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Lowering your medical costs

There are often ways to get your treatment or test for less money. Shopping around for health services isn’t the same as trying to get the best value in shampoo or gasoline. It’s difficult for a nonmedical person to compare treatments and medications, especially when it’s hard to know the exact cost of medical treatments. Your doctor may not know either because your medical costs depend on:

  • Your insurance plan, what it covers, and what you have to pay.
  • Where you get the service or test (in-network or out of network).
  • Whether the treatment or service requires preapproval and was preapproved.
  • Which pharmacy you use to fill your prescriptions.

What to do before your clinic visit, test, procedure, or referral  

  • Contact your insurance company to see if your insurance covers the cost and find out if there are steps you have to follow.
  • Ask if preauthorization is required:
    • If it is, make sure your doctor’s office submits a request for preauthorization (if the visit, test, procedure, or drug is not preauthorized, your insurance may not cover it).
    • Ask the testing center or call your insurance company to make sure the preauthorization was approved before your test or procedure.

Paying for expensive medications     
Pharmacies set their own prices for medications. You can save money if you shop around for the best drug price. Check online pharmacies and AARP Rx Discount if you are over 50 years old.

  • The price you pay may differ from the pharmacy’s cash price; your cost depends on your insurance coverage.
  • A drug that costs $10 at one pharmacy may cost $150 at another.
  • The closest pharmacy is not always the cheapest one. Check places like Walmart, CVS, Target, or Costco (you don’t have be a Costco member to use the pharmacy at the store or online). This can be done over the phone. Many of these stores offer large discounts for certain drugs.
  • Online pharmacies usually do not offer the opportunity to consult with the pharmacy about possible drug-drug interactions and other questions about your medications.
  • A drug’s price can vary depending on how frequently you place your order. For example, some mail-order pharmacies offer substantial discounts on 3-month (90-day) supplies.

Once you find the best price, you can change pharmacies even if your doctor has already ordered your prescription. Call and ask the pharmacy to transfer your prescription to the store of your choice. Keep in mind, though, that the transfer may take a few days.

Find out what your insurance covers  

  • Call your insurance company or check their website to find out what is covered. Make sure you have your insurance card available when you call.
    • To contact your insurance company, check your insurance card for the telephone number (it may be on the back in fine print).
    • Websites may also provide contact information, but often it is difficult to find a direct number to call.
  • Ask your insurance company about the co-payments required for medications, blood work, other medical tests, doctor’s visits, referrals, counseling services, and emergency room visits.
  • Ask about other costs you may have to pay for these medical services (in addition to your monthly payment).
  • The billing expert in your doctor’s office can provide you with the names of tests and the related test coding numbers. This information is useful when speaking with your insurance company.

Questions to ask your insurance company 

  • “Is there a limit on how many procedures or services my insurance will cover?”
  • “What kinds of treatment does my insurance cover?”
  • “What will my co-pay cost?”
  • “Is my doctor in or out of network?”
  • “Is the lab my doctor uses for tests in or out of network?” “Will I be charged for the cost of drawing blood (or other procedure)?”
  • “Are imaging tests (like x-rays, CTs, or MRIs) in or out of network?”
  • “Is the referral they made in or out of network?”
  • “Is preapproval or preauthorization required?”

If something isn’t covered by your insurance company, you have the right to appeal the claim

  • Note, though, that it’s much easier to check on coverage beforehand than to try to get coverage through the appeal process after your treatment.