Tips to help you save on health care

Being a savvy health care consumer has never been more important. With some people finding health care costs soaring as benefits dwindle, it pays to know how to make your coverage work for you.

Know before you go

It’s not enough to ask if a health care agency takes your health insurance. Your health care professional should be contracted with your insurance network. If you’re operating under a Preferred Provider Organization, or PPO, using a health care professional not on the list is going to cost a lot more of out-of-pocket dollars.

“You need to be very careful and definitely when you call to talk to a doctor ask if they are contracted with your insurance,” said Becky Weaver, office manager of Grand Junction dentist Scott N. Vandusen.

In general, Weaver said, clients are learning to check online or call their insurance companies before scheduling appointments.

However, health care professionals can move in and out of networks. If a health care provider moves out of your network, you’ll need to change medical providers or face paying more for the same services, Weaver said.

“People couldn’t understand why they kept having to pay so much even though they were insured,” she said about the misconception.

Save ER for emergencies

You should always go to a hospital’s emergency room during life-threatening situations; for example, if you believe you’re having a heart attack, experiencing a loss of consciousness, losing large amounts of blood, having seizures or convulsions, or experiencing numbness and paralysis, among numerous other serious conditions. However, not all afflictions require an emergency room visit, which can result in bills that are estimated to cost at least three times that of a primary care doctor’s visit.

“Sometimes you do need to go to the emergency room. In many instances, reasons for you to go to the emergency room could be handled at primary care,” said Kayla Arnesen, marketing director for Rocky Mountain Health Plans. “We have after-hours clinics that are very accommodating.”

Four urgent care facilities listed in Mesa County are: Med-X Urgent Care, 1060 North Ave. Suite N; Docs on Call, 3150 N. 12th St.; Family Health West Urgent Care-After Hours, 551 Kokopelli Blvd., Suite G, Fruita; and UCC of Montrose and Grand Junction, 517 N. First St.
Arnesen said it’s always a good idea to call your primary care doctor first unless your condition is so severe you cannot call.

Pediatricians, for example, typically have someone on call who can answer questions and potentially could save a costly trip to the emergency room. Arnesen called her pediatrician at
2 a.m. for advice when her child had a fever. She was advised to buy an over-the-counter drug.

“A $4 bottle of Benadryl solved the problem,” she said.

Focus on prevention

Many health care policies offer free or reduced-cost preventive services such immunizations, dental cleanings, eye exams and routine screenings such as prostate exams, mammograms, Pap smears, physicals and services for children. But don’t forget periodic screens for blood pressure, blood sugar and cholesterol, as well as testing for colon cancer and HIV.

However, if symptoms arise, it’s best not to try to ride out an illness in the hopes it will disappear, according to Dr. Dale Kliner of the Colorado Urgent Care Association. Waiting to seek treatment can sometimes result in worsening conditions that may require further medical care.

“More patients are being diagnosed with pneumonia after suffering minor conditions such as a cough, indicating that some patients are waiting to seek treatment, when their best interest is to act immediately,” Kliner said in a news release.

Go generic

The first question to ask your doctor after being prescribed a drug is whether it’s available in a generic form.

For customers of Rocky Mountain Health Plans, which make up 60 percent of Mesa County residents, getting a generic prescription can be a cost savings of 50 percent to 80 percent off name-brand drugs, said Kayla Arnesen, marketing director for the insurance company. Arnesen advised that patients first ask their physicians to prescribe a generic form of a drug, which may be easier than attempting to buy a prescription in its generic form once you get to the pharmacy.

“It’s a common misconception,” she said. “If generic drugs are available, they are just as safe as the brand name.”

Check your bills

Any number of mistakes on your medical billing could change the amount paid by your insurer or cause an insurer to reject the claim. 

  Be sure to check bills carefully for items such as correct account numbers, services administered and that the services were billed to the correct insurance company. Study your benefits booklet to be certain of your coverage.

If you locate a billing mistake, send a certified letter to your insurer and follow up in few weeks to check if it was corrected.

Don’t hesitate to call your doctor or insurance company if you have questions on a bill.

If your insurance company won’t pay for a service you feel is necessary, dispute it.

If you have questions, contact Colorado’s Division of Insurance.

Keep in mind state laws don’t apply to federal health care plans such as Medicaid and Medicare, plans that are self-funded by employers and plans that are based in another state.

Colorado’s Division of Insurance can be reached at 303-894-7490.

Or e-mail questions to .(JavaScript must be enabled to view this email address).


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