Healthcare is a super confusing service that all of us in one way or another take part in. Doctors, hospitals, pharmacies, visits, exams, medications, tests; it’s a lot to take in and manage! Even for someone like me that works full time in healthcare IT…I don’t even understand it all! I have learned a few tips during my time in healthcare (both fighting insurance companies on the billing side and helping doctors on the clinic side) and wanted to share a few tips to help you save some $$$ while going to the doctor.

Read your plan and know your benefits

Remember that big document (whether electronic or print) that came as a summary of benefits when you signed up for your new insurance plan? If you’re like me, you probably didn’t throw it away, but stored it away somewhere where it’s gathering dust. In reality, that document is super important. Healthcare insurance is essentially one big game. Sadly it’s in the insurance company’s benefit to set rules and hope you break them, because then they don’t have to pay (i.e. going ‘out of network’). Treat it like a game and learn the rules. Understand what’s covered and what’s not so when it comes time to get treatment you’ll know. One friend of mine realized her plan covered massages while she was pregnant – a big win! Each plan will be different and knowing what’s allowed vs what isn’t allowed will help you maximize the care you get while minimizing any unfortunate out of pocket expenses that you may have.

Check your providers (and facilities) to make sure they are in-network

It’s amazing to me that this is something you’d even have to check but calling before you go in to make sure your provider (and facility) is so important. Different offices and even different doctors can accept (or not accept) a variety of plans. Before seeing a new doctor, give them a call and specifically ask (they should be able to tell you), “Hello, I have this plan (i.e. ‘Humana National POS’), do you accept them? If they do, great, you’ll be ‘in network’ and pay a much lower cost. If not, you’ll be considered ‘out of network’ and have to pay a much, much higher amount. The same goes for surgeries too – a surgery will see a professional component (the doctor’s fee) and a facility component (the hospital’s fee). Be sure to ask about both as they might not both accept!

Understand the costs and read your bill

Once services have been rendered, the office/hospital will submit a claim (i.e. bill) to the insurance company for payment. The insurance company will either pay (or deny) the claim based on a pre-determined contracted amount. (i.e. doctor bills $100 but insurance has agreed that they get a $25 discount and only have to pay $75). The insurance company will then send you an Explanation of Benefits (EOB). Do not accept that EOB at face value! Take the time to read through it and make sure it seems right.

When possible, shop around

 A lot of people forget that healthcare is actually a service industry, meaning there are multiple service providers all competing for the right to sell you their service (healthcare). With that, you as a patient (i.e. consumer) have a choice! It’s perfectly within your rights to do some homework before hand to make an informed choice. If your doctor wants you to get a certain test or scan, you have the right to choose where to get it done. Different labs or imaging centers will charge different amounts for the same test/scan. Of course there is an aspect of quality as well, but so many times we forget that you can save $$$ by getting it done at a cheaper location. Sure your insurance will pay hopefully most of the bill, but you’ll still have a copay, a deductible and possible co-insurance to pay but saving on the overall cost saves you money! There’s a great app/site called Castlight that maintains records of services and their costs at different facilities. A lot of companies will include a membership to Castlight as past of your insurance package, so be sure to check on that. If not, you can do some of the heavy lifting on your own and make a few phone calls! A little work ahead of time can save you big bucks.

Call BS on anything that sounds fishy

By following the rest of these steps, you’ll likely be decently knowledgeable when receiving care. Keep a sharp eye out; healthcare is full of waste, redundancies and errors! Whether it’s receiving care at the office, talking on the phone to your insurance company, or reviewing a bill, don’t be afraid to call BS if something doesn’t look right. You have rights as a patient to not be ripped off, and don’t be afraid to call people/companies out! Take charge of your own health and play an active role!