When San Priy's primary care doctor prescribed a new allergy medicine that would have cost about $350 per month through his insurance, Priy – a veterinary services specialist in Las Vegas – asked if there was a lower-cost option.
"He suggested a generic that worked similarly but cost a fraction of the price," he says. The doctor also recommended using a discount pharmacy program instead of Priy's insurance. The result: His monthly tab dropped to around $30, for a drug that worked well to control his allergies.
"That conversation made me realize how important it is to ask questions about cost," Priy says. Now, before filling prescriptions, he always asks whether less expensive alternatives are available.
With today's rising health care costs and high-deductible insurance policies, many of us may have trouble affording drugs, treatments, or other procedures our doctors recommend. As Priy discovered, your doctor may be able to help you spend less, without sacrificing quality of care.
Some doctors may bring up cost concerns with you first, since affordability is such a common and critical problem.
Patients whose drugs are too expensive may split pills, skip doses, or never fill prescriptions at all, which can lead to "complications, hospitalizations, and higher health care costs down the line," says Sarah C. Nosal, MD, president of the American Academy of Family Physicians, who practices in New York.
"Addressing cost concerns helps patients stay on treatment and improves overall health outcomes."
Nosal doesn't wait for patients to bring up financial worries but tries to make sure every patient gets asked – either by her or support staff, such as nurses and medical assistants – whether cost is a problem. This practice is becoming more common among family doctors, she says. "By asking routinely, we make it clear that cost is a normal and important part of the care conversation," she says.
Not all providers ask such questions, though, leaving it up to you to bring up your concerns.
Overcoming Barriers to Communication
If you cringe at the idea of raising money issues with your doctor, that's common, says Caitlin Donovan, director of the Patient Advocate Foundation, a nonprofit that provides case management and financial assistance to patients struggling with medical bills.
Patients report feeling stigmatized by not having enough money to pay for their care or are worried doctors will give them lesser-quality care if they lack funds, Donovan says – even though patients aren't treated differently.
Another factor keeping patients from communicating, she says, is seeing your doctor as an authority figure. "There's this undercurrent of wanting to please your provider and be a so-called good patient," Donovan says. "Within that framework, you're thinking, 'I'm going to go along with what the doctor's telling me. I'm not going to push back, I'm not going to cause trouble, so I smile and say yes.' This leads to not voicing concerns or being fully honest with your provider."
You may go into your appointment intending to discuss problems with affording your care. But, Donovan says, "oftentimes you get on the paper gown and you're sitting in the office and a lot of the bravado leaves your body."
She encourages you to write down your questions and concerns ahead of your appointment, and to bring in a family member or friend who can be assertive. If you feel too shy or uncomfortable bringing up cost concerns, let them do this for you, Donovan suggests.
Types of Services Your Care Team Can Help You Afford
Costly prescriptions are a top issue, especially if you have chronic conditions and need multiple drugs. But they aren't the only price point that can give you pause – and which your care providers may be able to help you afford.
Transportation to appointments
"Your provider may recommend you go to radiation therapy but the facility isn't close, you don't use a car, or you can't afford gas or you can't afford time off," Donovan says. "You need to say, 'Can you recommend a closer facility?'"
Getting the best price for medical devices
Sometimes your provider may give you crutches or another medical device at an appointment. This isn't free, and you may be able to find a much cheaper one online, Donovan says. It's OK to question device costs.
Finding less-costly imaging centers
If you need a CT or ultrasound, your doctor may refer you to a hospital-owned facility or outpatient department – but these often are more expensive than freestanding, independent imaging centers, Donovan says.
She experienced this herself with maternal ultrasounds. She saved hundreds of dollars by having her referral switched to a freestanding facility that charged her only $5 out of pocket.
Questioning lab costs before work is done
Leah Ingram, a Maine-based author who blogs about frugal living, put her expertise to work when her doctor prescribed a blood test to check her hormone levels. Before getting the test done, she called her insurance company with the test's billing code. They told her it would not be covered, which would leave her with a $600 bill.
Ingram's doctor then worked with her to find a less costly alternative. Her doctor offered to use a private lab for a fee of $48, without billing insurance – an option Ingram gladly chose.
Scheduling procedures with your deductible status in mind
When feasible, your provider can set up tests or treatments when your deductible has been met.
Using strategies to cut prescription costs
Choosing generics, less expensive drugs that provide similar benefits, or drugs that are discounted by non-insurance programs like GoodRx can all help. Your doctor also may prescribe 90-day supplies, which reduce copays and trips to the pharmacy, or provide free drugmaker samples. Some drugmakers also may have medication assistance programs you can join.
Getting referrals to financial specialists
Case managers, social workers, billing managers, or other patient advocates can address financial issues, including finding assistance programs or setting up payment plans.
If you're not sure how to begin talking with your doctor about money matters, Nosal suggests starting the conversation by asking questions such as:
"I'm worried about the cost of this medication. Are there lower-cost options?"
"Is there a generic or different treatment that might be more affordable?"
"Don't feel embarrassed about bringing up cost," Priy says. "If a medication or test is too expensive, it's much better to speak up than to quietly skip it. … I believe health care decisions work best when patients feel comfortable discussing both their medical needs and their financial realities."
Show Sources
Photo Credit: E+/Getty Images
SOURCES:
Consumer Reports: "How to Talk to Your Doctor About Medical Costs."
Caitlin Donovan, senior director, Patient Advocate Foundation, Washington, D.C.
Sarah C. Nosal, MD, president, American Academy of Family Physicians, who has a practice in New York City.
Leah Ingram, blogger and author, Kennebunk, Maine.
San Priy, veterinary services professional, Las Vegas.
