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Category Archives: Financial Health

Strategy #5 of How to Avoid Price Shock from Medical Bills

08 Wednesday Aug 2012

Posted by integralpractice in Financial Health, Healthcare

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Tags

copay, copay assistance, coupons, drug, drug cost, free drug, hub, insurance, medical cost

This entry is a continuation of our blog series on how to save medical costs.

Strategy 5

Use the drug manufacturer as a resource for payment assistance. If you are purchasing a brand name medication, the drug manufacturer should be your first bet on getting financial assistance. Most drug companies have a dedicated “hub” that handles that particular brand of medication and will be able to help you with anything from providing you with a coupon card, to copay/payment assistance, to providing free drugs for limited amount of time.

Note that there are restrictions to these types of assistance. Mainly, you must be prescribed the medication for FDA-approved indications (they often need diagnosis confirmation from your physician) and meet the clinical criteria pertaining to that diagnosis.

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Strategy #4 of How to Avoid Price Shock from Medical Bills

27 Wednesday Jun 2012

Posted by integralpractice in Financial Health, Healthcare

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Tags

copay assistance, drug cost, insurance, medical bills, medical expense

This blog is continuation on a series where I discuss different ways for everyone to save on medical expenses.

Strategy 4

Choose a health plan that covers your medication and desired procedures. This will allow you to maximize your coverage benefit.

You can do this by asking the provider if they take that specific insurance, or asking the drug manufacturer which insurance covers their medication as a preferred product. Manufacturers usually have a list of insurance that covers their product and you can contact them by simply googling the drug name. Most brand name medications have their own website created by their pharmaceutical company, which will have contact information.

NZ

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3 Strategies to Avoid Price Shock from Medical Bills

14 Thursday Jun 2012

Posted by integralpractice in Financial Health, Healthcare

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benefit cap, deducatble, health finance, insurance, max out of pocket, medical bills, out of pocket pay

Talk to anyone and you can elicit myriads of sob stories relating to medical bills and insurance denials. Everyone from providers to hospitals to patients gets frustrated with the medical cost and billing. Issues such as delayed insurance claim processing, coverage denials, high deductibles are just few of seemingly endless causes of high medical bills and debts.

There are a lot of things school doesn’t teach you and this is one of them: how to avoid and manage medical costs and expenses. I want to create a serie of blogs to talk about simple strategies that anyone can use to help avoid this type of situation.

These are things I hope my patients would be aware. It would make my life and patient’s life a lot easier.

STRATEGY #1

Call insurance to verify coverage for each service/procedure you are undergoing. Find out if you have deductables for inpatient vs. outpatient expenses, medications, etc.

One of the biggest headache in medicine is dealing with health insurance companies. I see a lot of people naively believe that they will be covered because they have health insurance. Then they get a big shock when they realize that they have a $5000 deductable, or their insurance doesn’t cover their procedures or medications

Many people assume that if the procedure or medication is medically necessary, the insurance will cover it. Don’t confuse SHOULD with WOULD.

Ask your insurance if you have: 1. Deductable, 2. Benefit gap 3. Max out of pocket expense 4. Benefit cap. Note that these are annual so every year (either based on calendar year or anniversary year) you restart.

Realize that your copay varies depending on service and products

STRATEGY #2

Ask for out of pocket pricing.

When it comes to many outpatient procedures, and expensive medication therapy, many insurance will not cover the cost of treatment. If this happens, or you know your deductable will be too high to make a dent in your annual medical cost, ask the clinic/pharmacy for the price for if you want to pay out of pocket. Many clinics and pharmacies have self-pay pricing versus insurance pricing. No one likes to deal with insurance claims, and many places will offer a discounted price if they don’t have to bill the insurance

STRATEGY #3

If you receive a large medical bill, call billing and ask if you can pay the hospital in installments.

After all is said and done, you got stuck with a $12,000 medical bill for a emergency room visit. Or maybe it was a surgical procedure like a cardiac bypass where the insurance said you are somehow responsible for 25% of the cost, leaving you with a hefty bill. If this happens, the most important thing is to NOT ignore it. You don’t want the bill to go into collection (which usually happens if the bill lapses for a month or even less depending on the institution). Then you will be straddled with bad credit AND a interest on the bill. Call the hospital or the clinic and try to work out a payment installment option. Either pay a set amount monthly or do a split payment. This will save you your credit rating AND money by avoiding interest payments.

NZ

—-Terms—-

deductable = the amount of money you have to spend before your insurance will start paying the medical cost

benefit gap = amount range where your insurance is not covering for the cost and when the catastrophic coverage kicks in. This occurs with medicare part D patients, but can also occurs in regular insurances

max out of pocket = maximum amount of money patient will pay before insurance will covering some/all the cost

benefit cap = maximum amount insurance will cover. After that, patient is left to foot the bill

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