Meryl Davids Landau

	Patients with severe financial problems may find their physician is compassionate enough to accept the insurer s portion as full payment

Patients with severe financial problems may find their physician is compassionate enough to accept the insurer s portion as full payment

Getting a diagnosis isn't the only nerve-racking aspect of a medical visit. The bill you're handed can be even scarier, especially when you lack health insurance or face an intimidating deductible or co-pay. But just as big employers and insurance companies negotiate prices down as a matter of course, individuals can bargain with doctors and hospitals, too, says Erin Moaratty, chief of external communications at the nonprofit Patient Advocate Foundation.

Ideally, the time to make your case for a discount is before you go in for a procedure. Call the medical facility and ask for the projected fees; if you have insurance, contact the company next to find out how much it will pay. Then talk over your situation with the billing department, requesting a break.

You might win as much as 50 percent off full price if you offer to pay quickly by cash or check, says Cindy Holtzman, a medical billing advocate in Marietta, Ga., who's part of a growing industry of professionals dedicated to aiding patients with billing disputes.

Providers accustomed to accepting less than they'd like from insurers often realize that getting payment without hassle or delay is preferable to waiting for the full amount or having to hire a collection agency.

If you can't pay even a discounted amount promptly, you'll likely still be able to get a good deal if you promise regular payments of an agreed-upon size, Holtzman says. Patients with severe financial problems (especially those brought on by illness) may find their physician is compassionate enough to accept the insurer's portion as full payment. And uninsured low-income individuals who make too much to qualify for Medicaid may be eligible for free or reduced charity care.

The most effective way to get the billing department to trim its fees is to request, rather than demand, assistance.

"People are always more likely to lend a hand when you acknowledge them as fellow human beings, rather than as bureaucrats," advises Michelle Katz, author of "Healthcare for Less." Once you hammer out a payment plan, ask for your revised balance in writing.

You'll also want to scrutinize all bills for errors. Katz's husband was once billed $11,000 for a three-hour ER visit because the hospital had recorded him as having checked in the day before. The corrected total was thousands of dollars less. Holtzman recalls one hospital charging nearly $1,000 for alcohol swabs and cups for medications. Those items, at least, come with the room.

 

5 WAYS TO SAVE AT THE PHARMACY

By Kenny Lin

With our nation still mired in a deep recession, many of us are having a tough time paying for prescription drugs--especially those for chronic conditions like heart disease and diabetes. In fact, a Consumer Reports survey last year found that 28 percent of Americans have taken drastic steps to cut costs, like not filling their prescriptions, skipping dosages, and cutting pills in half without getting their doctor's OK.

There are, however, far safer approaches for saving money on prescription medications. Try these strategies:

1. Don't assume new drugs are superior.

Prescription drugs aren't like software and cell phones. Newer versions aren't necessarily better and may occasionally be inferior to older and less expensive pills. While prescription Clarinex for seasonal allergies is more expensive than over-the-counter Claritin, studies suggest it's no more effective. And prescription Nexium is certainly a pricey way to treat acid reflux when most heartburn sufferers can get substantial relief from cheaper, generic omeprazole. I also remember how excited doctors were about Vioxx for arthritis pain; we quickly switched patients away from ibuprofen, since Vioxx was thought to be easier on the stomach, but later regretted it when Vioxx was withdrawn from the market after being linked to heart attacks and strokes.

2. Avoid your doctor's sample closet.

Most family practices have a "sample closet" stocked with freebies of brand-name prescription drugs for common conditions from high blood pressure and diabetes to asthma and allergies. When I was in training, I often gave financially-strapped patients who were starting a new medication a month's supply of samples instead of a prescription. Although it seemed like a money-saving idea at the time, it wasn't long before the samples ran out and my patients were left with the choice of paying for an expensive medication or switching to a less expensive drug they hadn't tried before. In fact, a 2006 study in the Journal of the American Board of Family Medicine found that practices that distributed free drug samples ultimately cost their patients an average of $7 more per prescription each month than practices that did not give out samples.

3. Go generic when possible.

When your doctor suggests that you need a new medication, ask if it's possible to prescribe a less costly or generic alternative that might be equally effective for your particular condition. Many pharmacies and discount chains offer a month's supply of generic medications for $4 or a 90-day supply for $10. If you're taking more than one medication for a condition, like high blood pressure, you might be able to cut costs by getting a generic pill that combines the two medications.

4. Ask about drug discount plans.

If you don't have insurance coverage for prescription drugs, some pharmaceutical companies, as well as local and state government agencies, offer sizeable discounts on frequently prescribed medications for people who meet certain financial requirements. (Here are more details on the Together Rx Access program offered by drug companies.)

5. Buy in bulk.

If you've been taking a medication for three months or more, consider buying several months' supply in bulk via mail order. The Pharmacy Checker website provides a useful tool for comparing drug prices among reputable online pharmacies. Patients should check with their doctors before going this route, just in case their doctor is planning to make alterations in dosing or frequency.

 

Available at Amazon.com:

Last Child in the Woods: Saving Our Children From Nature-Deficit Disorder

No More Digestive Problems

 

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Health - For Help With Medical Bills Cut a Deal With the Doctor