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You talk to your doctor about personal issues you wouldn’t discuss with your best friend but, if you’re like many patients, there’s one topic you might feel squeamish about: Money.
Particularly if you have a high deductible or no health insurance at all, the doctor’s bill weighs heavily, and it’s something you should talk about. Your doctor needs to know what you can afford, and you need to get the most cost-effective care.
Here’s how to broach the topic without being rude.
1. Be upfront
“Patients should never have any fear about being up-front about their financial situation,” says Dr. Joanne Berkowitz, an internal and emergency medicine physician with the Doctors Center Medical Group Inc., in Fair Oaks, Calif. “If a patient says, ‘I’ve got a large deductible,’ or ‘I’m uninsured and I’m concerned about costs and would like to be as economical as possible,’ no physician is going to be offended. I like to know that up-front.”
Dr. Eric Bricker, an internal medicine physician, agrees. Bricker is chief medical officer of Compass Professional Health Services in Dallas, Texas, which helps employers and individuals cut health care costs and find the best-value health care and benefit options. “A physician wants to do the right thing for the patient,” he says. But your doctor is busy with many patients and, unlike the billing staff, doesn’t keep track of how much you pay out-of-pocket, so it’s up to you to explain your situation.
2. Understand that some things are non-negotiable
You can’t negotiate a price break on your insurance co-pay, which is set by contract with your health insurance company.
“And to a certain extent, the doctor’s time is not negotiable,” Berkowitz says, adding that she refuses to cut a visit short to save money if a complex case requires more time.
“I’m not going to give limited care when limited care is not adequate,” she says.
3. Don’t be afraid to ask for discounts on doctors’ fees
As part of their contractual arrangement with doctors, health insurance companies don’t pay full doctors’ fees, so there is room to negotiate if you’re paying out-of-pocket.
Berkowitz advises that, after explaining your financial situation, you ask your doctor directly if you can get a price break.
If it’s a large medical group, you might need to talk with someone in billing. Bricker suggests this language: “I’m going to have to pay for a lot of this out of my own pocket, so I need to be concerned about expenses. Is there someone I can talk to about reducing my bill?”
Never be afraid to ask how much something will cost and whether there’s a less-costly alternative, Bricker adds.
4. Be polite
Being honest about your financial situation and requesting a discount is one thing, but use common sense and don’t be too pushy. Remember, physicians need to charge for their services to stay in business, so don’t expect a free ride. Saying something like “but my other doctor would have done it for free” probably would not go over well, Berkowitz says, although she was hard-pressed to think of any other examples that might cause offense.
5. Shop around for medical tests
Some of the biggest costs you’ll face are not under your doctor’s control.
“Where things get really expensive are tests and procedures outside your doctor’s office, such as CT scans, MRIs and spinal injections,” Bricker says. “These can be thousands of dollars.”
It pays to shop around because costs vary widely depending on the provider. Bricker recalls how in one city the cost of an MRI ranged from $500 to $2,500. Rather than skipping a test to save money, discuss your need to keep costs down, Bricker says. Sometimes your physician will know which lab is least expensive. If not, ask if the test can wait, and then call facilities to ask for prices before setting the appointment.
6. Talk about drug costs
Sometimes physicians get in the habit of writing prescriptions for certain medications and might not consider costs.
Word your request to save money carefully. Instead of asking, “Can I get this in a generic?” ask, “Is there a generic medication that treats this condition?” Bricker advises. Although there might not be a generic equivalent for the original drug, there may be a less costly alternative that also treats the condition.
Beware of the long-term costs of free drug samples. Yes, doctors have cupboards full of free drugs they can give patients. But these samples are usually for the newest and most expensive brand-name drugs for chronic conditions. Once the free samples run out, you’ll be stuck with paying an expensive tab.
“You’re never going to get a lifetime of free samples, and then you’re going to pay through the nose for these drugs,” Berkowitz says.
Bricker says one of his company’s members got free samples for a new blood pressure medication for three months. Then when the samples ran out, she faced a $160 bill at the pharmacy for a one-month supply. “We had to scramble to get a generic alternative because she wasn’t going to fill the prescription.”
Although talking about money with your doctor might feel awkward at first, broaching the issue is good medicine — and really, it won’t hurt at all.
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