Sande Kaskel doesn’t see herself as a bargain shopper. But last year the Hollywood resident saved big on prescription drug costs, just by comparing pharmacies and asking for a better deal.
“I saved $500 just by being a good consumer and knowing to ask about prices,” said Kaskel, owner of Kaskel and Associates Insurance, which specializes in employee benefits.
With President Obama’s healthcare law putting a spotlight on the uncertain health insurance landscape, and a weak economy spurring layoffs and an increase in the loss of health benefits, consumers are becoming more price sensitive about out-of-pocket medical costs. The total cost of healthcare for a typical family of four covered by a preferred provider plan (PPO) is about 20 percent higher in Miami than the national average, according to the Millman Medical Index. In 2012, the average American family will spend $20,728 at the pharmacy and on inpatient and outpatient care, an increase of 6.9 percent over 2011. In Miami, a family of four will spend about $24,965.
Nationally, healthcare costs have continued to outpace wages and the inflation rate, according to the Kaiser Family Foundation. From 1999 to 2011, family premiums for employer-sponsored insurance increased 160 percent, while wages went up 50 percent and inflation has gone up 38 percent.
While the situation may seem dire, there are steps consumers can take to lower their out-of-pocket costs. Whether it’s prescription drugs, medical tests or even routine healthcare, consumers today are finding an informed shopper gets the best deal.
A generation ago, a patient would have never questioned a doctor’s orders, said Penny Shaffer, market manager for Florida Blue, formerly Blue Cross and Blue Shield of Florida. Now, armed with apps, websites and cost comparisons, patients are not only more educated about healthcare choices, but about the costs involved.
Here are some tips from the experts about how to be a savvy shopper while taking care of your health:Know your coverage
“For the insured, the biggest mistake is not understanding what your benefits are and what your contract covers,” Shaffer said. The average consumer doesn’t understand the difference between network and non-network providers, or how their deductible is met. “Most people go in as uninformed consumers,” she said. “Make sure you understand the benefit structure, how your personal choices can affect your health costs, how to best use your deductible and when co-insurance kicks in.”
Santiago Leon, an employee benefits specialist with ACC Insurance Brokers in Miami, said most insurance companies have online tools that will help you compare procedure costs by location and see performance statistics such as readmission rates and complications. If you have health insurance, go to your insurer’s website to see what tools it offers, he said.Where to seek care
Here’s the order to save you the most money, Shaffer said:
1. Your regular doctor.
2. Walk-in clinics at drugstores and groceries, which usually accept insurance and have their prices posted.
3. Urgent care centers.
4. ER — unless an emergency situation requires it.
Clinics linked to universities also can be a source for low-cost care. For example, Nova Southeastern University in Davie operates 20 South Florida clinics offering medical, dental, and optometric care, among other services. For information, visit www.nova.edu/healthcare/index.html. Shop around
With high-ticket tests like MRIs and CT-scans, costs can vary wildly from facility to facility. “The rule of thumb is a free-standing diagnostic center will be cheaper than a hospital,” Shaffer said.
For example, if you have a high deductible plan, an MRI might cost you $1,500 at a hospital, or $800 at a free-standing testing facility, said Martin Rosen, co-founder of Health Advocate, a Pennsylvania-based company that helps patients around the United States navigate the healthcare system. “Americans will drive around to save a nickel on a gallon of milk or a penny on a gallon of gas,” Rosen said. They need to employ the same mindset when it comes to healthcare.
When Kaskel, who has osteoporosis, needed a bone density scan, her internist suggested an imaging center, rather than the hospital.
“That saved me about $200,” she said.
If you need surgery, and your doctor practices at more than once facility, costs can vary whether it’s performed at a small community hospital or a large teaching facility, Rosen said. “Know the questions to ask. Be an educated and informed consumer,” he said.
With an HMO, the advantage is once you’re in an HMO-approved facility, everything is settled through the HMO, Leon said. With a PPO, there can be “lots of snouts in the trough,” he said, so the best advice is to call the facility before a procedure and make sure everyone is in network.
“It doesn’t always work, because sometimes an out-of-network anesthesiologist or specialist may need to be called in, but you can try to eliminate possible problems,” Leon said.
Of course, if there is an acute need, such as an emergency, you don’t have the luxury of shopping around, Rosen said.Negotiate discounts
Ask about it upfront, and be confident, especially if you don’t have insurance, Rosen said. “Ask ‘What’s the cost? Can I get a discount for paying cash? Can I arrange for a payment plan?’” he said. “Especially if you have been seeing a provider for a long time.” They’re running a practice and trying to make a living, too, but sometimes they will work with you.
Rosen said once he negotiated a $2,400 cash price for dental work down to the insurance company’s negotiated rate, which was $1,000.
“I had been a patient for a long time, and I asked in a nice, professional way,” he said. “The average consumer doesn’t realize that insurance companies are buying wholesale, and we are paying retail. You are never going to get those wholesale prices unless you ask.”
Remember this is a process best tackled in advance, Leon said. “It’s better to try and make a deal up front. It can be done, now more than ever, because so many middle class people are experiencing layoffs” and losing their insurance, Leon said. If you have been with a provider for a while, use that as a base for conversation. “Say ‘I no longer have this insurance, but I would like to continue with you,’” Leon said.
If you need a test and are uninsured, look up negotiated rates on your insurer’s website for a procedure and call the testing facility. The online tools typically require a logon and password, so if you aren’t insured, ask a friend who does have insurance to look up costs for you, Leon suggests. “You can call and try to cut a deal, but look for a locally-owned place,” Leon said. You will have less luck at larger companies like Quest or Lab Corp, as opposed to a locally-owned facility where you can talk to someone with the authority to negotiate, Leon said.Drugs
Pharmaceutical companies have programs to help reduce the cost of some expensive drugs, Rosen said. Ask your doctor for samples or coupons, or a co-pay card, Leon said. Check the drug manufacturer’s websites. Ask for generics.
Shaffer said to do a cost comparison to determine the best place to fill a prescription. If you need a 90-day supply, it may be a mail order pharmacy. If it’s an antibiotic, Publix offers certain common ones for free. Walmart and Target also offer $4 prescriptions, regardless of insurance, for certain maintenance drugs.
Kaskel, whose health plan has a $5,000 deductible, asks for the cash prices at pharmacies, and she’s not afraid to shop around. One drug that cost $100 a month elsewhere was only $30 at Walmart, she said. But the large chains don’t always have the best prices.
“I found the local pharmacies are more willing to negotiate a price, and they even deliver,” Kaskel said.
Apps can help you compare costs before you leave the doctor’s office, Shaffer said. The free Florida Blue mobile app for Apple and Android devices allows a patient to input a drug name and find costs at local pharmacies as soon as you’re handed the prescription. That way, if it’s very expensive, you can ask for an alternative on the spot, Shaffer said. “It saves a lot of money, and it saves a lot of time,” she said.Examine your bill
“People make mistakes. Don’t take anything for granted,” Rosen said. “Look at your bills and your insurance company’s EOB (Explanation of Benefits). They are done in huge volumes in automated processes.”
Shaffer said if you get a bill and don’t understand it, call the billing department for an explanation and to negotiate how you will pay it, and whether you will pay the full amount.
Leon said the last two client issues he resolved involved billing problems. He said common problems include billing issues when a customer is covered by more than one insurance provider, and insurance claim denials by HMO patients who don’t obtain proper referrals.
“The whole process is rife with opportunities for error,” he said. “This is why every doctor’s office has at least one person who does nothing but deal with this stuff.”
If you get a bill that you can’t afford to pay, call the provider immediately to discuss it, Leon said. “A hospital or physician can negotiate,” he said. “If you wait for it to go to collections, the collection people can’t or won’t negotiate.”
There’s no guarantee you’ll get a better deal, Leon said, but people “make amazing deals, sometimes paying over years,” he said.Don’t overinsure
Some people are used to having fully-featured policies from their employer. If they lose their job and have to buy their own policy, they think buying a fat policy is the only way to go. “They may be paying for more than what they need,” Rosen said. “For example, if you have a young, healthy person getting comprehensive coverage, they may never get the benefit out of it.” A cheaper high-deductible plan, with higher out-of-pocket costs and coverage for catastrophic events, may be less expensive in the long run, he said.
“People should understand what they need, and what their options are,” Rosen said.
Don’t be intimidated by the process, Shaffer said. “The older generation grew up never questioning the doctor,” she said. “Today it does fall on the individual to understand their health needs and the financial implications. … Asking questions is one of the most empowering things a consumer can do.”