A couple of days ago I received a call from a MarketWatch reporter (the Wall Street Journal), wondering if I could provide some tips and guidelines for people who are looking to reduce their medical bills. We had a good conversation, but all the while I was hearing that little voice in my head saying “tell her about the bigger picture”. At first I resisted, because I truly understand that most readers are looking for a few quick points that will come in handy next time they’re faced with a daunting medical bill. However, as we continued to talk, I felt that I wouldn’t be doing my job if I didn’t speak up about the real challenge: how to avoid the high medical bills in the first place. In a nutshell, here’s what I said.
Consumers’ real power lies in understanding the system and how to “work it” before they need medical services. The time to get educated comes long before you become a patient or a caregiver: it’s critical to undergo the educational process at a time when you’re clear thinking, not when you’re sick, or when you’re caring for someone else, leaving little extra time and energy for anything else. This means:
1) Learning the language used by insurance and billing representatives. Just like visiting a foreign country, if you don’t understand what people are saying it’s hard to get around. Consumers need to be familiar with terms like “deductible”, “co-pay”, “network” and “pre-authorization”. You need to have at least a basic understanding of what hospital “codes” mean and how to check a bill if it doesn’t seem correct.
2) Understanding what your insurance does and doesn’t cover, and why. We constantly come in contact with consumers who tell us that their insurance booklets are too long and too complicated to read, let alone understand. Our response is that if that’s the case, go online and look at the charts that are often provided that simplify the coverage, or alternatively, call your insurance representative or broker and ask them to help you understand the terms of your coverage.
And if you do find yourself or a loved one suddenly needing care, remember to:
3) Ask for information about costs of diagnostic tests and procedures, as well as equipment BEFORE anything is ordered. Our experience is that if patients ask kindly and respectfully, most medical providers and administrators are happy to offer information so that their patients feel comfortable with informed decisions about the cost of their care. Of course, in a medical emergency, this may not be possible; but if you find yourself in a situation where you do have the opportunity to ask, do it!
Obviously, these suggestions won’t mitigate all the challenges involved in skillfully navigating the choppy waters of medical finances. But, as we say often around here, our mission is not about putting out fires, it’s about teaching our clients how to avoid them from being ignited in the first place. Just like in so many other cases in medicine, prevention is the key!
By the way, Pathfinders is offering a series of classes about how to be an informed medical consumer; let us know if you’d like to sign up for our next offering!