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Medical Bargaineering: 7 Tips to Save Money on Medical Expenses

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This is a guest post written by Cynthia J. Koelker, MD, author of 101 Ways to Save Money on Health Care, Tips to Help You Spent Smart and Stay Healthy.

If you think your employer is paying for your health care, think again. You’re the one not receiving up to $10,000 per year so your employer can pay your monthly premiums. And the situation will only get worse, with higher deductibles, co-pays, employee contributions, prescription costs, etc. What will you do to stretch your health care dollar?

As a family physician I witness these problems every day. Patients worry about the cost of drugs, office visits, lab texts, X-rays, and hospitalizations. Every physician knows ways to decrease costs, but what doctor has time to explain, when we’re expected to see a patient every 10 minutes?

It’s much easier – and faster – to spend money than to think of ways to save. But if your doctor had time to discuss the situation with you, here are a few of the tips he or she would share:

  1. Do you want the most affordable drug the first time? Bring your formulary to every doctor visit. A formulary is a list of drugs your insurance covers. No way can your doctor know what’s on every formulary. If the information is not readily available, he’ll just have to guess.
  2. Do you want to avoid expensive testing? It’s much quicker for a doctor to order an X-ray or blood work than to explain what to watch for, and whether it’s safe to wait a few days. Although longer visits with your doctor cost more than shorter visits, another fifty bucks of discussion time may save you $500 on testing.
  3. Wondering if you even need to see a doctor in the first place? Doctors love acute illnesses. They’re so much easier to treat than chronic conditions. So easy, in fact, that often you could treat yourself at home with a little know-how. Don’t call to schedule a visit. Call to ask if you need to schedule a visit. Many problems resolve on their own within a few days. Although this deprives a doctor of “easy income,” it’s money in your pocket you could use for groceries.
  4. Should you spend $2000 on colon cancer screening? That’s how much a colonoscopy will run you. But for 1/100 of that amount you can do a test looking for blood in your stool. The U.S. Preventive Services Task Force states both are equally effective.
  5. Is an annual mammogram necessary? Recent analysis suggests that for women age 50-74, every two years is sufficient. And unless you’re at high risk, the benefit of a mammogram at an earlier age (less than 50) is so low that you needn’t bother.
  6. Do you qualify for a hospital discount? Many hospitals offer discounts for income levels up to 4 times the Federal Poverty Guidelines. That’s $88,200 for a family of 4. At an income of $44,100 a similar family may quality for a 100% discount on hospital fees. This usually includes both inpatient and outpatient treatment.
  7. Would you like to go to Hawaii? Quit smoking. $5 a day amounts to $1500 a year. The same patches that were by prescription a few years ago are over-the-counter today, at less than the cost of cigarettes.

These are just a few of the tips in the best-selling book, 101 Ways to Save Money on Health Care, Tips to Help You Spent Smart and Stay Healthy, recommended in the current issue of Reader’s Digest. Would you spend $13 to save hundreds or thousands? Sounds like a deal!

{ 25 comments, please add your thoughts now! }

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25 Responses to “Medical Bargaineering: 7 Tips to Save Money on Medical Expenses”

  1. Roxanne says:

    Thank you for this article and book recommendation. I am going to add it to my Amazon cart.

  2. Mike says:


    1) Telling people to self diagnose only leads to larger expenses as conditions worsen because doctors have learned the subtle differences that are only noticed by trained professionals.

    2) Telling people to skip colonoscopies because they’re expensive and you’re “not likely” to have colon cancer is ignorant. Colonoscopies also detect potentially fatal or life-altering conditions that can lead to painful and dibilitating disabilities.

    3) If you are quoting a government board regarding mamograms, you are fanning the flames of fear. The annual mamogram is necessary as you never know when it will strike as risk is still hard to determine. Additionally, insurance usually covers the annual for 45+ women as early detection improves outcomes for less money.

    You may as well tell people to consume laxatives and eat zinc supplements to avoid the doctor. Why not add blood-letting? Leeches are cheap these days!!!

    • Scott says:

      Sounds like you’re a doc…I think it is up to the individual to “know” your body and signs that something may be wrong. I would argue that every other year would be ok for those not at risk or not having signs of something wrong.

      I personally don’t want something up my bu?? every year.

      • Dan says:

        How exactly do you “know” something might be building up in your body?

        Colonoscopies are not recommended as occurring every year.

        If you really don’t know what you are talking about you should really keep your ideas to yourself.

    • You make several good points, Mike.

      Regarding self-diagnosis, we all do this to a certain degree. Most people with a cold know it’s a cold, not pneumonia. Where to draw the line is the question. That is the very first point I make in Chapter 1 of my book. I try to offer guidance consistent with state-of-the-art medical practice.

      Regarding expensive screening tests, everyone has to decide how to budget their own resources. Although colonoscopy is the current ‘gold standard’ for colon cancer detection, well over 90% of people undergoing the test have no cancer. It’s very easy for insured folks to decide to undergo the test because somebody else is (or seems to be) paying. If my income were only $20,000 a year, I doubt I’d spend 1/10 on this test, especially when a reasonable alternative is available.

      Regarding mammograms, when one argues for a certain testing interval, one has to take into account the likelihood of occurence according to age, the ability to detect the disease including limitations of the testing procedure (false-negatives and false-positives), the expected growth rate of a tumor, the potential harm inflicted on healthy women including unnecessary biopsies on questionable lesions (false-positives), as well as the cost to the individual patient and society as a whole. Why not do the test monthly? Or twice a year? Or only every decade? All of these considerations went into the current recommendations, reviewed in Chapter 23 of my book. By the way, the book urges women to get age-indicated screenings, and advises on resources to get free or reduced-cost Paps and mammograms.

  3. Roxanne says:

    Colorectal screening:

    Researchers recommend occult fecal blood screening, sigmoidoscopy OR colonoscopy for initial screening. If follow-up is indicated, a colonoscopy is recommended then.

    Mammography interval (Screening for Breast Cancer:
    Systematic Evidence Review Update for the U. S.
    Preventive Services Task Force):

    “No definitive studies of the appropriate interval for mammography
    screening exist, although trial data reflect screening intervals from 12-33 months.”

  4. Vince says:

    Good advice. The concept of taking responsibility for ones health seems to have been lost in this country. Too often expensive tests are ordered in response to the demands of patients or in the name of “defensive medicine”.

    • Scott says:

      Any wonder health insurance / costs go up 8-10% annually? We need to take back responsibility and use common sense even if you have insurance.

  5. Split Cents says:

    While physicians knowingly choose not to counsel their patients on cost-effective treatment, they might also mention to their uninsured patients that they plan to bill them 2-3x what they bill insured patients for all this unnecessary care!

    • Vince says:

      Physicians rarely do billing themselves. Everyone(ie, insurance companies and individuals) are billed the same amount. However, insurance companies pay what they want. If you are ‘self pay’ you should be able to negotiate your bill with your physician’s office manager or hospital administrators. I had an illness prior to being insured and I was able to negotiate a 60% reduction in my bill and agreed on an 18 month payment plan. Botton line: if you are self pay, do not accept the bill you receive as the amount you are obliged to pay.

      • Scott says:

        Agreed Vince. My wife did the same as she “needed” 2 tests; she asked how much if she paid and got a # and declined one test until she saw the results of the 1st.

        The office manager ended up reducing the services to provide a good service at a good price; its like buying a car…argh!

    • Self-insured patients should be aware that the standard HMO/insurance discount is about 30% off the total bill. Medicare is similar, about 30-40%. Medicaid is about 50%. Overhead for the average medical practice is about 50%, so doctors can pay their staff and bills, but not themselves, for seeing Medicaid patients.

      Chapter 1 of my book talks about how to save money on doctor visits, including asking your doctor for a discount.

      At some point these discounts become unsustainable, though. Strangely, every time I take my dog to the vet or visit the dentist, the bill is higher than I charge my own patients.

  6. Stacey says:

    I don’t see him telling anyone to self-diagnose: “Don’t call to schedule a visit. Call to ask if you need to schedule a visit.”

    Sounds like pretty reasonable advice to me – if you’re otherwise healthy, don’t call the doctor for every cold. When in doubt, call to ask the nurse if you need to see a doctor.

  7. Roxanne says:

    It would be great if doctors were gods, doing the perfect thing perfectly at all times. The truth is that we have to be good self-advocates most of the time, or take someone with us who can advocate on our behalf. Some doctors, of course, are looking for top dollar. I suspect most of them are people who try to 1) do a good job, 2) keep their patients healthy, and 3) avoid getting sued.

    I went to my doctor with alarming symptoms that she tried to downplay. I insisted it was more than what she thought, and insisted on more (not less) care. As it happened, my symptoms were caused by an undiagnosed tumor that required prompt surgery. Doctors can’t always detect “subtle differences that are only noticed by trained professionals.” We own our bodies, and if we’re going to get the best care (and the best price), we need to take ownership of our medical treatment, too. Maybe that means demanding care they’re not already inclined to offer. Maybe it means asking more questions and laying financial situations on the table. Maybe it means asking about less-expensive (and hopefully, equally useful) alternate procedures.

    I had headaches, probably from a sinus infection. My doctor suggested an MRI; I countered by suggesting a course of antibiotics. She was amenable, and my headaches went away.

    Although she shouldn’t have to, my doctor always knows which common meds my insurance will cover, and she always starts with the option that will cost me the least. If I ask about a procedure, she knows whether my insurance will cover it and advises me accordingly. Which is all good news for me, but it’s not universal. I don’t like to see doctors painted with the broad brush of omniscience, nor is it fair to paint them all fee-mongers.

    I agree that calling ahead to determine the need for an appointment is sensible. Who has the time or co-pay to throw away?

  8. Roxanne says:

    Also, this column wasn’t written by the usual columnist; it was written by the physician who wrote the book. Wang isn’t the one offering advice here.

  9. Mike says:

    What I meant by “subtle differences that are only noticed by trained professionals.” was that if you use WebMD for self diagnosis you will be misled most of the time.

    I had tendonitis in my elbow from poor posture using a computer. The range of potential illness and afflictions was staggering. My primary physician was able to immediately tell me what was wrong and even told me how he assumed I used a computer – he was right!

    For other illness, such as a respitory infection with coughing and phlegm, it could also be walking pneumonia, which is deadly if untreated. I think the rule of thumb must be when in doubt go to the doctor. An ounce of prevention is worth a pound of cure.

    I did agree with points about advocating for less invasive procedures/tests first. I also like the idea of having the prescription drug list for your insurer at the appointment. I didn’t even know that hospitals give discounts.

    Of course, I had done the cost of cigarettes calculation myself once. I think that is a “stupid-tax” (to quote Dave Ramsey) as it is a product that is expensive and will cause long-term health problems if not kill you.

    • Scott says:

      “I had tendonitis in my elbow from poor posture using a computer. The range of potential illness and afflictions was staggering. My primary physician was able to immediately tell me what was wrong and even told me how he assumed I used a computer – he was right!”

      I am able to look at your name an know you are a man…everyone uses a computer!!!

      Let’s talk about what they mis-diagnose too. In 1993, docs looked, Xray’d my knee 3-4 times. It wasn’t until my not able to walk they finally did an MRI and found a tumor that was there. If they had been thorough, they might have removed it when smaller!

      Secondly, appx. 2006, I had obvious (hindsight is a great thing) signs of gout. Docs said “I was too young” although 10 years of elevated uric acid. Even the “specialist” had to see me 4-5 times in excruciating pain to finally draw fluid from 2 bloated knees. I’m now on a $4/mo med with no side affects and am hiking, biking for miles. Thanks to them, I lost 3 years of my life activities to the fullest.

      The only thing that is funny is he freaked out when he saw the big blob of cement in my knee-bone and the expression on his face was priceless…he forgot to look at my history that day.

      BTW, I’m 39 and 180 lbs, so pretty normal on the health side…

  10. Dan says:

    re: Should you spend $2000 on colon cancer screening?

    Having recently been diagnosed and treated for colon cancer I can’t emphasize enough how off base this recommendation is. In my case a 3 millimeter bit of cancer was identified and treated as very early stage (no radiation or chemo). By the time you are bleeding your colon is pretty mucked up and you are looking at very severe, long treatments.

    If you are over 50 and/or have a family history of cancer you should get this test.

    • Screening tests are meant to detect a treatable disease at an early enough stage to make a difference in outcome in people presumed to be healthy and at average risk.

      I’m glad you were able to be diagnosed early. This sounds like a case where the colonoscopy was life-saving. Though you don’t state whether you had symptoms, your family history puts you in a higher risk category.

      Many of my patients are uninsured and lower income. Spending $2000 for a screening test that has a greater than 90% chance of being normal is a big problem. Annual testing for occult (hidden, invisible) blood in the stool is a reasonable alternative. Again, this is for asymptomatic people. Those known to be bleeding or who have other symptoms would still require colonoscopy.

      The issue is complex and the goal is not to neglect needed care, but rather to use the resources at hand for the best outcome.

  11. FlyFisher says:

    Great idea on the formulary. Did not know these existed or how useful they could be.

  12. aua868s says:

    eat well and exercise well!

  13. Stan says:

    These are some good tips. I would add that not all docs are careful with your money. After my wonderful doctor got old and retired, I had to go through around six physicians over about 20 years to find one that connected with me. And I didn’t have any chronic problems, besides my love for tube steaks and the resulting cholesterol numbers. Some of them made me feel they cared more about making the drug sales reps in the waiting room happy than me. And were more than happy to write prescriptions in the bat of the eye. I now have a great doctor whom is willing to give me educated alternatives to expensive life-long maintenance drugs. And we also have a mutual wait-and-see about (this time) a messed up and slightly painful tendon. I think he is right, we are going to bypass expensive surgery. And the cost to me has a 15 buck Walmart gizmo I sleep with.
    I bought Dr. Koelker’s 101 Ways book and it helps to read it before calling my own doctor or rushing to ER. In fact, so far, I haven’t called my doctor at all. I just keep a good supply of OTC stuff in my medicine cabinet, keep my regular check-ups and blood tests with my doctor, and cut back on the hotdogs, except for special occasions, like at the ball park. I’m happy, not wealthy, but I’m healthy.

  14. Ralph says:

    It seems like medical insurance can be costly to you whether you have benefits or not. Thanks for some of the money saving tips.

  15. Andrea says:

    Thank you for explaining how you may be able to save money for you and those involved in your small business. Avoiding expensive testing like blood work unless absolutely necessary seems to save a good 500 bucks alone.

  16. Joy says:

    Going on generic medications is also one way to save on medications. You can use the coupon code 15C2G at International Drug Mart and save your money.

    With the above coupon code any one can avail $10 discount, when you order above $70 and 10% discount when you order less than $70

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