Have Insurance that Works for You

Looking at the total cost of your plan (premiums, deductibles, co-pays, out-of-pocket maximums), and making sure your plan covers your providers, hospitals, and prescription drugs can lower your out-of-pocket medical costs. You should review your plan each year to make sure it is the best plan for your needs.

Work With Your Health Care Team to Get Necessary Pre-Authorizations

Many health insurance companies require you to get approval before you get medical care. If you don’t get the pre-authorization, your claim might get denied.

Go to In-Network Providers When Possible

In-network providers have a contract with your health insurance company to provide you with care and services at a discounted rate. Going to in-network providers, facilities, and pharmacies can save you money.

Keep Track of Your Out-of-Pocket Maximum

While your insurance company usually keeps track of what you paid out-of-pocket for the year, and may even list that on your Explanation of Benefits (EOB), it can be helpful to keep track on your own to make sure the amounts match – mistakes can happen! If you’ve reached your out-of-pocket maximum and a provider wants to charge you a co-pay, you can show them your EOB.

Leverage Your Out-of-Pocket Maximum

If you’ve reached your maximum for the year, consider addressing any other health care needs you have, rather than waiting until the new plan year.

Make Sure Health Care Providers Have Up-to-Date Information

This helps providers to file your claims and contact you in a timely manner. Bring your insurance cards with you to each medical appointment and to the pharmacy.

Compare Options and Prices

It may be helpful to think about your health care options like you would any other item or service you buy. For example, you usually don’t have to use a specific lab for a blood test, and there can be significant cost differences between labs! The same can be true for other tests and prescription drugs.

Discuss Costs with Your Health Care Team Before Treatment

Your health care team may have suggestions for reducing costs, for example, arranging health care appointments grouped together, helping you avoid extra co-pays for office visits.

Negotiate with Health Care Providers

Ask for up-front prices for non-emergency tests and procedures and if there are discounts available. You might qualify for an “ability to pay” or “charity care” program at a health care facility. Many hospitals have a billing department and patient navigators or financial counselors who can help you negotiate a bill.

Ask Questions

Don’t be afraid to ask questions. Ask your health care team if services will be covered by your insurance and if there are ways to lower your costs.

Ask for Help

You are not alone. Ask your health care team and/or your insurance company if you need help. They likely have resources to support you or can direct you to somewhere that does!