Editor’s Note: When we debate health care policy, we seem to jump right to the issue of who should pay the bills. This week’s TIME cover story asks another question: Why exactly are the bills so high in the first place? Bitter pill: Why medical bills are killing us
$3,200 was the average out-of-pocket health care cost for a family of four in 2011
Expert: People frequently overpay for services because they don't do research
The best way to lower health care costs can be summed up in two words: Just ask
The health care debate is full of numbers: 48.6 million uninsured Americans; $2.6 trillion spent on health care annually; family premiums that have increased 97% over the past decade.
But those numbers are abstract and hold little meaning for Americans struggling to pay their medical bills.
Perhaps a more accurate number is $3,200: the average out-of-pocket health care cost for a family of four in 2011. Or $815 – the typical cost of an abdominal MRI in Chicago. Or $24,431 – the hospital fee for having a pacemaker inserted in San Diego.
Those are the numbers that can leave you feeling helpless.
When you’re ill, the last thing you should do is turn down care. Instead, learn to take charge of your health care costs to prevent your medical bill from making you even sicker.
“(People) frequently overpay for services just because they don’t know that there’s price variation – that you can get the exact same care at a different facility across the street for a fraction of the cost,” says Dr. Jeffrey Rice, founder of HealthCareBlueBook.com, a free price comparison website for patients.
Bitter pill: Why medical bills are killing us
Rice often tells the story of his son, who needed outpatient foot surgery. Rice was initially quoted $37,000 for the procedure. His total after insurance and discounts would be around $20,000, the doctor told him. So Rice asked if there was another facility where they could get the procedure.
His new total? $1,500 for a happy and healthy son.
“If there was a gas station that said $20 a gallon, you would not go there, correct?” Rice asks. “But in health care, that’s how bad it is. There are people who pay five times too much for their health care every day.”
The best way to lower your health care costs can be summed up in two words: Just ask.
Tell your doctor up front that you’re concerned about price, Rice says, and ask them to help you save money. Ask how much the procedure is going to cost. Ask if the test they’ve ordered is necessary or if you can wait a week to see if the condition heals on its own. Ask if there’s a cheaper alternative or generic version of the medication they’ve prescribed.
“Those are fair questions to ask your doctor,” Rice says. “Many times, the doctors know ways to give you perfectly good care without running up large health care bills.”
iReport: Tell us your health care story
Another important question to ask is whether the doctor or facility is in your insurance network, says Karen Pollitz, an expert in private insurance with the nonprofit Kaiser Family Foundation.
Going outside of your insurance company’s preferred network of caregivers can double your out-of-pocket costs. Most companies have a website or number where patients can call to check, but you should also call the doctor or hospital to confirm, Pollitz says.
Patients should also feel free to ask about payment plans for larger bills. Medical providers usually offer lower interest rates than a credit card company. And nonprofit hospitals are mandated by law to have financial relief programs for the uninsured and underinsured. Many hospitals and doctors’ offices will also waive a portion of the bill if you pay in cash.
“Always ask,” Pollitz stresses. “The worst it can be is a waste of time.”
Befriend your local pharmacist
Thanks to the Affordable Care Act, pharmacists are now encouraged to slow down and talk to clients, says Ernest Boyd, executive director of the Ohio Pharmacists Association.
Called “medication therapy management,” this section of Medicare Part D helps pharmacists focus on the patients they serve instead of just filling bottles at a rapid rate. Take advantage by chatting up your pharmacist on a regular basis.
Think about it, Boyd says: “What other health professional do you have available to walk up to and talk to for free who has a six-year doctorate degree?”
Patients often have multiple doctors and specialists they’re seeing, with medications from each. This can lead to complications, duplications and drugs that are added solely to treat the side effects of other drugs, Boyd says.
A pharmacist can look at the larger picture if you arrange a “brown bag review,” he says. Bring all the drugs you’re taking (prescription, over-the-counter and natural remedies) in to the pharmacy and have a pharmacist go over them one by one.
For example, one elderly patient was taking 14 drugs prescribed by multiple doctors for various ailments. Boyd cut that down to eight, saving her more than $1,200 in co-payments without altering her treatment.
At the very least, your pharmacist should be able to recommend a generic or alternative medication for the one you’re taking at a much cheaper price.
“The physician knows the diagnosis; the pharmacist knows the drugs,” Boyd says simply.
Do your research
Most people would rather do their taxes than read their health care insurance plan, Pollitz says. “It’s just icky. I think that’s the technical term.”
But understanding your plan – such as knowing your deductible or any co-pays for which you’re responsible – will help you prepare for upcoming expenses.
Some larger companies offer benefits counselors who can help guide you through the fine print, Pollitz says. If one is not available, HealthCare.gov offers definitions of basic terms, compares your options (HSA or FSA? PPO or HMO?) and explains the rights/protections given to you under the Affordable Care Act.
There are also several websites that can help you lower your health care costs by letting you know what you should be paying.
Searching for Medicaid or Medicare options, or the right individual health insurance plan? HealthPocket.com rates insurance companies based on government, nonprofit and commercial data sources to show you all your options.
Rice’s Healthcare Blue Book basically offers blue book prices for medical procedures – like the “Kelly Blue Book” value for a car that you go into the dealership with to negotiate.
Type your ZIP code into HealthcareBlueBook.com and select the medical procedure or test you need. The site will then return the “fair” price for that test in your area.
GoodRx.com offers a similar service for prescription medications. Consumer Reports picked it as the best app for finding the lowest drug prices in store and online. The site also shows generic alternatives (if there are any) and posts coupons to help you save.
If in the end, your bill still ends up being more than you expected to pay, don’t be afraid to fight back, Pollitz says.
“People are inclined to take ‘No’ for an answer,” she says. “You can always complain. You can always appeal.”
Through the ACA, states are starting Consumer Assistance Programs that are designed to empower patients. One of the jobs they’re required to do is help you file an insurance claim, Pollitz says.
If the insurance company denies the appeal (which they usually do, Pollitz says), you have the right to take it to an outside reviewer. Those who do, Pollitz says, win about half the time.
Visit HealthCare.gov or your state’s labor department for more.