Insurance Information: Tips & Advice

Tips for High Deductible Health Plans

As many of you know, the cost of medical insurance has continued to skyrocket. In an effort to calm some of these horrendous rate increases, many employers have had to ask their employees to contribute more toward the premiums or have had to increase the deductibles on the plans being offered. Many health insurers have also changed their contracts so that lab and x-rays are no longer paid in full.

If your employer has gone by way of the High Deducible Health Plan, consider yourself lucky. This means that you now have some control over your medical expenses and how they get paid. Here are some guidelines to get the most out of your health plan.

If you still have a copay plan, but your lab and x-rays are now applied to the deductible, you may consider asking your doctor if he can extend your 3 month labs to every 4 months. This will result in 3 series of lab charges instead of 4.

If you are now enrolled in a High Deductible Health plan with a Health Savings Account, your routine physical, labs, mammogram, PSA, well-child care and one screening colonoscopy every 10 years for those over age 50 will be covered up front with no deductible. However, you must meet your deductible before sick visits, emergency room, hospital or prescription services apply. A prescription discount card is attached.

What do you do if you get sick? Depends on your sickness. Show your medical card to the provider. The provider cannot ask you to pay for services up front, because the services will be discounted by the medical plan when the claim is processed. Somewhere between 30 and 60 days later, you will receive an Explanation of Benefits from your medical plan that will tell you how much the bill was, how much has been paid and how much you owe. You will then wait to get a bill from the provider that matches the Explanation of Benefits. If the bill you receive is too large for your budget, call the billing office and ask to make payment arrangements. Never use your credit card to clear medical bills. You will end up paying excess finance charges. By making payment arrangements, you can have some control over when and how much you pay. As long as you make the agreed upon payment, you cannot be sent to collections and you shouldn't receive dunning phone calls.

What if you need to get a prescription? Your medical plan more than likely offers a discount. You may find that with the discount applied, you pay less than the copay you were paying under your previous health plan. Or, you can ask your doctor if your medication can be doubled and then cut the pills in half. I.e. My husband took 3 .25 mg. Of Mirapex daily. The cost without a discount was $145 per month. The cost with a traditional Rx card was $50 per month. By getting a 1.5 mg. Tablet and cutting it in half, we pay $35 per month for 15 pills with the discount. My husband is still getting .75 mg. Of medication. He is still getting a 30 day supply. And, we have more control over our expenses. Always, ask your doctor if there is an alternative to taking the medication he is about to prescribe.

Expensive medical tests are great and they sometimes tell us a lot and sometimes they tell us nothing. Always ask your doctor if there is a less costly way to find out the same information. The exposure to radiation may be more harmful in the long run. During my pregnancy, my AFP test came back indicating that my daughter would have severe Down's Syndrome. My doctor strongly recommended that I come in for an Amniocentesis. I had read that this caused miscarriage 1 in 200 times. I had had 7 miscarriages and was not about to do anything that might cause one. My doctor spent 2 hours on the phone trying to convince me. He told me that if my child was severely disabled that I might want to terminate it. He told me that we might need to have a surgical team present to save the baby. I still refused and suddenly, he suggested that I have a Level III Ultrasound, which could tell me with 98% certainty if my child would be healthy. Not only was this test less invasive and dangerous to my baby, but it was less costly to everyone, as well. I had a very healthy baby girl.

Remember that doctors are human. They make mistakes. It is very important for you to report your symptoms clearly and accurately. If you were to look up symptoms for any disease, you probably have most of them. Before you take any pill, write down how you have been feeling and how you feel at the moment before you take this pill. Keep a journal. Report any aches, pains or side effects immediately. Be aware. Become an educated consumer. Ask questions. Challenge your doctor. Why are we doing this? Is there another way? Sometimes, pills can cause a lot of problems in the long run.

If you are thinking of becoming pregnant, please take early steps to ensure your success. Take prenatal vitamins, drink plenty of water, limit caffeine, avoid artificial sweeteners, get plenty of rest and don't smoke. Report to your doctor any medication, supplements or herbs you are taking. Many are not good for your fetus. Do read “What to Expect When You're Expecting”. Though it might seem like a good idea to get an early ultrasound to “see” your baby, this is not a necessary expense unless you are in pain or bleeding. The reality of pregnancy is that many early pregnancies end in miscarriage and there is really nothing your doctor or anyone can do to prevent it before your 12 weeks is up. Save your doses of radiation until you absolutely need them. It is still unclear what long term danger ultrasound might pose to your baby.

In this world, salesmen come in many forms. Your doctor is one of them. He is selling himself and his services. His role is to become so important to you that you wouldn't dream of going anywhere else. You are the consumer and you are buying what he is selling. Again, be cautious. Know your numbers and what they mean. What is your blood pressure reading? Is it always this high or did you just run from the parking lot to get out of the rain? Did you have a bad day at work? What is your cholesterol? What was it last time? Know your family history. Do your breast exam. Listen to your body and note any changes in how you feel. What has recently changed in your life, your diet, your sleep pattern? Are you worried about something? Is there something that you recently started eating or doing that could be triggering a headache or pain?

Before starting any medication or having any type of surgery, please get a second opinion from someone outside that particular practice! If you get two conflicting, get a third opinion. Never be pressured into starting medication or having surgery—unless, of course, you are in the emergency room and your life depends on it. Surgeons make their money by performing surgery!

In today's day and age of the internet, you can take charge of your medical care. You can go on line and look up what your test results mean. You can look up who's had surgery and who hasn't and what the results have been. You can probably find out a lot about your doctor or hospital, as well. Be educated about who is treating you and the treatment you are getting. Soon, you will be able to find out what actual costs are from one facility to the next.

Make sure that you get 7-8 hours of uninterrupted sleep each night. Eat 3 balanced meals daily, eat what you want, but count your calories. Avoid too much sugar and artificial sweeteners. Do sprinkle salt from time to time. Drink water. Drink some caffeine if you like it. Avoid soda. Stretch as much as possible. Don't stay up all night watching tv or using the computer. Go outside and breathe some fresh air. Reduce your smoking. Do your breast exam. Have your annual physical. And, make a decision to be happy.

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