Empowering Patients: 18 Essential Questions to Save on Medical Bills and Insurance Costs

by | Nov 14, 2023 | Insurance

healthcare insurance

…actively engaging in your healthcare necessitates participation in decision-making, fostering open and effective communication with your healthcare provider, and taking ownership of your health.”

Alan Feren

There are common questions patients can ask to clarify how their prescribed treatment will be billed, the estimated cost of that treatment, and what is expected to be covered by insurance. Everyone’s healthcare situation is unique. Knowledge is power when handling healthcare costs. The United States healthcare insurance system is complicated at best. Use the following questions to be an informed healthcare consumer and use your dollars wisely.

Insurance Coverage

  1. What services are covered by my insurance plan? Understand the extent of your insurance coverage, including services, procedures, and medications covered. This knowledge helps in planning and budgeting for healthcare needs. Learn more about how to read an insurance policy here.
  2. Are there any specific in-network providers or facilities I should use? In-network providers often result in reduced out-of-pocket costs. Inquire about recommended providers or facilities covered by your insurance plan.
  3. What are the out-of-pocket costs for visits, procedures, or medications? Clarify the specific out-of-pocket expenses for various medical services to avoid unforeseen financial burdens. Understand how deductibles, co-pays, and out-of-pocket visits work together or separately within your health insurance policy. Do you have an opportunity to participate in a Health Savings Account (HSA)? Learn how you can cover insurance bills using an HSA
  4. Can you suggest generic alternatives for prescribed medications to lower costs? Discuss cost-effective medication options, such as generic equivalents, to reduce expenses while maintaining the required treatment. Additionally, check insurance tier options for more affordable medications.
  5. How does the billing process work for services provided during this visit? Understanding the billing process ensures clarity on costs and potential areas for negotiation or clarification. Pay attention to any paperwork given prior to a healthcare visit or procedure regarding billing. Don’t sign any agreements before completely understanding what they mean to billing the patient.

Medical Necessity

  1. Are all the tests, treatments, or procedures being recommended absolutely necessary for my condition? Engage in discussions to ascertain the necessity of proposed medical interventions, ensuring that all recommended actions are essential for your well-being. Understanding all options helps the patient make the best decisions for their healthcare
  2. Can we discuss alternative, less expensive treatment options? Explore cost-effective alternatives to the proposed treatment plans, considering their efficacy and affordability. It may be possible to try a less expensive treatment option and evaluate its effectiveness before moving on to a more expensive alternative.
  3. Are there lifestyle changes I can make that might alleviate the need for certain medications or procedures? Ask about lifestyle modifications that could potentially reduce dependency on certain medications or medical procedures.

Follow-Up and Monitoring

  1. Do I need all the follow-up appointments/tests you’re recommending, or can some be spaced out to reduce costs? Discuss the frequency and necessity of follow-up appointments and tests, considering the balance between required care and cost management. Alternatively, if a deductible has been met, see if appointments/tests can be scheduled before the end of the insurance contract to decrease or eliminate additional out-of-pocket expenses.
  2. Are there at-home monitoring or self-care methods that could reduce the need for frequent office visits? Explore self-care strategies or at-home monitoring to minimize the need for multiple office visits, thereby reducing costs. Consider telehealth appointments to reduce the number of office visits.
  3. Could you provide resources or educational materials that might help me manage my condition without frequent medical intervention? Seek educational resources to empower self-management, potentially reducing the need for frequent medical interventions. Healthcare providers often have literature to give to the patient in their office. Alternatively, providers may suggest reputable websites where patients can find trustworthy health information.

pills and twenty dollar bills
pills and twenty dollar bills

Billing and Payment Assistance

  1. Can I request an itemized bill to understand the charges more clearly? Always request an itemized bill to see the breakdown of charges and services provided. Check each bill for errors. If you are charged for a test or visit that did not happen, contact the provider to dispute the bill and have it resubmitted to insurance. Here is a great book to guide you through the process.
  2. Are there payment plans or financial assistance programs available for those facing financial challenges? Inquire about available payment plans or financial assistance options to manage medical expenses more effectively.
  3. Is there a possibility to negotiate or reduce the cost of services provided? Explore the potential for negotiation or cost reduction for services rendered, which some healthcare providers may be open to discussing. Simply asking for a discount may result in a significantly reduced bill.
  4. What is the self-pay cost? Sometimes the self-pay cost is less expensive than paying the deductible and co-pay. Understanding insurance policy and payment responsibility as a patient will indicate whether or not self-paying will cost less.

Miscellaneous

  1. Can you recommend specific over-the-counter medications or remedies instead of prescriptions when suitable? Ask about over-the-counter alternatives or non-prescription remedies that might be effective and cost-efficient. Keep in mind that sometimes prescriptions are less expensive than over-the-counter medicine. Ask the pharmacist about the costs of both before purchasing.
  2. Are there community or local resources that offer discounted or free healthcare services or support for patients? Explore community resources that provide healthcare services or support at reduced or no cost. County health departments often offer basic services such as vaccines or family health clinics at reduced or no cost.
  3. Could I get copies of my medical records or test results to avoid duplicate tests if I see other healthcare providers? Request copies of medical records and test results to avoid duplication of tests when consulting with other healthcare providers. Alternatively, use healthcare provider patient portals to access records and test results. Those results may be forwarded to additional healthcare providers. Learn more about patient portals here.

If you need more help, a patient advocate can help you sort out the tangle of healthcare and insurance billing. Learn how to find a patient advocate here.

Conclusion

Using these questions as a guide during medical appointments empowers patients to actively manage their healthcare expenses and make informed decisions regarding treatment, insurance coverage, and cost-effective alternatives.

A little effort on the patient’s part may significantly decrease healthcare costs. Patients who educate themselves about their health insurance benefit coverage and provider billing practices are in the best position to reduce the cost of their healthcare.

Not sure what questions to ask at a doctor appointment?  Download our FREE 7 Questions Everyone Should Ask at a Doctor Appointment.  Click HERE to get your download now.