Putting health care costs under the knife

The Dallas Morning News (MCT) - Sharon Alt remembers receiving a panicked phone call from her daughter three years ago.

Her daughter, then age 22, was uninsured and in excruciating pain from an infection. She was about to receive treatment in the emergency room. Alt asked to speak to the doctor.

"My first question was, 'Does this have to be done in the emergency room or can she go into the doctor's office later and get treatment?'" Alt said.

That question saved her about $2,500.

"And does she have to have anesthesia? Can we just give her some painkillers instead?" Alt asked the doctor's assistant.

That question knocked another $1,500 off the bill.

Alt still relishes trimming a $6,000 medical bill down to less than $2,000. After minor treatment, her daughter left the emergency room and scheduled an appointment with the family physician.

With health care costs steadily rising and family budgets contracting, financial and health care experts recommend that consumers take control over their medical costs like Alt. Most urge being relentless in asking questions, searching for alternatives and maintaining self-discipline.

Shop for better prescription deals, said Devon Herrick, a health care economist at the National Center for Policy Analysis, a Dallas-based conservative think tank.

"Consider therapeutic alternatives and generics," Herrick said. "Compare prices among local pharmacies and reputable online sites."

William Linburg, 56, of Dallas had success searching online for Imitrex, a migraine drug, at ProgressiveRX.com. For 10 years, the drug was covered under his employer's medical plan. But when he left his employer two years ago, he could no longer afford the medication, which cost $28.77 a pill.

With two to three migraines a week lasting eight to 12 hours, Linburg went online for relief. ProgressiveRX.com found him a generic form of the drug for $3.66 a pill.

"I forwarded them a copy of my doctor's prescription and within two weeks received my order," Linburg said.

Many doctors provide patients with free samples of drugs that pharmaceutical companies are promoting. And increasingly, physicians are distributing coupons for discounts on a particular medication.

Many pharmacies, including those at Wal-Mart, Kroger, Target and Walgreen stores, offer generic drugs for $4 a month or $10 for a 90-day supply.

CVS Pharmacy last month began offering a $10 drug plan, which includes a 90-day supply of more than 400 common generic medications and discounts on medical care at its in-store clinics.

If lab work is needed, Herrick suggests shopping around, calling at least two labs to get test prices in advance.

"Check prices for both cash and your insurance plan's negotiated rate," Herrick said. "Paying upfront and filing insurance forms yourself may save significant costs."

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For those with company-provided health insurance, enrolling in a flexible spending account can offer savings, said Debra Squyres, director of human capital consulting at the Dallas office of TriNet, a human resources outsourcing company.

"If you have predictable, fixed expenses for items such as health care or dependent day care, it may be a good idea to explore taking advantage of the tax deferrals offered by FSAs," Squyres said.

An FSA allows an employee to put pretax dollars into an account to pay for medical care, but the employee forfeits any unused funds at the end of the coverage period.

If you're uninsured and receive treatment at a hospital, ask for a written copy of the hospital's financial assistance guidelines, suggests Gerri Detweiler, credit adviser with Credit.com. Patients can generally download charity care applications online.

Uninsured patients also may negotiate with a hospital's billing office to discount their bill down to the amount charged to a typical insured patient, which is substantially lower. Some hospitals offer a sliding fee scale, which may allow patients to pay according to income and family size.

Try cutting hospital visits altogether. Doctors say many chronic conditions _ such as heart disease, obesity and diabetes _ can be prevented or managed through free health fairs and diagnostic facilities to avoid hospitalization.

Many retail clinics can cost significantly less than an office visit. MinuteClinics, walk-up clinics currently offered in CVS stores in 26 states, treat common ailments such as allergies, bladder infections and strep throat for $59 to $69.

Prices for 12 common vaccinations range from $30 for a pneumonia shot to $110 for meningitis. Those with insurance may owe nothing, since many policies cover the full cost.

Avoiding the emergency room saved Alt money on yet another medical crisis. While her husband was whacking weeds in the back yard, some debris flew into his eye.

Instead of the emergency room, Alt waited until they could visit their ophthalmologist, which cost less than $200.

She's not heartless, though.

Said Alt: "Had his eye been bleeding and falling out, I would have taken him to the emergency room."

(EDITORS: STORY CAN END HERE)

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CUTTING COSTS

Here are some strategies to reduce medical expenses:

_ Cut office visits. Try actively managing chronic illnesses, such as asthma, diabetes and obesity.

_ Participate in free health fairs or visit walk-in clinics, which cost less than half of a doctor's office visit.

_ Call at least two labs to get test prices in advance. You'll save significantly by shopping for diagnostic procedures, paying upfront and filling insurance forms out yourself.

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_ Shop for better prescription deals. Compare prices among local pharmacies and reputable online sites.

If you're uninsured, you should:

_ Ask about cash rates and discounts before receiving care. Negotiate the deposit amount to no more than 10 percent of your monthly income.

_ Ask the hospital billing office to discount your bill to the rate charged to a typical insured patient.

_ Ask for a written copy of the hospital's financial assistance guidelines.

SOURCES: Credit.com; National Center for Policy Analysis

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© 2008, The Dallas Morning News.