How to trim your health bills



Save by reducing taxable income

Surprisingly, these accounts, offered by many companies, even small ones, are often not used by consumers -- so if you didn’t sign up for 2009, consider it next time around. Employees of companies that offer the accounts can have set amounts (minimums and maximums are set by each company) taken from their paychecks pretax and put into these accounts to be used for health expenses as major as brain surgery or minor as contact lens solution. (Each company can decide what it will allow in its specific plan; you can get a good idea of allowed expenses under the federal government’s flexible spending program at www.fsa According to Laurie Brubaker, a benefits expert with Aetna, which administers some of these accounts for businesses, setting aside $2,000 from a salary of $25,000 will create a tax savings of $450. Use Aetna’s calculator to match your allocation with your salary at www

Spend it or lose it

Many people often don’t open an account because any money left at the end of the year is forfeited. Cathy Tripp, a senior consultant in the Minneapolis office of benefits consulting firm Watson Wyatt, suggests making a list of medical needs for the year, including prescription sunglasses and new contact lenses or a visit to the doctor to check on an allergy, and making those appointments before the benefit year ends. And remember: The money is deducted over the course of 12 months, but the full amount you choose to set aside is available to you from the first day of your benefit year.



Review what you take with a doctor

Shopping for lower prices isn’t necessarily the first step you need to take if you want to lower your prescription drug bill, says Michael Cohen, president of the Institute for Safe Medication Practices in Horsham, Penn. First, review the drugs you take (a good practice once each year regardless, doctors say), to determine whether you still need the drug or that dose and whether you could safely substitute a less expensive option for the drug.


A visit with your doctor to review the drugs is your best bet. If you’re concerned about the cost of the visit, you can ask if the doctor will go over your list by phone. (And see below for strategies to reduce the cost of an office visit.) A local pharmacist can also review your drug list and make suggestions to your physician for changes, but never stop taking a drug unless the doctor has specifically given you the OK.

Ask your pharmacist if your particular medicines can be split or if you can use two lower doses to make up the dose you need. Review the costs, including any co-pays. Those options can sometimes save money over the cost of buying the exact dose prescribed. Then . . .

Price shop

Sure, the corner drugstore may be convenient, but it may also be expensive. According to the National Center for Policy Analysis in Washington, D.C., comparing prices among local pharmacies can save consumers almost 10% on brand-name drugs and up to 81% on generic drugs. You can check comparison prices in your area at, but also call the local pharmacy to confirm. And some pharmacies may match competitors’ prices. Costco’s prices for brand-name drugs often rank among the lowest, and the warehouse store doesn’t require a membership fee for people buying only prescription medicines.

Don’t assume Internet prices are cheapest. Local pharmacy prices for a 30-day supply of the cholesterol drug Lipitor (80-milligram dose) hovered around $83 recently. The same drug cost $119.99 at

Go for the generic

This year, many pharmacies, supermarkets and big retail stores such as Walgreens, Ralphs and Target began offering hundreds of generic drugs for as low as $3 per month per prescription. Not all stores offer all generics for the low price, and the list can vary from chain to chain, so check by phone or at the store’s website. CVS charges $10 per year for a savings pass that entitles cardholders to buy 90-day supplies of more than 400 generic drugs for $9.99 each. That fee also gets you some discounts on nonprescription drugs and on visits to its Minute Clinics, staffed by nurses who can give some vaccinations and treat minor illnesses. As the economy continues to falter, expect more deals from drugstore chains. Kmart, for example, lets many customers at most stores buy one of several nonprescription products such as pain relievers and a decongestant for the discounted price of $1 each time you buy a prescription, for a savings of about $3 to $6. Find the website addresses for the stores you frequent and sign up for alerts.

Buy in bulk

Sixty- and 90-day supplies of drugs are often cheaper by mail order and at retail stores than a 30-day supply. That’s especially true for people with insurance coverage for prescription drugs; buy a 90-day supply and most insurers charge only a two-month co-pay, which can be a savings of at least $20 per year for each generic drug you take, and at least $80 per year for brand-name drugs. Consumer Reports Best Buy Drugs advises checking online prices, for U.S. and foreign pharmacies, at Use the price per pill to compare the costs on the site, and factor in the shipping costs that most sites charge. The Food and Drug Administration offers advice at on buying drugs online through only verified Internet pharmacies.


Scout for coupons and offers

You can get discounts on some brand-name drugs by looking for coupons on the drug’s website (plug the drug name into a search engine to find the site) or at www Discounts can sometimes apply to co-pays as well.

Check out other cost-saving programs

Additional deals that can save you money include the Together Rx Access card, sponsored by 10 drug companies and offering discounts on many brand-name drugs, and the SunRx Discount health pass, sponsored by pharmacy benefits manager SunRx. Check or call (800) 444-4106 for income eligibility and the current list of drugs that qualify. Anyone without insurance (as well as many small business owners) can sign up and print out the SunRx card, which offers -- at participating pharmacies -- up to 15% on many brand-name drugs, up to 70% on many generic drugs and some money off nonprescription drugs. Sign up at or call (800) 650-3184.



Delay may lead to serious problems

Even if you have insurance and are paying only a co-pay to see a physician, the costs can mount, especially if you have young children. But not seeing the doctor when necessary could result in a far more serious illness -- and far more serious costs, says Carolyn Clancy, head of the federal Agency for Healthcare Research and Quality (AHRQ). So . . .

Talk with your doctor

J. James Rohack, president-elect of the American Medical Assn., advises people facing economic problems to be upfront with their physicians about cost concerns. “The doctor cannot waive a co-pay required by insurance -- that’s a part of his or her contract with insurers -- but doctors may be able to help with some costs, such as providing samples of certain medicines,” he says. Consumer advocacy groups such as the Medicare Rights Center, based in Washington, D.C., and New York City, suggest trying to negotiate the fee if you’re paying out of pocket. Doctors have to wait weeks to months for payment from insurers, and may be willing to forgo some profit for faster payment, says Paul Precht, communications and policy director for the group.

Insured? Stay in your network

If you do have insurance and have been seeing doctors outside your plan, ask physicians, colleagues or friends if they can recommend doctors from your list. That may mean saying goodbye to a trusted physician, but it can save you more than $100 on a single visit. Ask your out-of-network doctor if you can stay in touch by e-mail or phone if you have questions, and also ask if the doctor would consider joining your insurance network.

Try bartering

People who own their own business, such as plumbers or lawyers, may consider barter to help pay doctor fees. Joanne Levine, who owns a PR firm in Chicago, does public relations for a few companies in exchange for barter credits that go into an account with a bartering firm. Levine has used the credits to pay for care by a periodontist, an optometrist, a surgeon and a dermatologist. “But not very many general practitioners are registered with the firm I use,” she says. There may be fees involved in maintaining a barter account, so this option may be best for people who pay for other expenses through bartering as well. Find information about barter memberships at or the International Reciprocal Trade Assn. at


Go to a retail clinic

If you or a child has a minor problem such as a low fever, a scratchy throat or a minor skin infection, a retail clinic may be all you need. They’re staffed by experienced health professionals, typically registered nurses or physicians’ assistants. Fees are about $50 to $65 for a visit, often well below doctors’ offices, and if you have insurance, you may be charged just a $10 or $20 co-pay, well below the cost of an emergency room visit co-pay or fee. Check the websites of clinics, such as Minute Clinic (owned by CVS), at and Take Care (owned by Walgreens), at; there may be a discount offer that can save you an additional $5 or $10.

Visit community health centers

These local clinics offer care on a sliding scale, based on income. If you’re not eligible for free care, the centers will work with you on payment options, which could include helping you find financial assistance in your area.



How to get -- or keep -- a policy

In danger of losing your job, and the health insurance that comes with it, in 2009? Take a breath. This is a topic we’ll revisit often in 2009, but we have some basic advice right now.


If you lose your job in 2009, before you officially leave the premises, ask the firm if it would consider paying for your health coverage for an extended period of time, says Emily Spitzer, executive director with the National Health Law Program in Washington, D.C. If not, and if the firm offers a COBRA (Consolidated Omnibus Budget Reconciliation Act) plan, sign up for it for at least in the short term. It’s an opportunity to pay for the same health insurance you’ve had while employed with the company. Though firms are allowed to charge up to 102% of what they pay to cover you, and, if applicable, any dependents, it is likely to be the most comprehensive coverage for the least amount of money, Spitzer says. During that period, you can look at other health-insurance possibilities, including an employed spouse’s insurance options, an individual policy and public assistance, if you qualify. But buy yourself that time. Remaining insured is important; not just because of a possible emergency, but also because an interruption in coverage for you, or for a dependent who has an ongoing medical problem, could mean a delay in coverage for a preexisting condition, even when you get the new job and its benefits.

Then do your research

Here are some resources that should help:

California’s Health Consumer Alliance:, a partnership of consumer-assistance programs;

Families USA:, a nonprofit seeking affordable healthcare for all Americans;

HealthCareCoach:, a project of the National Health Law Program.



Ask financial questions first

The AHRQ’s Clancy says too often the only question patients have about surgery is where to park on the day of the operation. But many hospitals offer free parking for one car (with a patient’s identification number), so don’t worry excessively about that . . .


Talk with the hospital brass

Whether or not you have insurance, a meeting with a financial officer at the hospital could help with costs. Showing a willingness to pay, even if over time, can generate goodwill, says Mark Rukavina, executive director of the Access Project, based in Boston, an affordable healthcare advocacy group. Some hospital financial staff workers may work with your insurer ahead of time to let you know what costs will be covered and what you will have to pay out of pocket. If you can’t pay, the financial office may be able to direct you to financial assistance options, or set up a payment schedule.

Don’t agree to use a credit card or retirement account

Recently, articles in the Wall Street Journal and Business Week have reported on some hospitals running credit checks on patients seeking care, before treatment is even provided. In some cases the check has turned up assets such as an available credit limit on a credit card, or a 401(k) account, and the hospitals have asked patients to use those assets to guarantee and then pay their bill. Rukavina of the Access Project advises against using credit cards to pay medical bills unless you plan to pay the bill in full by the end of the month. If not, your medical bill rises by the monthly interest fee you pay, and not paying it can result in penalties and higher fees on all of your credit cards because of the changes to your credit score. And any early use of a 401(k) account will trigger penalties and leave you without resources for retirement, the reason you set up the account in the first place. If you are asked to use these resources, Rakavina advises asking to see the hospital’s chief financial officer and to insist that you be allowed to set up an extended payment plan. Consumers who find themselves in this predicament can visit the Access Project website for assistance at

Consider surgery in a foreign country

Medical tourism, having surgery in a foreign country such as Singapore or Thailand, has been making headlines as a lower-cost option for people without insurance -- surgeries can cost as much as 90% less, according to the Medical Tourism Assn., a trade organization. However, the National Business Group on Health, which advises large corporations about healthcare expenses, recently issued a brief that pointed out concerns about medical tourism, in addition to benefits, such as a risk to patients who speak English only but must interact with medical staff who do not. The American Medical Assn. says people who opt for surgery in a foreign country should arrange for a doctor to monitor them on their return. That, of course, would involve additional fees, especially if the doctor thinks follow-up care or even a repeat surgery is necessary.

So far, most insurance companies don’t cover surgeries overseas, though WellPoint, which insures millions of Californians, is doing a trial run with a small company in Seattle. If successful, WellPoint and others could cover the option for a larger number of people beginning in 2010. Because of the huge cost savings, largely due to lower salaries and lower-cost malpractice insurance in many foreign countries, insurers could decide to waive all co-pays for foreign surgeries, in addition to covering travel and lodging costs for the patient, and, often for a travel companion as well. For more information, have a look at the Medical Tourism Assn.’s website at www.medicaltourism, or contact PlanetHospital, a firm in Calabasas that arranges surgical care overseas.

At least one company, North American Surgery Inc., based in Vancouver, Canada (, negotiates on behalf of individuals and small companies and is able to offer prices for many surgeries at U.S. hospitals that can rival foreign rates. The company checks on accreditation and even patient outcomes before signing on with surgeons and hospitals, but you’ll want to check on your own as well, and ask your primary-care doctor to speak with the surgeon you choose.



Early detection can pay off

Even if you have no known health problems, certain tests such as mammograms and prostate exams should be done regularly so that any indication of a problem can be detected as early as possible, Clancy says. AHRQ recently created test checklists for men,, and for women, And . . .


Look for free or low-cost screenings

Many associations offer free screenings for many conditions at certain times of the year. Type the name of the condition and the word “screening” into a search engine to see what’s available. In the Los Angeles area, screening dates are often posted at www.healthy, or you can find some free tests by calling 211. Type in “health observation days” at and you’ll find a calendar with an observance day for just about every disease. Organizations often hold screening programs on those days, and websites for hundreds of organizations that offer information, and, often, free or low-cost tests are listed.

Look after yourself

The AMA recently introduced a program called Healthier Life Steps -- a guide for consumers with or without their physicians. Go to .html. The point here is that by stopping smoking, losing weight, exercising and controlling chronic diseases, Americans can save money on healthcare and be healthier. For example, when Mike Huckabee, the former governor of Arkansas and a presidential candidate, was diagnosed with diabetes, he opted for losing weight and exercising and never took -- and so never spent money on -- any medication.