Try retail
therapy Some large pharmacies and retail
stores, such as CVS, Eckerd, Target, and Wal-Mart, have recently opened
in-store clinics. Often staffed by nurse practitioners (yes, they can
diagnose you and even write prescriptions), they don't require an
appointment, and the price—typically $25 to $60—is less than what a
visit to most doctors' offices would cost you.
Visit a nurse's office
Nurse practitioners can frequently offer the same care as a doctor, at a
lower rate. "Nurse practitioners fill a needed void in the health care
system today," says Allison Beard, spokesperson for the American College
of Nurse Practitioners. Research comparing nurse practitioners with
physicians shows that nurses tend to spend more time with patients,
charge less, and do just as good a job of diagnosing problems.
Pick up the telephone Got
that same old sinus infection again? Your physician might help you for
free by phone. But if not, try calling TelaDoc at 800-835-2362. It
provides real live doctors for quick telephone consults. Cost: $35, plus
an $18 registration fee and a small monthly fee. If the doctor feels
that your diagnosis is simple and obvious, he or she can call in a
prescription to a nearby pharmacy. "We're not here to diagnose anything
serious like diabetes or heart disease," says Roger Moczygemba, M.D., a
family practitioner in San Antonio and one of TelaDoc's nearly 200
participating physicians. "But for simple problems and simple
treatments, we're an easy and affordable option." For more information,
go to www.teladoc.com.
MEDICATIONS
Comparison-shop The price
of drugs can vary enormously from one drugstore to the next. Surfing the
Web for the best prices can save you a bundle. For mail-order options,
go to www.pharmacychecker.com to compare prices on many common
medications sold by U.S. and Canadian pharmacies. (Caution: buying
Canadian drugs is illegal, though rarely prosecuted.) For info on
prescription-assistance programs, discount-drug cards, and discount
pharmacies, go to the
website of the
nonprofit Medicare Rights Center and click on Discount Rx Resources.
Consumer Reports also has a
free website
that will help you compare drug options to find what's most efficacious
and economical. For more on the safest, cheapest, and most reliable drug
for your condition, visit
www.aarp.org/comparedrugs.
Consider generics or cheaper brands
For most drugs, "there is absolutely no difference in the therapeutic
value of generics and name-brand drugs," says Eric Mack, R.Ph., Ph.D.,
an associate professor of pharmaceutics at California's Loma Linda
University School of Pharmacy. Kao-Ping Chua, spokesperson for the
American Medical Student Association, suggests that you have a
heart-to-heart talk with your doctor, explaining that you need to
economize on the cost of your pills. Be grateful for free name-brand
samples if you have a short-term need for a drug, but be cautious of
them if your need is ongoing. You'll save more money in the long run if
you take a cheaper generic that works just as well.
Pick store brands "What
holds true for prescription drugs holds just as true for
over-the-counter drugs," says Mack. "Store brands are often made by the
very same manufacturer as the advertised name brands. But there's no
difference except for the packaging and the price," he says.
Be inventive Sometimes
doctors can't prescribe a generic because there is no generic. But, even
then, consider asking your pharmacist about alternatives to bring up
with your doc. In the case of the pain drug Arthrotec, for example, the
name-brand version typically sells for more than $200 for 90 tablets.
"Yet it's exactly the same as taking two generics—diclofenac and
misoprostol—that together cost about $110 per 90 doses," says Bill
Overkamp, R.Ph., president of Bill's Pills, an online pharmacy.
Ask if it's safe to split…
"Most tablets and pills (but never capsules) can be split, often saving
you a substantial amount," says Overkamp. For example, if your
prescription is for 10 milligrams of a given drug, you may be able to
buy it in 20-mg doses and then split the pills in half. Pills labeled
"time-released" or "long-acting" are exceptions; they usually are not
safe to split. Always check with your doctor, and never take less than
the prescribed dose of your medication.
...or to double up Buying
smaller doses of your medicine can sometimes save you money. Overkamp
notes that the antidepressant fluoxetine generally costs about $90 for
45 40-mg pills, but you can often buy 90 20-mg capsules for only $50.
Taking two of these lower-dose pills would save you $40 for 45 doses.
Freebies If you have a
limited income, you may be eligible for free or low-cost drugs through
your state or the manufacturer. The Partnership for Prescription
Assistance can help you learn if you qualify. Call 888-477-2669, or go
online. Those 65 and
over with annual incomes less than $14,700 (single) or $19,800 (couple)
and limited assets may qualify for drug coverage under Medicare at very
low cost, and additionally may be eligible for a Medicare savings
program (also known as a Medicare buy-in program) that can help pay for
other Medicare out-of-pocket expenses. "Many people who could benefit
from these programs know nothing about them, and that's sad," says Deane
Beebe, a spokesperson for the Medicare Rights Center in New York City.
Contact Medicare for more information by calling 800-633-4227 or
visiting
www.medicare.gov.
EYE CARE
See through the hype "The
retail markup on eyeglass frames tends to run as high as 1,000 percent,"
says Doug, an optician who also works as a sales rep with a major
eyeglass wholesale company and who asks that we not give his full name.
The cheapest frames, he says, are available at large retail stores and
optical chain stores. But these usually don't hold up as well as frames
from eye doctors' offices or boutiques. And because of the markup, the
price of the frames you really want may be more flexible than you think.
"Negotiate," says Doug. "If you buy two pair, ask for 20 percent off.
You'll probably get it. Also ask if they ever issue coupons or run
seasonal sales. If you can't get a price reduction, try to negotiate
something else, perhaps an extension on the warranty, an upgrade on the
lens from plastic to polycarbonate (which is lighter), or scratch
protection."
Score a free exam EyeCare
America, a program run by the American Academy of Ophthalmology, has
helped more than 760,000 people in the past 20 years. If you are 65 or
older, have not seen an ophthalmologist in the past three years, and do
not belong to an HMO or have coverage from the VA, then you may be
eligible to receive a comprehensive eye exam and care for up to one
year. The program is also open to people under 65 who are at increased
risk for eye disease. You can find more information by calling
800-222-3937 or
going online. Many Lions Club chapters work with optometrists and
ophthalmologists in their communities to provide free eyeglasses to
those with limited means. You can find the Lions Club nearest to you by
calling 800-747-4448 or visiting
their website.
HOSPITALS AND EQUIPMENT
Skip Saturday night at the hospital
"Unless it's a true emergency, don't check yourself into a hospital on a
weekend," says Charles Inlander, a consumer-health advocate based in
Allentown, Pennsylvania. "Many hospital departments aren't open on
weekends, and others have reduced staffs, which means you might be
paying $1,800 a day for a room with a view of the parking lot." Better
to schedule your hospitalization for Monday and get the attention you
need to mend as quickly as possible.
Check your bill—twice
Your hospital bill comes to you looking like a veritable rat's nest of
codes, numbers, debits, and credits. How can you tell if the accounting
is accurate? You often can't. Yet the number of mistakes on hospital
bills is high. "In my experience, 50 percent of bills have an error or
an overcharge somewhere," says Susan Dressler, president of the Alliance
of Claims Assistance Professionals (ACAP), whose members help patients
decipher their medical bills. "I was contacted by one woman, quite
alive, I assure you, whose hospital bill showed a charge of $40 for
'cadaver-kit preparation,'" says Dressler. "I had another client who was
charged a small fortune for 20 daily doses of a heavy-duty painkiller.
If he had taken that much, he'd be dead!" If you think your hospital
bill may be a bit overstuffed, ask the hospital accounting person to
explain it to you, line by line. If that doesn't prove productive,
contact ACAP at 630-562-1000 or online.
Most members charge by the hour ($30 to $120), although some will charge
a percentage of any amount they recover. They can also help you if your
insurance company is reluctant to pay for your care, even though your
policy seems to indicate it should. Similar services are rendered by a
Philadelphia-based company called Healthcare Advocates. Call
215-735-7711, or go to
their website.
Take your ailment on the road
"Some of the best hospitals in the world today are located outside the
United States, in countries like Thailand and India," says Paul Zane
Pilzer, "They often have U.S.-trained physicians, and sometimes deliver
safer and better services in a comfortable, resort-type atmosphere."
And—as reported on 60 Minutes recently—a quintuple-bypass
operation might run $12,000, as opposed to $100,000 or so in the States.
In South Africa an outfit called Surgeon & Safari advertises package
deals that give you orthopedic, plastic, ophthalmologic, or dental
surgery, plus the chance to spy on lions and elephants, all for less
than you'd spend for a few days in an American hospital. If you prefer
to stay in the Western Hemisphere, Costa Rica Health Escapes advertises
that "Costa Rica not only offers quality medical care, but offers it at
a fraction of the cost for the same procedures in the United States." Of
course, wherever you go for surgery, whether in the United States or
abroad, very carefully check credentials and get referrals.
Bargain like the big boys
Your hospital may be charging you way more than it does some of its
other patients—especially if you're paying your own way. Pulitzer
Prize-winning investigative reporters Donald Barlett and James Steele,
tell how a hospital in Orlando charged one uninsured patient $35,200 for
an appendectomy. Medicare would have paid $6,200 for the same operation
in the same hospital; a typical insurer, $7,000. There are currently no
fewer than 70 class-action lawsuits involving at least 400 allegedly
not-for-profit hospitals and hospital systems whose uninsured patients
say they have been price-gouged. If you have no insurance or Medicare
and feel you were taken for an anesthetized chump, don't be afraid to
ask your physician and the billing department about cutting the bill
down to size. If those talks go nowhere, you might want to hire a
(contingency-based) attorney.
Accept hand-me-downs If
you find yourself in need of a walker, wheelchair, reclining bed, or
other piece of potentially pricey medical equipment, don't rush out and
buy a new one. "Your church, senior center, or social club may know of
people who have hardly used equipment that they'll sell you for a song.
It never hurts to check," says Bryn Mawr's Jennifer Campbell. "Have a
professional evaluate the piece of equipment to make sure that it's the
right one for you."
INSURANCE
Handle COBRA with care
The Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA) says
that if you leave your job, you can take your health insurance with you
and keep it for up to 18 months, provided you pay for it on your own.
But that's not always a good idea. If you are fairly healthy, you might
be able to find a policy that will be more economical than your COBRA
plan, says Pilzer. The longer you wait, the older you'll be, and the
more a new plan is likely to cost. Be cautious about moving from group
insurance to individual, however, if you have pre-existing conditions.
Your new insurer may try to exclude them from coverage. You might want
to check with your state department of insurance to know your rights
before you make any changes.
Think before you apply If
you get turned down for health insurance once, you'll have to report it
on all future applications. So don't apply in writing until you're
fairly confident you will be accepted. How do you find that out? Apply
in person or over the phone, or ask a good broker who represents many
companies. Different companies have different "look back" periods—the
span of your recent health history they take into consideration, usually
from three to 10 years. If you had some health issues in the past, you
may have better luck with a shorter "look back."
Check your health credit
Few people know about it, but there is an outfit called the Medical
Information Bureau (MIB). Similar to a credit bureau, MIB keeps tabs on
things such as test results and serious ailments you suffer. Though not
everyone has an MIB record, if you have applied for individual life,
health, or disability coverage within the past seven years, chances are
you do. And the bureau can tell insurers whether you are a good risk or
not. MIB is subject to the Fair Credit Reporting Act, and so, if you ask
to see a copy of your record, the bureau is required to send you one.
Get your report by calling 866-692-6901 or going to
the website. You'll see
what insurance companies are told, and that will give you a good idea of
how easy or difficult it may be for you to get insurance on your own.
And you can correct any errors that may be costing you coverage.
Silence is golden After
you've made an application to a health insurance company, you'll
typically get a telephone verification call. "Listen to each question
carefully, pause, think about the question, and then answer only and
exactly what has been asked. A simple yes or no without comment is often
your best reply. Don't start a conversation. Don't elaborate on your
answers. The person at the other end of the telephone is not your
friend, and any extra information you provide can only be used against
you—and may wind up on your MIB," says Pilzer.
Think short-term
Normally, you wouldn't want a short-term health insurance policy. Unlike
most policies, they are not guaranteed renewable. But because of that
feature, they tend to cost much less than regular insurance—about one
half to one third as much. If you know you won't need to renew the
policy because you've got a job with good benefits lined up, "it makes
sense to flip to a short-term policy and save yourself a bundle," says
Pilzer. "Most carriers carry short-term insurance, so the switch may
just require a call to your present agent."
DENTISTRY
Be a guinea pig Just as
medical schools are a place to go for cheap medical care, "dental
schools offer extremely high-quality care for about one third the price
you'd pay elsewhere," says John Dodes, D.D.S., a dentist in private
practice in New York City and author of several books on dental health,
including Healthy Teeth: A User's Manual (St. Martin's Press,
1999). "Just be aware that going to a dental school for care isn't going
to be quick," he adds. "It can be very time-consuming."
Watch the markup "It's
perfectly okay to ask a dentist, 'Is this a fair price?' " says Dodes.
One Pennsylvania man was handed a $90 bill for a single tube of hydrogen
peroxide tooth-whitening gel. He went online, searched for "dental
supplies," and rapidly discovered that the wholesale cost for the tube
was about $7. "Er, excuse me, but that's a 1,200 percent markup," he
pointed out to his dentist. The dentist charged him $21 for the tube and
wrote "$69 professional discount" on the bill.
The Politics of Health Care
Nearly all the people interviewed for this story say
that although take-charge tactics can help to reduce health costs, the
need for such tactics is indication that our health care system is
troubled. Or, as Peggy Cabaniss of the National Association of Personal
Financial Advisors puts it, "the system is nutty."
Activist William Schwied, M.D., says that ultimately
the only answer, if Americans want reasonably priced, effective health
care, would be to adopt a national, government-funded health care
system, similar to what exists in Canada and Western Europe. Pilzer, who
is not only an author but also a former economic adviser to two former
(Republican) White House administrations, agrees that a "complete
reform" of the system is needed, though he favors a free-market
approach. Among his proposals: allow health insurance to be sold across
state lines, make all insurance premiums tax-deductible, and allow for
international competition in pharmaceuticals.
Both experts, divergent as their opinions may be, do
agree on one point: "Nothing is likely to change if government officials
continue to have unlimited lifetime health benefits while the rest of us
do not," says Pilzer. "How can they possibly understand what so many
Americans must suffer to get decent health care?" says Schwied.
