LDL, which leads to formation of plaque in artery walls in addition to lowering the risk of developing the blood clots that lead to heart attacks. On the other hand, certain wines only prevent blood from clotting at levels high enough to declare someone legally drunk.
An aspirin a day keeps the cardiologist away. If you're a man over 40, a woman past menopause or a smoker or have high blood pressure, high cholesterol, diabetes or a family history of heart disease, you can sharply lower your risk of a heart attack by taking an aspirin every day or every other day (consult your doctor first). The cost of aspirin: about 20¢ a day. The average cost of treating a heart attack: $25,000, including hospital, doctor and drug bills.
Take advantage of the free healthcare screenings that are offered at these events. Be sure to get copies of these results and bring them in to you next doctor's appointment. This may save you in getting a test that you might be due for or you may discover a condition that you were not aware you had.
Having a health plan does not mean you can be reckless with your body or with your policy. As described above, if you have a family history of breast cancer you may want to consult you doctor on considering your first mammograms earlier than the age of 40. By starting this exam earlier, you become more aware of what is normal and what is not, and will tend to report something like a lump in the breast before it potentially becomes more serious, thus costing more money because it was not caught early enough. Some local healthcare facilities even have programs that provide uninsured women with free breast and cervical cancer screens (even treatment, if necessary). For example, the National Breast and Cervical Answer Early Detection Program, allows women with low household income receive free or low-cost mammogram and Pap tests. For more information visit http://apps.nccd.cdc.gov/cancercontacts/nbccedp/contacts.asp
Every doctor who examines you while you are staying in the hospital will charge you. Even the doctor who pops his head in to ask how you are doing and orders some meds will charge for the visit. This is why it is important to maintain a good relationship with your primary care physician. If he or she agrees that no other physician needs to see you, be sure you are not charged. Your primary care doctor should let you know when a specialist or another physician is needed.
The single best way to save thousands on your health-care bills--and, help you live longer too, but be sure you do not overdo it. The U.S. preventative Services Task Force has recommended: Periodic blood pressure checkups for all adults, total blood cholesterol measurement for men between 35 and 65 and women 45 and 65, screening for colorectal cancer for those over 50, mammogram for women between 50 and 69, Pap smears every three years for sexually active women, vision tests for those children entering school and for the elderly, and tests for elderly people to access hearing loss. A more complete list can be downloaded at the American Academy of American Physicians website at www.aafp.org/online/en/home/membership/resources/aafp-pda-downloads/clinprev.html or more general preventative and management guidelines can be found at the National Guideline Clearinghouse at http://www.guideline.gov/resources/pda.aspx Check with your doctor to determine how often you should be screening for certain disease and which ones. Depending on your family history of diseases, you may find yourself altering some of the ages or even screenings.
The following are some other preventative measure that will help you save on your healthcare bills.
It is perfectly fine to be “inquisitive” while you are in the medical facility and it is your right to get an explanation if you do not understand why something is being done. For example, due to the shortage of nurses, many hospitals will place Foley catheters in their elderly patients for the convenience of the staff (i.e. nurses do not have to attend to the patient as much because now, if a patient needs to go to the bathroom, they use the tube instead of calling the nurse for assistance). As a patient, you are charged for the Foley catheter as well as the catheterization (both technical fees). If you are not satisfied with the explanation given by the nurse, be sure to ask a doctor BEFORE it becomes a procedure and equipment charge on your bill.
At the top of your itemized bill there should be a code that defines what you can to the hospital for. If this code is incorrect, your insurance company may reject reimbursing for your treatment because it may not have been the “protocol” for that particular treatment. For example, if you are admitted for chest pain, and while being tested it is discovered that you have iron deficiency anemia and require colonoscopy/upper endoscopy, make sure the anemia diagnosis is clearly outlined as urgent and the in-hospital evaluation as necessary. If it is not, your insurance company may decide not to pay for the in-patient work up, and you may be stuck with the bill. Most insurance companies have a protocol of treatments they expect the doctor to follow in order to get reimbursed. If your doctor prescribes a different treatment or set of tests than the insurance carrier is used to seeing, it is possible you will not get reimbursed. This is why it is best to catch any problems before they become an issue by reviewing your record as soon as it becomes available. If a problem with your insurance happens, your doctor should have an explanation and be able to write a letter on your behalf stating the reasons the treatment was necessary, based on your diagnosis.
Instead of charging one overall fee for an operation, which is sometimes known as bundling, some doctors inflate their bills by charging for the individual steps, or they may be unfamiliar with what items are bundled in certain codes and bill them independently. This may include anything from the initial incision to the final suturing. Or they may charge separately for the preliminary examination, the procedure itself, and the follow-up care. In rare instances, doctors may perform and charge for inappropriate procedures. To avoid problems, have your surgeon list ahead of time the procedures that will be performed, and try to get a quote for a single fee that covers all services from the billing department. Even then, check for possible unbundling if your bill contains more than one or two charges.
This could be a $90 charge for a 70-cent I.V or $129 for a “mucous recovery system” (otherwise known as a box of Kleenex). On the other hand, don't forget to look at erroneous charges such as “surgical supplies.” Be sure you understand what was included. For example, did this include the stapler and suture clip that you were billed separately on your bill? Keep in mind that items in a surgical kit are sterile, so only a few items in the kit may have been used (which is legitimate), but were tossed after the kit was open because it was not considered sterile anymore
Hospitals often shift the charge for a lower-cost service or medication to one that's more costly. For example, a doctor may order a generic drug, but you are charged for a pricier brand name. Or your diagnostic code may reflect a more serious condition requiring more costly procedures. You can double-check the doctor's orders against the diagnosis to make sure it is consistent with the procedures listed on your bill. These codes can be found on the web at www.cdc.gov/nchs/icd9.htm.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
The American Recovery and Reinvestment Act of 2009 (Stimulus Package) created changes to HIPAA Privacy and Security rules. Congress passed the act on February 17, 2009. The legislation created new tools for the aggressive enforcement of the HIPAA Privacy and Security rules. A violation of the HIPPA Privacy and Security rules could result in additional enforcement (in the form of penalties) against those who do not adhere to the law. You must be aware of how a professional administrator, doctor, employee or any other professional may violate your rights by speaking or displaying your protected health information (PHI) that others may hear or see.
This is your Protected Health Information (PHI)
Electronic mail addresses (email)
social security numbers
Medical record numbers, including a prescription number
Health plan beneficiary numbers (Member IDs)
Examples of wrongful disclosure of PHI include:
Placing PHI in the subject line of an e-mail
Failing to encrypt an e-mail containing PHI that is sent outside of the professional’s office
Asking you to leave PHI information in a common area
Asking you to yell out your PHI information in a physician’s waiting room
Keep an ear open in your doctor’s office, at a lab, hospital or radiology center. Mention the violation to those individuals that do violate your rights and if you want to take it a step further, report them to the authorities and fines may be enacted against them. http://www.hhs.gov/ocr/privacy/hipaa/understanding/index.html
|Jennifer Mathes, Ph.D.|