Tackling Insurance
Where to Cut
If you have to cut back on expenses, how do you cut back without negatively impacting your health?
Ask questions. By asking your doc about the clinical necessity and urgency of expensive diagnostic testing and medications, you can understand what value they may or may not add to managing your health. "Most physicians are comfortable in the current environment educating patients on the medical and financial value of tests and medications," says Gregory Weidner, a physician at Mecklenburg Medical Group. Be prepared with follow-up questions regarding expectations, when to call back, and potential medication risks.
Have a trusted primary physican. Having a trusted primary provider, says Stephen O'Brien, a pediatrician at Cabarrus Pediatrics, can help you navigate the healthcare system. "A primary provider can help prevent disjointed experiences and unnecessary tests because they are familiar with the patient's history," says O'Brien. "A physician who knows you or your child well will generally order less potentially unnecessary tests and will be more available for follow-up should any complications or unexpected changes arise."
Denied!
What to do if you're denied coverage for a procedure or medication
Tell your doctor. "We write a lot of letters to health insurance companies to get approval for all kinds of things for our patients," says Amy Ryan, a pediatrician at Eastover Pediatrics. "It doesn't work 100 percent of the time, but sometimes that's all it takes. We do it often for things like speech therapy, physical therapy, or when higher-cost medicines are denied and we need to prove why they're better suited for a patient over a cheaper drug used to treat the same problem."
Health Savings Account vs. Flexible Spending Account
Health Savings Account | Flexible Spending Account | |
| What is it? | An account where pretax money from your paycheck can grow to pay for medical expenses that aren't covered by insurance and to pad plans with high deductibles. At the end of the year, unspent money rolls over, and if you change jobs, your HSA goes with you. | Similar to an HSA, this account allows you to set aside pretax dollars from your paycheck for out-of-pocket medical, vision, and dental expenses, as well as work-related day-care costs. It helps you reduce your taxes, but unused money at the end of the year disappears, so make sure to spend what you set aside. |
| Verdict? | You can't opt in if you have a health plan with a low copay, like an HMO or PPO. Only people with high-deductible health plans (at least $1,100 for singles and $2,200 for couples) are eligible for HSAs. | Good for budget-wise savers and for those with more traditional medical plans, like HMOs or PPOs, who aren't eligible for HSAs |
Who Gets What?
Where does your insurance premium dollar go?
Take comfort in knowing that 85 percent of each dollar goes to medical costs, says Lew Borman, spokesman for Blue Cross and Blue Shield of North Carolina. Wanna really see where your money's going? Take a look:
| Physician: | $0.35 |
| Outpatient facility services: | $0.19 |
| Prescription drugs: | $0.16 |
| Hospital inpatient services: | $0.15 |
| Operating expenses/administrative: | $0.12 |
| Earnings: | $0.02 |
| Income taxes: | $0.01 |
Drug Wars
Do you get what you pay for in the pharmacy? We found out
Last year, a survey found that four in ten Americans, half of whom were regularly taking at least one prescription medication, reported struggling to keep up with the costs. "The price of healthcare is going up for everyone," says Darlyne Menscer, a faculty member of the family medicine residency program at Carolinas Medical Center. "Consumers need to save money where they can." But do less-expensive generic meds deliver as well as their trademarked counterparts? We gave them a head-to-head comparison:
Prescription | Generic | Advantage | |
| Cost | Because drug companies have only a short time to recoup the research and development costs of making the drug, you can pay up to $50 more a month, says Menscer. | Their major appeal is their low price tag. | Generic |
| Covered by Insurance | May only be covered when a generic isn't available. | The first choice of many insurers. | Generic |
| Availability | Since name brands are brought to market as soon as they're FDA approved, the newest drugs are prescription only. | Tend to lag behind name brands initially; a generic doesn't exist for every prescription medicine. | Prescription |
| Quality/Effectiveness | Undergo a rigorous FDA approval process. | Undergo the same approval process and contain the same active ingredients as their counterparts. | Tie |
Winner: Generic "Generics have gotten better over the years and are probably reasonable for most people," says Menscer. "But you can always consult your pharmacist or physician about the alternatives."
More from Charlotte magazine's Your Healthiest You package:
- Your Healthiest You: Navigating the modern healthcare system
- Finding a Doctor: How to avoid the most important doctors in your life
- Well Appointed: 5 ways to get more from your next doctor's visit
- Shoot It: Vaccines and immunizations you may not have received yet, but should
- Tests and Screenings You Shouldn't Miss
- ER Dos and Don'ts
- Medical Myths: Debunking junk science
- Tackling Insurance
