How not to go broke at the doc­tor’s of•ce

Time is money, right? Save both and learn how to pre­vent med­i­cal over­charges.

Glamour (South Africa) - - Contents - Words by Lau­ren Brown West-rosen­thal

When you walk into a cof­fee shop you know ex­actly how much you’ll pay for a latte or Amer­i­cano. That’s true for al­most every­where you spend money – ex­cept your doc­tor’s of­fice. You trust your doc­tor to run a test, and then you find out it wasn’t cov­ered by med­i­cal aid. You go in for what seems like a rou­tine pro­ce­dure, then get a bill (af­ter med­i­cal aid pays its share) for more than your monthly rent. Health care is a killer combo for any­one’s bud­get: un­pre­dictable and ex­pen­sive. As a re­sult, as many as 56% of young women skip see­ing the doc­tor be­cause of the cost. But you do have some con­trol over your med­i­cal bills. Here’s how to rein in those ex­penses, with­out putting your well-be­ing at risk.

SET your­self up for SAV­INGS

A lit­tle prep can pre­vent sur­prises later. Most doc­tors’ of­fices will ask for your med­i­cal aid in­for­ma­tion and can tell you stan­dard of­fice fees when you make an appointment. Next, con­tact your med­i­cal aid com­pany to con­firm your co-pay­ment. That’s the bare min­i­mum you can ex­pect to shell out. You can also ask whether a treat­ment you think you need is cov­ered, like travel vac­ci­na­tions and flu shots.

Your med­i­cal aid de­ductible is one of the big­gest in­di­ca­tors of out-of­pocket costs, so know if you’ve met it and try to time vis­its ac­cord­ingly. Of course, no one can ever plan a health scare, but you can ask if it’s pos­si­ble to process your claim be­fore your de­ductible re­sets for the fol­low­ing year. The folks in billing are likely fa­mil­iar with the pinch pa­tients feel when a new plan year kicks in.

Take ac­tion IN THE room

If your doc­tor is rec­om­mend­ing any­thing be­yond a ba­sic blood draw or urine sam­ple, know that those spe­cialised tests or pro­ce­dures may cost you – and you may have other op­tions. We sug­gest ask­ing, “I’m con­cerned about my out-of-pocket costs. Tell me what tests or pro­ce­dures you want to or­der to­day, and why. Is it an op­tion to wait and see?” It’s of­ten per­fectly safe to de­lay, but you and your doc­tor can de­cide how ur­gent your sit­u­a­tion is.

Re­mem­ber: a doc­tor’s pri­mary fo­cus is un­der­stand­ing your symp­toms, de­ter­min­ing what tests are needed and pre­scrib­ing treat­ments to help, but you can still ask about prices. They should know gen­eral fees, and recog­nise what care tends to be above and be­yond the ba­sics. The re­cep­tion­ist may also be able to check with your med­i­cal aid.

As your doc­tor ex­plains the next steps, lis­ten up. Cer­tain words should send up ‘This is pricey!’ flags. Med­i­cal aid gen­er­ally cov­ers most pre­ven­tive care, such as vac­cines and screen­ings for di­a­betes, blood pres­sure, choles­terol, and colon and breast cancer, in­clud­ing your of­fice visit and lab work (as­sum­ing you stay in net­work). But there are some grey ar­eas. For ex­am­ple, if your doc­tor rec­om­mends tak­ing a ‘se­cond look ’ or a re­peat test, that may not be cov­ered. When care switches from pre­ven­tion to ac­tual treat­ment, know that you may be in more ex­pen­sive ter­rain. So when in doubt, ask.

Also your pre­rog­a­tive: wait­ing to get a test or pro­ce­dure un­til you have a clearer pic­ture of the cost. Con­sider ask­ing your doc to take a beat, and then call your med­i­cal aid right then and there. A rep­re­sen­ta­tive should be able to es­ti­mate what’s cov­ered and how much you’ll have to pay.

If you and your doc­tor are sure there’s no other way around a pricey pro­ce­dure and treat­ment, or if you don’t have any aid, you may want to ask about pay­ment plans or fi­nan­cial as­sis­tance – ne­go­ti­ate un­til you reach an agree­ment that you can both meet.

SCRU­TI­NISE THE bill

It sounds silly, but when you get a bill, first ver­ify that it’s ac­tu­ally yours. Mis­takes hap­pen, and some­one else’s throat cul­ture is truly the last place you should be spend­ing your money. Also check that there are no du­pli­cate charges or ser­vices you didn’t re­ceive. In hospi­tal set­tings, some­times tests or med­i­ca­tions are or­dered that don’t get ad­min­is­tered – and only you will know to cry foul. If any­thing seems amiss, call your med­i­cal aid com­pany im­me­di­ately. It could be their er­ror or a slipup in your doc­tor’s billing of­fice, but just be­cause you’ve been billed doesn’t mean the cost is set in stone. If the facts do check out, but you’re con­cerned about your abil­ity to pay, it’s al­ways worth ask­ing what can be done. Al­ways re­mem­ber that as a pa­tient, you alone are in con­trol of your health.

“If there’s no way around a pricey pro­ce­dure, or if you don’t have any aid, you may want to ask about pay­ment plans or fi­nan­cial as­sis­tance.”

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