Combat costs by becoming more active in the process

It’s easy to feel that health care decisions are out of your control.

Doctors order tests and prescribe drugs. Follow-up appointments are scheduled automatically. The default position for health care providers sometimes seems to be more care.

Consumer advocates argue that patients should take a more active role in the process, especially since the typical American spends more each year on health care. Hewitt Associates, a human resources consulting firm, projects that the average employee’s out-of-pocket medical expenses – excluding premiums – will rise 10 percent this year, to $1,880.

It’s a lot tougher to be a smart, active consumer of health care than it is to be a smart, active consumer of, say, electronics. But it can be done.

Here are 10 suggestions for trimming your medical expenses, gathered from interviews, consumer advocates and news reports. It should go without saying that living a healthy lifestyle is, perhaps, the biggest thing you can do to boost your health and lower your health care spending.

1

Look for alternatives to the doctor’s office. A lot of the time, of course, you need to see your doctor. But sometimes you can ask to see if the follow-up visit is necessary. Or you might find it cheaper to have something treated at a health clinic or through a nurse practitioner. The main point, consumer advocates say, is to challenge assumptions about when a visit may be required.

2

Shop for better deals on prescriptions. Compare prices among local pharmacies, reputable online sites and the big chain stores. Try to make sure you’re getting generics when they’re available.

3

Check and compare costs before a service. This is not always easy to do, but some information is out there. The Centers for Medicare and Medicaid Services posts costs for 31 common hospital procedures ( www.cms.hhs.gov/ HealthCareConInit and click on “hospital inpatient”), and for a fee you can get cost reports from HealthGrades, a ratings company. Some large insurers have also begun to post some costs online for members.

4

Barter. It may sound crazy, but a Harris poll from 2005 found that majorities of patients who tried to negotiate lower prices with their doctors and their hospitals succeeded. So try driving a hard bargain.

5

Save. If you’re in a high-deductible insurance plan and your employer offers Health Savings Accounts, take advantage of that. Track your out-of-pocket costs carefully and enroll in a pre-tax flexible spending account if you have access to one – but don’t leave money unspent, or you lose it.

6

Check bills closely. As many as eight of 10 hospital bills contain errors, according to Money magazine. On average, the errors raise the bill by 25 percent. So keep track of every procedure and medication, and check it against the bill. If you see an error, send a certified letter asking for a correction, and copy everything to your insurance company.

7

You don’t ask, you don’t get. If your insurance plan doesn’t cover something – or if you need to see an out-of-network specialist – try to negotiate with your insurer. It’s easier and cheaper for them to make a deal than to fight a drawn-out appeal.

8

Seek information online. The amount of legitimate information about medical services online is growing, though relatively few people use it as a resource. A survey conducted for the American Institutes for Research found that 22 percent of respondents considered Web sites a trustworthy source of information. But there is a growing body of solid data, such as the Web site for the Centers for Medicare and Medicaid Services, which has a wide range of information about services and some tools for comparing among providers, such as nursing homes. It’s at www.cms.hhs.gov/Quality InitiativesGenInfo. Another Web site with lots of information on “outcomes” and quality measures is the National Committee for Quality Assurance at www.ncqa.org/.

9

An aspirin a day … Money magazine notes that a single aspirin costs about 20 cents, and that treating a heart attack costs about $25,000. Taking an aspirin once every day or every other day can bring down your risk of heart attack – so, with your doc’s say-so, you should take one if you’re a man older than 40, a woman past menopause or a smoker, or if you have high blood pressure or cholesterol, diabetes, or a family history of heart disease.

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Chill. Stress is the underlying cause of between 60 percent and 90 percent of trips to the doctor, according to the Mind/Body Medical Institute. Exercise lowers stress in the short term, and helps keep you healthy in the long term.