Asking a few questions about your health insurance and knowing your options can protect your wallet after a doctor’s visit.
1. Know your options
How much you’ll spend at the doctor depends on what type of doctor you visit. Most plans will cover a phone call with a nurse, an online doctor visit, or visits to a doctor’s office, an urgent care clinic, or a hospital emergency room. Nurse lines and online visits are usually cheapest (and often free). Emergency rooms are the most expensive.
2. Ask if the doctor is in your plan’s network
Most health plans have a network of doctors, specialists, and other providers. You’ll pay more if you get care outside the network. Ask your health plan if the doctor, facility, or hospital you want to visit is in your network. If you go to a doctor outside your network, ask the doctor about the cost. Some might be willing to negotiate lower prices with you.
3. Ask how to save money on prescriptions
Most plans have a list of drugs that they will pay for. The list also shows how much you’ll have to pay. If the drug is too expensive, ask your doctor if there’s a generic version. If you choose the brand-name drug, there may be coupons or discounts that can save you money. Ask your pharmacist where you can find coupons.
4. Ask questions if you get a bill
If the visit was covered by insurance, don’t pay more than the explanation of benefits from your health plan states you may owe. If the bill was for more than you were expecting, ask the doctor or facility for an itemized bill. Look for errors or duplicate charges. Call your health plan if you have questions. You can also ask the doctor for a discount or an interest-free payment plan.
Resources
- Health insurance glossary
- Care options and costs
- Get estimates of costs of common procedures
- Avoiding big medical bills (video)
- Health insurance: 5 things you may not know
- Understanding an explanation of benefits
- What you need to know about telehealth
For more information, click here.
Teaching Suggestions
- Ask students whether they or their family members have requested from their physician and pharmacist if a less expensive drug is available?
- Are you aware that many states offer state pharmacy assistance programs that help pay prescription drugs based on financial need, age, or medical condition?
Discussion Questions
- Have you considered using a mail-order or legitimate online pharmacy for your prescriptions, especially if you will take a drug for a long time?
- What are your options to get the medical care you need and avoid a big bill?
Melissa Hart
Focus on Personal Finance, 7e 