Asking a few questions about your health insurance and knowing your options can protect your wallet after a doctor’s visit.
1. Know your options
How much you’ll spend at the doctor depends on what type of doctor you visit. Most plans will cover a phone call with a nurse, an online doctor visit, or visits to a doctor’s office, an urgent care clinic, or a hospital emergency room. Nurse lines and online visits are usually cheapest (and often free). Emergency rooms are the most expensive.
2. Ask if the doctor is in your plan’s network
Most health plans have a network of doctors, specialists, and other providers. You’ll pay more if you get care outside the network. Ask your health plan if the doctor, facility, or hospital you want to visit is in your network. If you go to a doctor outside your network, ask the doctor about the cost. Some might be willing to negotiate lower prices with you.
3. Ask how to save money on prescriptions
Most plans have a list of drugs that they will pay for. The list also shows how much you’ll have to pay. If the drug is too expensive, ask your doctor if there’s a generic version. If you choose the brand-name drug, there may be coupons or discounts that can save you money. Ask your pharmacist where you can find coupons.
4. Ask questions if you get a bill
If the visit was covered by insurance, don’t pay more than the explanation of benefits from your health plan states you may owe. If the bill was for more than you were expecting, ask the doctor or facility for an itemized bill. Look for errors or duplicate charges. Call your health plan if you have questions. You can also ask the doctor for a discount or an interest-free payment plan.
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- Ask students whether they or their family members have requested from their physician and pharmacist if a less expensive drug is available?
- Are you aware that many states offer state pharmacy assistance programs that help pay prescription drugs based on financial need, age, or medical condition?
- Have you considered using a mail-order or legitimate online pharmacy for your prescriptions, especially if you will take a drug for a long time?
- What are your options to get the medical care you need and avoid a big bill?
The Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief and Economic Security (CARES) Acts required health coverage for the COVID-19 test – including the test itself, the related visit, and other services related to the testing – with no cost-sharing for individuals covered by private health plans, Medicare and Medicaid. The CARES Act, passed by Congress in March 2020, includes a provision that states insurers must pay for an out-of-network COVID-19 test at the price the testing facility lists on its website. But it sets no maximum for the cost of the tests.
Although providers are required to post the price for a COVID-19 test on a public website, there is no regulated price for the test. However, Medicare covers the testing without cost-sharing for patients and reimburses providers $51 – $100 per diagnostic test depending on the type of test administered. This price contrasts sharply with the outrageous charges made by certain providers that can run from $2,000 – $5,000 per test.
There is a better way to control the cost of testing. Here are a few reminders to help protect consumers from balance billing, and insurance companies or your employer from a costly claim.
- Call your doctor’s office if you are experiencing symptoms like a fever, cough, fatigue or if you think you may have been exposed to the virus. Your primary care physician will schedule and direct you to an in-network testing site.
- DO NOT go directly to an emergency room. There are collateral charges for a COVID-19 test at an ER that you will be responsible to pay. Before going to an ER for the test, ask yourself: Would I call an ambulance right now if I suspect exposure to the virus?
- For a free COVID-19 test, call your local county health department to schedule a test. If the appointment results in an extended waiting period, call or go to an urgent care facility and request a test.
- If you are insured, stay in-network with your health carrier. If you are uninsured, you should utilize the testing resources of your local county health department.
- If your symptoms warrant a test, follow the posted CDC guidelines.
For more information, click here.
- Ask students if anyone in their family received a COVID-19 vaccine. If so, enquire if there was cost-sharing.
- If the cost of each COVID-19 test, by law, is free to the public with health coverage, how can some providers charge from $2,000 to $5,000 per test?
- Why is it important to first call your primary care physician if you experience symptoms like fever, cough, fatigue or if you believe you have been exposed to the virus?
- If you are uninsured, what are your options to receive free COVID-19 test?
Ads abound for products that claim to treat or prevent serious health conditions. Unfortunately, these products often are unproven and useless. Sometimes the ads even make false promises for Alzheimer’s disease and dementia – diseases for which science has no cure.
In March 2019, the Federal Trade Commission (FTC) and the Food and Drug Administration (FDA) issued warning letters to certain companies making unproven claims that their products can treat or cure Alzheimer’s or other diseases .Many of these products are sold on websites and social media platforms – and called “dietary supplements” or natural remedies. But that doesn’t mean they are necessarily safe. Products that claim to do it all often do nothing.
The reality is that phony miracle products can be dangerous, and not just because of interactions with medicines you’re already taking. They also might cause you to delay or stop proven medical treatment ordered by – or available from – your physician. They might also delay you from making important dietary and lifestyle changes to help your condition. And some may contain unlabeled and unapproved drugs, which can cause serious injury or death.
For more information, click here.
- Ask students to make a list of credible sources of health information.
- Ask students if they, their relatives or friends ever bought a dietary supplement or health-related product that did not work as promised. What action(s) did they take?
- Why is it important to talk to your healthcare professional before you take any dietary supplements?
- What are some of the most effective ways to stay healthy, instead of wasting your money on unproven dietary supplements?
On June 26, 2015, the Supreme Court made an important decision about the Health Insurance Marketplace keeping quality, affordable coverage for millions of Americans. The Supreme Court’s decision confirmed that if you qualify, you can receive financial assistance, including premium tax benefit to make coverage more affordable no matter where you live.
On average, consumers enrolled in the Marketplace are receiving $3,260 per year in tax credit, or $272 each month.
About 8 in 10 consumers could find coverage for $100 or less with tax credit through the Marketplace.
If you don’t have health insurance, see if you can get health coverage for 2015. You may qualify for a Special Enrollment Period due to life change, such as marriage, having a baby, or losing other coverage. Open enrollment for 2016 starts on November 1, 2015.
For more information, click here.
- Ask students if anyone in their family is affected by the Supreme Court ruling, and if so, how?
- Ask students to prepare a summary of the major provisions of the Affordable Care Act.
- Why is it important to inform the Marketplace about any changes to your household, income, and insurance status?
- If you have health insurance through your employer or purchased it on the individual market, does the Supreme Court ruling impact you?
In 2015, Lindsey Duncan and the companies he controlled have agreed to settle Federal Trade Commission charges that they deceptively touted the supposed weight-loss benefits of green coffee bean extract through a campaign that included appearances on The Dr. Oz Show, The View, and other television programs.
Under the FTC settlement the defendants are barred from making deceptive claims about the health benefits or efficacy of any dietary supplement or drug product, and will pay $9 million for consumer redress.
The FTC charged that Duncan and his companies, Pure Health LLC and Genesis Today, Inc. deceptively claimed that the supplement could cause consumers to lose 17 pounds and 16 percent of their body fat in just 12 weeks without diet or exercise, and the claim was backed up by clinical study. In September 2014, the FTC settled charges against the company that sponsored the severely flawed study that Duncan discussed on Dr. Oz show.
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- Prepare a list of activities individuals can do to stay healthy and maintain a healthy weight.
- Choose a current issue of Consumer Reports, Money, Kiplinger’s Personal Finance, or other magazines and summarize an article that relates to losing weight.
- How can you reduce personal health care costs, including losing weight?
- Why is it important for consumers to carefully evaluate products?
- What are the keys to successful weight loss?
A new study, published in March 2015 in the Annals of Emergency Medicine, shows that the annual rate of emergency department visits by young adults age 19-25 decreased by 1.4 percent in 2011. This represents 191,000 fewer emergency department visits by young people in this age group.
For this study, currently the most extensive analysis of its kind, researchers examined more than 17 million emergency department visits between 2007 and 2011 from the Nationwide Emergency Department Sample database of the Agency for Healthcare Research and Quality’s Hospital Cost and Utilization Project.
The Affordable Care Act requires health plans that offer coverage to allow young adults to stay on their parents’ plan until age 26. This has allowed young adults to seek care in the most appropriate setting, reserving costly emergency department use for real emergencies.
For additional information, click here.
- Ask students what else can be done to reduce the high cost of healthcare.
- What can students do to reduce their own personal healthcare costs?
- What are several reasons for the rising healthcare expenditures?
- Has the Affordable Care Act reduced the costs of healthcare?