Surviving Your High-Deductible Health Plan
Patients used to ask very few questions about their doctors' orders. Now New York internist Marina Gafanovich finds many patients inquiring frequently about alternative treatments or whether the test or procedure she recommends is absolutely necessary.
Dr. Gafanovich believes more patients are asking "not because they want to know what's best for their health but out of necessity for their wallets." These days, she says, more patients have high-deductible health plans (HDHPs), which means they could be responsible for the first $6,350 in health care expenses for themselves or as much as $12,700 for their families.
An HDHP is a type of individual health plan that requires you to pay a large amount toward your own medical costs before the insurance kicks in. Patients have become very price-conscious as a result.
If your high-deductible health plan has given you health care sticker shock, you might be able to save money by shopping around and quizzing your doctor.
Alternatives to consider
Here are some less costly alternatives that might work for you.
Ask about at-home tests. There are a number of devices that may allow you to assist in your own diagnosis, depending on your condition.
For example, sleep apnea is a serious sleep disorder where your breathing stops and starts intermittently, so you wake up tired. If your doctor suspects you suffer from sleep apnea, he may order a sleep test where you are observed overnight in a specialized clinic. Watermark Medical has a sensor-equipped headband approved for use by the Food and Drug Administration that allows you to test yourself at a fraction of the cost. You get it from your doctor, wear it for a night or two, and return it to him to read the results.
Here's another: The FDA also approved a smartphone app, AliveCor, that can help identify irregular heart rhythms that can lead to stroke if not treated. If your doctor suspects you have an irregular heartbeat, he's likely to order an electrocardiogram or ECG. AliveCor is similar to an ECG at a fraction of the cost. You sign up for an account and attach the AliveCor Heart Monitor to your mobile device. The app converts electrical impulses from your fingertips into ultrasound signals that are transmitted to your device's microphone and that your doctor can see and interpret.
Comparison shop. Prices for office visits, medical procedures and prescription drugs can vary greatly. Remember that sleep apnea test mentioned above? The website Clear Health Costs found that a polysomnography test to diagnose apnea can range from $600 to over $6,000. Calling around to different providers can pay off.
Some health insurance companies have pricing tools for health services on their websites. The sites allow you to compare the cost of many common medical services and procedures of providers (in-network and out) in your area. Several states, such as Maine, have websites that allow you to see costs at different facilities in your area.
You also can research charges for doctor visits on a number of different free sites such as Healthcare Bluebook. They'll tell you a fair price for services in your area and that price is often the amount doctors will accept from insurance companies. You can use the information not only to find the least expensive provider but also to negotiate with the more expensive group if you'd rather go there.
Bid what you need. There are a number of online services that allow doctors and facilities to bid for your business. One, MediBid, encourages you to research the doctors' credentials just like you would when choosing a new provider. The idea behind these websites is that the competition will result in lower prices. Note: There is a small fee for signing up to solicit bids.
Make use of a Health Savings Account. If you have a high-deductible plan, don't miss the chance to sock money away, pre-tax, in a Health Savings Account (HSA). You then pay for medical expenses from the account. The federal Office of Personnel Management has good details about HDHPs and HSAs.
Do your own research
Research your symptoms. Dr. Barbara Bergin, an orthopedic surgeon in Austin, Texas, and blogger says, "There are a ton of websites and blogs where you can learn about many benign causes of pain or illness, and what to do about them."
Many doctors are trying to help patients with high-deductible plans by educating them and giving them a few tips for self-treatment, she says. "Obviously that doesn't always work and sometimes you just have to see your doctor or go to the emergency room. But for the vast majority of conditions, there is a lot of information out there on the Internet," she says. "Use it!" Just check where the information comes from and make sure it is a credible source, she cautions.
Use urgent care rather than the ER. If you're experiencing a health problem and it is not life-threatening, you will save a good deal of money by going to your local urgent care facility rather than a hospital emergency room. Many urgent care clinics located in the neighborhood pharmacy or supermarket are staffed by physician assistants or nurse practitioners and their fees are lower than the hospital's ER, says Kevin Coleman, head of research and data for HealthPocket, a health insurance cost-comparison website. "If you're dealing with the flu or an eye infection, they are something you should consider," he says.
Proceed with caution
There are a couple things to remember when you're looking to save money on your health care costs when you have a high-deductible plan.
If you're successful in paying less for medical care, it will take you longer to reach your deductible and for your health insurance to kick in. If you are not going to spend anywhere near $6,350 (barring any emergencies) or $12,700 for your family, it is better to pay less than worry about reaching your deductible. But should you have a chronic condition that is going to get you close to your deductible, even if it is high, you may not want to reach it later rather than sooner, Coleman says.
Also, he says, be aware that some less expensive at-home tests or out-of-network services may not count toward your deductible or annual cap on out-of-pocket expenses.
In addition, some doctors may be reluctant to suggest over-the-counter or at-home testing, Gafanovich says. "If not performed correctly, there can be a lot of confusion over the test results," she says. If the results are misinterpreted, it can mean that the patient does not get the treatment that they need, or will negate further investigation into their symptoms."
Your doctor may not want you to go this route for fear he could be sued or lose his license should something go wrong.
This article Surviving Your High-deductible Health Plan originally appeared on Insure.com.
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