I hate going to the doctor. It’s right at the bottom of the “things I like to do with my time” list, down there with cleaning the bathrooms and catching mice in the garage. In fact, I hate going so much that I put off a visit with a specialist (endocrinologist) that I should be seeing every year for a little while. A little while being…um, three years…oops. And of course, when I finally called to try to make an appointment, “we have nothing available for the next three months, unless you want to come as a new patient – then you only need to wait two months.”
Background – I was diagnosed as a teenager with Graves Disease, an auto-immune disease that causes an overactive thyroid (hyperactive). At age 19 I had radioactive iodine treatment to destroy part of my thyroid, and have been on artificial thyroid hormone ever since. Sad fact – the doctor who originally diagnosed me, and who remained my doctor until the tragedy with his family, was Dr. William Petit. You might have seen something about him in the press, or if you stream HBO you might have seen the documentary about his family, “The Cheshire Murders”. I remember him telling me about his daughters when I was younger, apparently they loved to read just as much as I do.
Anyways, I made an appointment as a new patient (which, of course, confused the staff, because “you’re a new patient? But then why is there history here?” sigh…) so I could get in sooner. It was that visit that reminded me how you need to educate your doctors about high-deductible health plans, particularly if you have an HSA (Health Savings Account). Doctors tend to be ignorant of what the treatments they recommend actually cost – often responding “I don’t know” when asked about the cost of a visit, a procedure, bloodwork, or prescriptions. .
Most of the advice in the personal finance blogosphere on high deductible plans comes from people who are young, healthy, and generally don’t have kids. My family – is not like them. I am on a maintenance medication for hypothyroidism, and will be for the rest of my life. My husband, in addition to being a septic shock survivor, also suffers from idiopathic intracranial hypertension (pressure in the brain) and sleep apnea. My kids have been to the hospital a number of times – most recently just a few weeks ago when my husband caught our two year old playing with Tylenol he had somehow uncapped.
And I’ve had a high deductible plan, although not an HSA, for the past six years. What do I have if not an HSA? I have what’s called an HRA (Health Reimbursement Account/Arrangement) and an FSA (Flexible Spending Account), both of which add up to my deductible. Every year, I’ve hit (and exceeded) the deductible, and this year will be no different. So I have plenty of experience in using my high deductible plan, and stretching that deductible as far as I can.
Today I’m going to share that experience with you. Below you’ll find some information on how some doctors just don’t get it, and tips for you to educate yourself and your doctor about high deductible plans.
High Deductible Health Plans – Educating Your Doctor
Most doctors have no clue what the things they recommend cost. Note – I’m sure that my online personal finance friends like Hatton1; Physician on FIRE; Dad, Dollars Debts; and Wall Street Physician are exceptions. Case in point – when I was visiting my endocrinologist, we had the following conversation. Please note that Synthroid is the name-brand drug for underactive thyroid, and levothyroxine is the generic.
- Her: You know, if you took the name brand medication, instead of the generic, we might not have to adjust your dosage so often (goes on to explain that name brand medication is formulated to always be steady, while generic might fluctuate from refill to refill).
- Me: That might be true, but Synthroid is much more expensive than levothyroxine.
- Her: How much does Synthroid cost?
- Me: (thinking, you’ve been an endocrinologist for decades. How do you not know this?). Over a hundred dollars a month.
- Her assistant: I thought you had insurance, though?
- Me: I have a high deductible plan
- I receive stares from both of them
- Her: And how much does levothyroxine cost?
- Me: $4 per month from Walmart. $10 if you want to get a three month supply.
- More stares
The fact that they didn’t know what kind of insurance I had, or what the impact of their recommendation has on families, is sadly pretty typical. Physicians – know that one of every four people stepping into your practice is on some kind of high deductible plan. Soon that will be half of all patients. You can’t make recommendations without thinking about the cost anymore, or assume that because a patient has insurance and a service is covered, that it’s fine to make whatever recommendations you want.
As a patient, you need to educate yourself on the “gotchas” and push your doctor to be sure they’re giving you the right kind of and amount of care, without going too far just because you have insurance. How do you know what makes sense and what doesn’t? You’ll need to research your condition, what prescriptions are needed, and what the best course of action is. You’ll also want to stay tuned to the “educate yourself” section below-and to not be afraid to question your doctor.
Some doctors will get defensive, try to make you feel stupid, or ignore you. Those are not doctors that you want on your care team. Seek out professionals who will treat you with respect, and who will respect your time and money. Repay that with your business, and your recommendation to others.
High Deductible Health Plans – Educating Yourself
As a patient, you need to be prepared to educate your doctor on all kinds of matters, in order to protect your wallet. You also need to do things you might never have on a copay plan. This is a new world of health insurance, and no one will be looking out for you – except for you. So here are some tips and tricks of common “gotcha!” areas where you need to be on the lookout for surprise charges.
- Preventive visits and procedures (annual physicals, well-woman checkups, colonoscopies, etc.) can quickly turn from 100% covered to a huge bill with no notice or consent by you. You’ll need to be crystal clear that you give consent for nothing at all above and beyond the preventive visit, and if that’s not possible, you’ll need to be prepared for the possibility of a huge bill.
- Example – The last time I tried to get a new primary care doctor, and asked for a physical, they decided to “surprise!” me at the first visit that it wasn’t a physical. It was a “getting to know you” visit (where of course I had to bear the entire cost of the visit), and I would have had to make another appointment and take more time out of another workday to get the physical I requested in the first place. When I asked if I would be billed for this “getting to know you” visit, I got an “I don’t know?” from the person seeing me. I was furious and never stepped foot in there again.
- Imaging, like MRI’s, ultrasounds, PET scans, and CAT scans are extremely expensive under a high deductible plan. In fact, MRI’s and CAT scans can wipe out your entire deductible on their own. Two tips here. First, if someone recommends imaging, find out if it’s really necessary. Studies have shown that there is a lot of unnecessary imaging going on. Second, if it is needed, try to find a place to have it done that’s not a hospital. There are usually imaging centers where the cost is much lower. Obviously this is for non-emergency situations, in an emergency you just get it done right in the hospital.
- Specialize – very narrowly. For particularly complex conditions, find a specialist that has a lot of experience in/specializes in that condition. They’re much less likely to recommend unnecessary treatments, imaging, or procedures, since they have a lot of expertise in that area. We did this when my husband required a total abdominal wall reconstruction about a year and a half ago. It took months, but we were able to locate a doctor who had decades of experience in the procedure-even teaching it to medical students – and see him for a successful reconstruction. This is a complex surgery – it took seven hours, a week long hospital stay, visiting nurses for several weeks, and no driving/lifting anything (even the baby, who was only a few months old) for months. It’s nothing to mess around with, particularly after our experience with his near-death from septic shock. You would think this would work with the endocrinologist too, but sadly no.
- Prescriptions can be a killer. Interestingly the first, best place to check is Walmart’s $4 prescription list. Three month supplies of these medications can be had for $10. Even if I have to pay out of pocket, it costs me less to get my generic drug there than anywhere else (even mail order). If the prescription you need isn’t on that list, though, don’t fret. Other great sources of inexpensive medication include Costco, GoodRX, or your insurance companies mail-order pharmacy. Be sure to check all the sources, though, because you might be surprised at the difference in cost. If your doctor wants to write a prescription for something you can get over the counter (like Tylenol, or vitamins) just say “no thanks” and get it from the store.
- Bloodwork can be a cost killer. I stopped seeing a primary care doctor who would run a ton of bloodwork after a preventive visit (in his office, of course) that came back at a cost of thousands of dollars out of my pocket. I had no complaints, it was all “just in case” bloodwork. Remember that if you’re on a high deductible plan, you’re paying for every single test. Question your doctor as to whether all those tests are necessary.
Above all, though, don’t put off getting medical help because of the cost. Patients with high deducible plans often put off medical care due to fear of the cost. Question your doctor so you understand the true need for their recommendation, and seek out the least expensive source of care you can, but don’t hesitate to get the care that’s recommended. Issues that are minor early on can escalate into something major, more expensive, debilitating, or worse.
Take that Tylenol incident I mentioned at the start of this article. What do you do when your toddler somehow gets off a childproof cap and plays with medication you know they’re not supposed to have? You call poison control, of course (1-800-222-1222: the number every parent needs to know). Was I worried about the cost? Yes, it’s going to cost my deductible-at least. My deductible is $3250. But I still didn’t hesitate. I’ve had to call poison control a few times before for other incidents (like when my middle son ate a jack-in-the-pulpit…why???), and I know they recommend a wait and see approach when it’s appropriate. So if they say to go to the hospital, you need to go. Apparently if a toddler eats Tylenol, they can show no symptoms for days and then can die of liver failure. So only a blood test can tell for sure if a child has eaten the pills.
What Are Your Tips?
If you also have a high deductible plan, or have gone without insurance, you know just how costly medical care can be. What are your tips, websites, and other resources for saving money on care? Let me and your fellow readers know in the comments.
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