When you live with a chronic condition, you know how quickly medical expenses can add up. Between doctor visits, medications, tests, and specialist care, health care costs can overwhelm your budget. In a recent WebMD Reddit AMA, Erin Bradshaw, vice president of patient services at the Patient Advocate Foundation (PAF), answered user questions about how to lower these costs.
In her role at PAF, Bradshaw helps people navigate the financial issues that come with living with a chronic condition every day. She says one of the biggest challenges is that many people don't start thinking about costs until they are already facing a large bill or a denied claim.
"Most people reach out to us when there is an immediate urgent reaction," Bradshaw says. She says that might be a bill they can't afford, a medication that costs more than expected, or a treatment their insurance won't cover.
If you have a long-term condition such as diabetes, heart disease, arthritis, or multiple sclerosis, planning ahead can make a big difference in your financial stress. Here are some steps you can take to achieve that goal.
Understand Your Health Plan
One of the most important ways to save money is to understand your insurance coverage before you need expensive care — and that includes thinking critically about which health care plan you choose in the first place.
Many people pick a health plan based mainly on the monthly premium, but it's important to look at the bigger picture, including deductibles, copays, out-of-pocket maximums, and provider networks, says Bradshaw. This is one aspect of health care navigation that PAF helps people address.
“We take a holistic approach in helping people understand their plan design entirely and educate them in a layperson’s perspective,” says Bradshaw. “Some people have choices and some don't. But if you can choose, we want you to really understand what benefits you’re selecting.”
She encourages treating your health care plan selection like you would any major purchase.
“Write down your treatments, your medications, who you want to see, your specialist, and other important details,” says Bradshaw. If you want expanded access, then you want to compare options like an HMO versus a PPO or an Advantage plan versus traditional Medicare.
For example, if you regularly see specialists or need treatment in different states, you may want a plan with a broader provider network, says Bradshaw. A plan with a lower premium could end up costing more overall if it doesn't cover the doctors or medications you need.
“Get a baseline and make sure your care goals are aligned with the plan you're picking,” says Bradshaw.
Stay In-Network If Possible
When your doctor recommends a specialist, imaging center, or treatment facility, don't assume every option costs the same. Become an active participant in choosing your specialist or testing facility rather than automatically accepting the first option offered. Ask whether the recommended option is in your insurance network and whether there are lower-cost alternatives.
“Ask questions and have them run price comparisons because the hospital could be much more expensive than maybe the local facility that offers the same thing,” she says.
For example, an MRI performed in a hospital may cost significantly more than the same scan at a standalone imaging center. Finding out before you schedule can help you avoid unnecessary costs.
Don't Ignore Bills or Insurance Letters
It’s common to feel overwhelmed by a new diagnosis and focus on treatment while letting bills sit unopened with the thought that you’ll deal with them later. But facing your fees early is crucial. Many financial assistance programs, appeals, and charity care options have deadlines. If you wait too long, you could lose access to help that might have reduced your costs.
Open every bill and insurance letter as soon as it arrives. Review it carefully and ask questions if something doesn't make sense.
“There might be solutions you can access, but if you get too far down the path, you lose those options,” says Bradshaw.
Match Bills to Your Explanation of Benefits
One of the most valuable tools you receive from your insurance company is the Explanation of Benefits (EOB). An EOB is not a bill. It explains what services were billed, what your insurance paid, and what portion you may owe.
Bradshaw recommends staying organized and comparing every medical bill with the corresponding EOB. This can help you spot billing errors, duplicate charges, or services that may not have been processed correctly.
Keep your records in a notebook, spreadsheet, or folder so you can track expenses more easily and resolve problems if questions come up later.
“I'm a strong believer in organization and keeping records, whether it's you doing it or a loved one who is your advocate,” says Bradshaw. “Keep it simple — just a simple notebook of what your EOB was, what your questions are, who you spoke to, and then what the outcome was.”
Take Advantage of Financial Assistance Programs
You may think you earn too much money to qualify for financial help, but Bradshaw says that's often not true. There are several types of assistance programs that may help lower health care costs:
- Manufacturer copay cards for eligible people with commercial insurance
- Charitable copay assistance programs
- State assistance programs
- Medicaid programs
- Medicare Savings Programs
- The Extra Help program for Medicare prescription drug costs
- Hospital charity care programs
These resources can help cover costs such as deductibles, copays, coinsurance, medications, and even insurance premiums in some situations. The key is to get on their radar in time for support to be helpful.
“Ask early, apply early, stay organized, and don't assume that you're not eligible for something,” says Bradshaw.
Compare Prescription Prices
Prescription costs can vary widely from one pharmacy to another. Even if you have insurance, it may be worth comparing prices before filling a prescription. Tools such as prescription discount programs can help you see pricing differences among local pharmacies.
In some cases, the cash price at one pharmacy may be lower than what you'd pay through your insurance at another location.
You can also ask your health care provider whether a lower-cost generic medication is available or whether there are therapeutic alternatives that may cost less.
Time Your Care Strategically
You may be able to save money by planning certain services around your coverage year. For example, if you've already met your deductible and the out-of-pocket costs are lower later in the year, it may make sense to schedule certain visits before your benefits reset.
Bradshaw also suggests considering whether it's possible to get a 90-day prescription refill before the end of the plan year, depending on your insurance coverage and medication needs.
“It gives you a little bit of cushion to calculate these things out,” she says.
While not every service can be scheduled in advance, being aware of your deductible and benefit timeline can help you make informed decisions.
Appeal Insurance Denials
If your insurance company denies coverage for a medication, treatment, or procedure, don't assume the decision is final. Many denials are overturned after additional documentation or review. Your health care provider's office may also be able to help with the appeal process.
Pay close attention to deadlines, since appeals usually must be filed within a specific timeframe.
“Always appeal a denial,” says Bradshaw.
Negotiate When You Can
If you receive a bill you can't afford, contact your clinic’s billing office before you have to skip payments. Ask whether discounts, payment plans, or financial assistance programs are available.
Some offices may offer discounts for paying a portion of the bill upfront. Others may allow you to spread payments over time with little or no interest. The key is to start the conversation early.
If a doctor’s office asks for a large payment before treatment, don't automatically cancel your appointment. Explain your situation and ask what options are available.
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SOURCE:
Erin Bradshaw, executive vice president, advancement of patient services and navigation in program development, Patient Advocate Foundation, Hampton, Virginia.
