The “Top 10” ways to Prevent Healthcare Financial Disaster

07 Oct The “Top 10” ways to Prevent Healthcare Financial Disaster

By Gabe Sullivan

Health costs are one of the greatest financial burdens our country faces today and will continue to face in the coming years. Patients, doctors, caregivers, and employers are plagued by the high costs of hospital tests and procedures, medical bills, health insurance and prescription medications. To some degree, these unreasonably high costs within the healthcare system are a result of a lack of communication between necessary parties, increasing challenges placed on physicians to assure treatment accuracy, and mis-information between doctors and their patients. In order to create a cost-effective, efficient health care system, doctors and patients must work together and use the lessons they learn from each other to reduce financial harm.

At Costs of Care, we have developed ten lessons to assist patients and reduce the financial risk associated with receiving care. Although far from comprehensive, these points provide a starting point for patients and raise topics to question during care.  Here are our “top ten” lists for patients:

 

Ten Lessons Patients Have Taught Us to Help Protect Them From Financial Harm

 1)    Try to have a price estimate available for the tests and procedures that you perform most often.

2)    Be careful stating absolute prices, as out-of-pocket expenses can vary.

3)    When faced with a potentially dangerous situation for themselves or their family, patients are particularly vulnerable to unnecessary tests and treatments. It is critical to help them understand the value of the care you are providing.

4)    Less is often more – one of the biggest consequences of unnecessary tests is that they may lead to more unnecessary tests.

5)    Emergencies happen when we least expect. Encourage your young and healthy patients to purchase insurance even if they rarely need medical care.

6)    Weigh the risks and benefits of ruling out unlikely conditions with the patients’ and the systems’ financial burden.

7)  Even when patients go to an “in-network” hospital, if the physician providing the care is “out-of-network,” patients will be charged extra. Encourage them to verify whether the physician who is treating them accepts their insurance.

8)    Avoid sending tests “out of academic curiosity.” Not only does this drive up the cost of care, but some patients might have to pay out of pocket for them.

9)    Encourage patients to call their insurance company before a visit or bring you a copy of their benefits, deductibles and co-payments you can keep in their file.

10)  As part of your history and physical, assess each patient’s financial risk and make sure you do no harm.

Ten Lessons Patients Can Learn To Protect Themselves From Financial Harm

1)    Remember: high cost does not necessarily equal high quality

2)    Preventative care is not only medically beneficial, but also financially advantageous

3)    Utilize urgent care after hours; it is usually cheaper and faster than emergency department services.

4)    It can be very hard to obtain an estimate of costs prior to a visit, test, or procedure. You can spend hours trying to find this information and get shuffled from nurses to physicians to coordinators to administrators.  Try to learn who, in your clinic or your hospital, is in charge of estimating costs

5)    Use websites, blogs, and online materials to learn about the costs of care for different medical centers. Change Healthcare and Transparency messenger are two sites that can help patients compare prices.

6)    Call the clinic, hospital, or lab ahead of time to check prices. Sometimes just by calling you can receive a discount as large as 60% of the bill!

7)    If you have to pay out of pocket, making a first payment on the day of the visit can reduce your bill significantly.

8)    In almost every city, there are free clinics and community centers where you can obtain basic care.

9)    Even when you go to an “in-network” hospital, if the physician providing the care is “out-of-network”, you will be charged extra. Always ask if the physician who is treating you accepts your insurance.

10)  Emergencies happen when we least expect. Save some money for unexpected situations!

 

These “top 10” lists were compiled and edited from learning points generated by the Costs of Care’s 2012 Essay Contest, which provided insight into the financial challenges patients faced in the healthcare system. The 2012 contest sought anecdotes from patients and their caregivers illustrating opportunities to improve healthcare. Costs of Care has posted these stories on the blog and continues to run these stories each Monday throughout the year.

Michele Rhee, a member of Costs of Care’s board of directors, weighed in on the lists not only as a health care professional, working as a project manager at The National Brian Tumor Society, but also as a former patient. She made three distinct points about what doctors and patients need to keep in mind and learn from one another to create the high quality, cost efficient care. First, it is important for both patients and doctors to remember what type of patient or doctor they are prior to the visit. If a patient knows he or she is the type who prefers to be involved in decisions, then it would be best if they see a doctor who also prefers collaborating, rather than just instructing the patient on what actions to take. Second, to achieve the best care, it is vital for patients and doctors to communicate with each other. Finally, Ms. Rhee points out patients sometimes erroneously assume that doctors know how much tests and various forms of care will cost and what insurance will cover. It is critical for doctors and patients to work together, and learn lessons from each other, in order to create an accessible, high-quality, and cost-effective health care system.  Hopefully, these lists provide a solid tool for patients to use as a start to their more comprehensive healthcare financial discussion.

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Gabe Sullivan is an intern at Costs of Care and a junior double majoring in Health, Science, Society and Policy, and Psychology at Brandeis University.

3 Comments
  • Sean Parnell
    Posted at 16:08h, 07 October

    A lot of this makes sense, but some of it is debatable, and also overlooks some important things. For example, depending on how you define preventative care, much of it except for vaccinations is a waste. If you include taking your medicines, then yes, that’s valuable too. But routines screenings and regular checkups for low-risk people so that ‘things are caught early’ is of little value.

    Also, the advice here largely ignores the cost-saving options for self-pay patients. Cash-only doctors, telemedicine, medical tourism – real prices for care are available, even for specialty, hospital, and surgical care. And those real prices are typically much less, see here for an example: http://theselfpaypatient.com/2013/10/02/an-auction-for-medical-procedures-medibid-breaks-new-ground-in-healthcare/

    There’s some good advice here, but it’s only a part of the picture. As odd as it sounds, most people can save money without what is currently sold as health insurance, instead paying cash for primary care and obtaining alternate types of health coverage, such as joining a health sharing ministry or buying a critical illness, accident, or fixed benefit s insurance policy.

  • Diane
    Posted at 16:09h, 07 October

    Vaccinations are a waste and so is fluoride. The preservatives in vaccines are toxic to people and are causing a host of poor health and disease unrelated to the vaccine, immune deficiency disorders, autism alone – the vast spectrum of autistic disorders are astounding costing millions. Immune disorders from the mercury (thimerosol) in vaccines for people over 6 is destroying lives silently. No one will blame it where blame should go. I find it odd that one child out of a million dies from vaccine related adult leukemia at 2-1/2 yrs after fighting since he was 1 year old is, and I quote from the oncologist ” a negligible loss for the benefit of the many” BUT if a toy manufacturer makes a stuffed animal and that plastic eye chokes a child to death, there is a massive recall and all toys removed from stores. Why do vaccines get such sloppy standards and never a recall…never a doctor reports reactions from vaccines even with a parents pleadings. Children in America are being poisoned for no reason. Measles is not deadly I had them, I’m 48. I survived. Follow the money. Follow the source of the ingredients of vaccines…if we eliminated all the vaccines, there would be no immune disorders, Alzheimer’s or autism because there would be no immune trigger for the body to respond to. But all those 3 are big big money to health community. If fibromyalgia wasn’t in existence, or rheumatoid arthritis etc…there would be no specialty rheumatologists, no toxic pharmaceuticals for palliative treatment that may kill person taking them or make them more ill with infection. Leave the body alone. It has all the ability to fight off what’s out there to attack it by itself to add to the body, kills immune system and renders it threatened because of foreign toxins injected into its major organ, the skin.

  • healthcare claims adjudication
    Posted at 16:09h, 18 October

    It sounds really good all the ten ways to prevent healthcare financial disaster is interesting in same way it is more debatable. thanks for sharing this wonderful article…