50 Ways To Squeeze Value From Your Healthcare Dollar Without Killing Yourself

by Julie Rains on 25 June 2008 20 comments
Photo: happysnappr

Healthcare will most likely be my family's largest expense in a couple of years, when we've finished paying our home mortgage. We're not heavy users of the healthcare system: to take care of my own needs, for example, I have seen my family physician for a non-routine visit just 3 times in the last 15 years. Just one family member takes a prescription medicine on a regular basis. What have we done to incur such high costs? We're Americans who want to protect our family from a medically-induced financial disaster. We're not alone.

According to Davis Liu, M.D. and author of "Stay Healthy, Live Longer, Spend Wisely: Making Intelligent Choices in America's Healthcare System" health insurance premiums grew 73% compared to wage increases of 15% from 2000 to 2005. Dr. Liu doesn't have a well-crafted plan to solve the national healthcare crisis but he does offer practical ideas for getting the most out of your healthcare dollar. Here are 50-plus ways to save money without compromising your well-being, drawn mostly from Dr. Liu's book but supplemented by my experience, research, and wisdom of the Wise Bread community.  

  1. Skip the annual physical but get specific screening tests recommended by the U.S. Preventive Services Task Force (USPSTF).
  2. Save on prescription medications if you meet certain eligibility guidelines found at Together Rx Access.
  3. Review all medical bills and question anything that doesn't seem right, especially services that should be covered under your insurance plan; talk to your insurance agent, employee benefits counselor, and/or insurance company representative to make sure that covered items are paid correctly. 
  4. Call your physician’s office to ask about a non-urgent problem (or to see if a symptom requires immediate treatment) rather than scheduling an appointment.
  5. Ask your pharmacist about medications including prescriptions, over-the-counter drugs, and behind-the-counter remedies; you'll get free, valuable advice from a healthcare professional who has spent many years studying medicines. 
  6. Compare your physician’s recommendations with clinical guidelines (e.g., pediatrics, obstetrics/gynecology, urology); ask about anything that you don't understand or seems to be unusual care.
  7. Do self exams (see techniques for women and men).
  8. Get high-deductible healthcare insurance rather than forgoing insurance because the uninsured have higher death rates from chronic disease and accidents.
  9. Carry continuous coverage so that exclusions for preexisting conditions will be limited according to federal law associated with HIPAA (Health Insurance Portability and Accountability Act).
  10. If you may lose your job or already have lost your job, compare the cost of COBRA coverage (extended to displaced employees but includes the employer’s and employee’s cost) to other options such as purchasing insurance on your own (either a comprehensive or high-deductible plan) or getting coverage on a spouse’s plan.
  11. Open a HSA (Health Savings Account) linked to a high-deductible insurance plan and take a tax deduction for your contributions, subject to limitations as stated in the federal tax law.  
  12. If your insurance company doesn’t cover USPSTF-recommended tests, question why it doesn’t cover expenses proven to prevent disease and start a letter-writing campaign asking for coverage; write your insurance company and your state’s insurance commissioner.
  13. Take a tax deduction for medical expenses that exceed 7.5% of your adjusted gross income (AGI).
  14. Go to a provider (physician, physician extender, or hospital) that is in your insurance company’s network so that you can take advantage of discounted rates already negotiated by your insurance company.
  15. If the provider that you prefer is not in your insurance company’s network, ask the provider to join so that you can get discounted rates.
  16. Choose a high-performing healthcare plan by checking out plan ratings by the National Commission on Quality Assurance.
  17. Select a physician who follows standards of care according to evidence-based medicine; find those who meet the NCQA criteria in its searchable physician directory.
  18. Get free blood pressure, blood sugar, and cholesterol checks at health fairs. Take the results to your physician for discussion and further testing if needed.
  19. Wait at least 24 hours after the onset of a fever (with no other worrisome symptoms) before making a doctor’s appointment.
  20. Take free or nominal-fee health classes on topics such as childbirth preparation and diabetes prevention; beware that some of these classes are sponsored by pharmaceutical companies.
  21. Find free skin cancer screenings but don’t wait to find a free check if you think you may have a problem.
  22. If there is a competitive market for healthcare services (e.g., more than one maternity hospital in your town), negotiate prices, preferably before you receive services.
  23. Check out the safety, effectiveness, and clinical soundness of home remedies, herbs, and supplements at The People’s Pharmacy and Consumer Reports-Health.  
  24. Evaluate hospitals using The Leapfrog Group's ratings.  
  25. Donate blood and receive free blood pressure, iron-level, and temperature checks.
  26. Establish a relationship with a primary care physician through an “establish visit.”
  27. Get better, more informed, and quicker medical advice by preparing a written summary of your medical history (should include surgeries, medical conditions, medications, allergies, family history, and social history).
  28. Communicate priorities during the initial part of the physician visit, rather than waiting until the very end of the visit to express your concerns about an important matter.
  29. Help your physician arrive at a diagnosis with a minimum of tests by discussing your symptoms in terms of when you first noticed the problem and when it occurs; what it feels like (sharp or dull, constant or intermittent) and what seems to make the problem better or worse; where in the body it occurs; and why you are concerned.
  30. Make sure you understand any diagnosis, additional testing requirements, treatment plan, and further assessments recommended by your physician before you leave the office.
  31. Before allowing medical treatment (giving informed consent), determine the benefits, risks or complications, and alternatives to treatment plans.
  32. Don't hesitate to get a second opinion not only on the diagnosis but also for the treatment plan, if you feel uncomfortable with your physician's plan and especially if you have a rare disease.
  33. If you are waiting on test results, “Never accept the phrase, ‘we’ll only contact you if the results are bad.’” Ask for a call back or, preferably, written documentation of your test results.
  34. Get immunizations to prevent certain diseases (see Center for Disease Control’s recommendations).
  35. Ask your primary care physician what type of specialist treats the problems you are concerned about to avoid paying for a visit to the wrong type of specialist.
  36. Make sure your physician is licensed by checking with state boards.
  37. Don’t be overly influenced by ads for prescription medicine: ask about symptoms mentioned in commercials or ads rather than requesting specific medications; stick with your current regimen if it is working without complications. Heavily advertised medications are almost always more expensive than non-promoted ones.
  38. Consider generic drugs to replace name-brand drugs; for a list of generic drugs with their equivalents, check out the Electronic Orange Book
  39. Compare drugs in the same class by price using Consumer Reports-Health website.
  40. Cut costs on prescriptions through patient assistance programs; learn more at Rx Assist or Partnership for Prescription Assistance.
  41. Ask for free samples of medication from your physician.
  42. Tell your physician about cost concerns and see if there is a less expensive but just as effective alternative treatment.
  43. Read the labels and ingredient lists of over-the-counter medicines to make sure that you are not overdosing on certain active ingredients.
  44. To get more face time with your physician, schedule multiple visits rather than signing up for concierge care (flat fee for dedicated service).
  45. Say "no" to body scans that are more likely to lead to unnecessary testing and cause harm via radiation rather than detect deadly disease.
  46. Take part in group visits with your physician or support groups for those with similar diseases.
  47. Exercise, maintain a healthy weight, and don’t smoke.
  48. Research medical issues using reliable sources such as the Mayo Clinic.
  49. Sign up for discount programs with non-insurance companies such as Merck’s Prescription Discount Program (available to those who do not have prescription coverage) and Pfizer's program.
  50. Visit a dental clinic associated with a dental or dental hygiene training program to save on fees (see health reasons for proper dental care).
  51. Tap into hospital programs that offer aid for low-income, low-resource patients.
  52. Take a vacation.
  53. Leave the country to receive quality healthcare often at heavily discounted prices (see Adventures in Medical Travel article from Kiplinger and read about Amy's journey to wellness in India).

If you've saved money on healthcare and improved your health, tell me about it.

Note: I received a copy of Stay Healthy, Live Longer, Spend Wisely in exchange for a book review. Disclaimer: This book and my post are intended to provide readers with a general understanding of healthcare issues rather than provide personalized medical, financial, or legal advice. Please consult your physician, CPA, attorney or other advisors for help with specific situations.

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Guest's picture
Guest

Great list especially numbers 1 and 45. As someone who works in public health, I am often appalled at the tests and screenings care providers will try and convince worried patients they need, especially when they will gain from it.

Guest's picture
katy

Julie, G-d bless you, really, for this all encompassing list of tips and care. You do such good service here.

Guest's picture
Lucille

If you have chronic conditions you really need to know more about them than your doctor does. There are plenty of reputable sites with patient education information and study information is readily available online.

There are also some doctors that are heavily invested in putting you on certain drugs because there is a gain for them if they do. Some also have rigid agreements or some other incentive in who they refer you to for tests or other treatment.

If a doctor is very pushy about a certain drug or certain referral without giving you a medical reason why this is to your benefit you might want to think twice about the relationship. We ended up firing our family practice doctor over this. It got to the point we might as well have been seeing the drug company rep rather than the doctor.

I have become a big advocate of supplements and natural remedies but it is very hard to sort the scams from the beneficial things. If an actual MD suggests it or a reputable source like a research university or the NIH has studied it and finds some benefit I will try it. I also try to stick with individual supplements rather than the blend intended to cure something specific. The packaged herbal cures seem to not be clear about what is in them and are far more expensive than just buying individual bottles of a specific vitamin. Those packaged cures are also going to be a nightmare if you have a reaction and a doctor needs to know what you took.

Julie Rains's picture

Knowledge is power when it comes to healthcare. Research is valuable, not always  to dispute a recommendation but to engage in an intelligent dialogue and understand the issues involved in making an informed decision. 

Speaking of finding another family physician, I will mention that sometimes the best physicians are not those with perfect interpersonal or social skills; so if someone makes you feel good but doesn't seem to follow guidelines, then it is time to reconsider the relationship. I have also noticed that some physicians will write prescriptions or make recommendations based on what they think the patient wants rather than what is right.

Fred Lee's picture

Julie, I'm appalled at how much we pay in premiums for our insurance, and it is employer based. Our contributions have increased astronomically, and at some point you begin to wonder not only if it's worth getting insurance through your job, but if you can even afford it.

It makes you wonder what sort of disaster is awaiting us in terms of health care. And best of all, nobody can agree on a solution. Maybe like the environment, it takes a disaster for action to occur.

Thanks for the list, it's very informative.

Myscha Theriault's picture

Slamming post Julie, really.

I'm sort of on the road and not able to fully enjoy all the links, but it's so great to know it's here for referencing when I'm ready.

This really is an incredible service article. I'm sure it will do well and provide assistance to many people.

Great job.

Guest's picture
AndyS

Great list, but even better is to exercise, so as to stay healthy. This is the best way to minimize rising health costs. Limited funds should be no excuse for not exercising and here is a list I put together recently on Frugal ways to get and stay in shape. Simple exercises that don't cost much means we can all afford to be healthy.

Guest's picture
Guest

# Get immunizations to prevent certain diseases (see Center for Disease Control’s recommendations).

Great list. I don't know if I'd necessarily advise a lot of immunizations though. There are dangers associated with over-vaccination, especially for children (recent studies show that there may be a link between vaccines and autism)

Also, Wal-Mart offers $4 Generic Prescriptions on many common medications, so if you are prescribed something be sure to call and check and see if you can get the generic version for less (and when you get prescriptions ask your doctor if he/she can write the prescription for a generic equivalent).

Finally, I advise you to take advantage of offers that are in the local news (or in your drug store ads) for gift cards for New/Transferred Prescriptions. In a lot of markets, CVS heavily pushes $25 Gift Cards for new or transferred prescriptions. A lot of pharmacies will accept these coupons from competitors too. Over 1 year, I transferred my prescription from CVS to Rite-Aid to Wal-Greens to Ralphs to Albertsons to Wal-Mart, averaging approximately $25 in gift cards per transfer.

Julie Rains's picture

(partly obscured by the numbering system, at least on my screen) and I agree that it can be essential to keeping healthcare costs down; for me, it has kept down my blood sugar and blood pressure. And, more efficient circulation hopefully helps things heal faster. I don't know how much exercise has helped to keep my healthcare insurance costs down: perhaps there is no benefit or perhaps my monthly insurance could easily be more than my mortgage.

Linsey also wrote about prescription savings. I have considered switching drugstores to get savings (transfer incentives) but thought it might be confusing to remember where to call and my drug records are all at one place though I could see how that could be cost-effctive. I am going to be checking out one of Merck's programs and let y'all know how that goes.

 

Guest's picture
Lucille

Exercise can be really helpful but it isn't a sure thing. Exercise is great for preventing things like type 2 diabetes, heart, high blood pressure and weight related issues.
It won't prevent a whole host of things though. But if your injured or dealing with an illness or chronic medical problem being in good shape gives you a serious leg up on getting closer to healthy.

Something to keep in mind about pharmacies that isn't strictly financial is to be aware of how rushed the pharmacy is and the number of pharmacy techs to number of pharmacists. We moved some prescriptions after noticing issues of overwhelmed pharmacy staff and confused techs working without any supervision. If they are over worked and understaffed it increases the risk of a prescription error.

Oh, and always double check they gave you the right drug. Most pharmacies print the pill description on the papers they give out. I caught a prescription error using this.
http://www.drugs.com/pill_identification.html

Guest's picture
Guest

No, there aren't actually studies showing a link between autism and vaccines, there are anecdotal reports of such a link which is not the same thing.
The original article which started the whole debate has been debunked so many times.
The CDC link is full of information regarding this fact.
I'd also like to point out that the decision to immunize does not only effect you, but others around you- it's called herd immunity and it's more important than many realize.
If you are concerned please educate and inform yourself and then make a decision.
Sorry to hijack the thread Julie but this is a very sore point for this epidemiologist.

Guest's picture

For a newcomer to the insurance scene this is quite helpful. Thanks!

Guest's picture
Guest

I am a high income earner, but I still decided to sign up for my company's high deductable health plan this year.

I didn't do it to save money, but I just thought it was a good idea to keep healthcare system costs lower.

It really makes you think twice before just running to the doctor for no reason. It also makes you seek out generic drugs if they will do the trick.

With a HDHP it is much more of a buyers market and if everyone went on one it would drastically decrease the waste in the current healthcare system.

Guest's picture
Randy

I recently wrote a similar short article on how to save on meds: http://fiscalzen.com/content/five-tips-help-save-meds . Pill splitting can be an effective tactic for saving on medications. In addition, there are a couple of brand-name prescription coupon sites that can save you some cash if generics aren't an option.

Regards,
Randy

Guest's picture
John Krumm

If we could pass some kind of universal health care system like every other industrialized country in the world that would end a lot of these headaches. People should not have to worry about the cost of their necessary medical treatments. It's plenty to deal with trying to get and stay healthy. Imagine having every necessary procedure paid for, and pharmaceuticals costing a couple dollars. That's life for much of the rest of the first world, and even some of the third.

Guest's picture

Overall, excellent 50+ tips. Loved the part about taking a vacation. Would caution on #41 - Ask for free samples of medication from your physician - as this is the best way the pharmaceutical industry gets you hooked on expensive treatments that often are not better than proven generics. The only time it might be acceptable is if it is for a self-limited problem where the doctor gives you all the treatment you need and you don't need to buy more.

Free book excerpts are at my website - http://www.davisliumd.com/dl.html

Best wishes for good health,

Davis Liu, M.D.

Julie Rains's picture

Hi Dr. Liu, thanks for visiting and adding the caveat about free drugs. I enjoyed the book!

Guest's picture
Pam munro

Been finding vitamins at great discount with expiration dates at the end of the year. A guy at church who is studying to be a pharmacy assistant said that they could be weaker - but at the dosages I got I thought it would be OK - I did some internet research and learned that even for prescription DRUGS the expiration dates are EXTREMELY conservative and that with a few exceptions, stored drugs will last for YEARS. You just should check to see if the tablets have deteriorated, which will give you a sign of decomposition. So I feel much better about the CoQ10 I snagged at 99 cents a bottle (normally $25!!) and the other bargain supplements I get!! (Not to mention that I can use my old stash of anti-depressants in an emergency if I have to...)

Guest's picture

Nice post to have about the health care!!.Health is very important for every one,with out proper health we can't do any thing,so we have to take care of it.From the site i got more details of health care thanks for sharing!!

Guest's picture
Randa

I work for a health insurance broker and many of his clients would benefit greatly from reading this list! Health insurance premiums are very high, especially if you have had ANY reason to go to the doctor or recently had a baby. This is such a great resource for people because I don't think the public is educated enough on health care. A lot of people don't realize that simple exercise and paying attention to what you eat can make such a HUGE difference in your health and therefore your health coverage premiums as well. It's time that people get themselves informed so they can take better control of their lives! Thanks again!