Controlling your health care spending: Managing the perfect storm

CMDRC perfect stormThe costs of health care have simply gotten out of control. It is now routine practice for me to discuss not only my recommendations for ultrasounds, pap smears, bone density scans and other tests and procedures but increasingly I have an ethical responsibility to discuss the out of pocket costs of these tests and procedures as well.

There is a perfect storm brewing—one that has the potential for dramatically increasing your out of pocket medical expenses. The mixture of declining physician reimbursement, continuing liability concerns, high-deductible insurance plans and larger co-pays will translate into more expensive health care costs for all of us. So here are some thoughts on reducing your personal health-related expenses.

Rule #1: Stay out of emergency rooms unless it’s an emergency!

It’s Tuesday morning at 8:00 AM. You’re a 24 year old woman with two children and you wake up with intense right lower quadrant pain that radiates down the front of your thigh. Your appetite isn’t all that good but you don’t have a fever or diarrhea. You had a normal period a week ago and you’re taking oral contraceptives. The pain is intense—8 points on a 10 point scale. You choose the following action plan.

  • You call your sister, the medical student.
  • You call your mother who tells you she’ll meet you at the closest urgent care center.
  • You don’t call anybody but go to the closest emergency room.
  • You drink chamomile tea followed by rice water and wait for 30 minutes to see what happens.
  • You call your physician’s office and ask to speak with a health care provider

Although none of these is a wrong answer you don’t want to start this day with an emergency room visit. Emergency rooms have long, arduous and expensive routines. Unless you truly have reason to believe what you’re experiencing is a medical emergency you want to think twice before spending many hours getting “ground up” by the emergency department system.

Don’t get me wrong. Emergency rooms are the only place I’d be if I truly had a medical emergency but I also know that I’m not leaving there without numerous blood tests or a CT scan (or MRI)—and G-d only knows what else! The potential out of pocket expense and hassle for what may be a very annoying but non-emergency condition can be ENORMOUS.

So before you choose this path you might want to simply call your physician’s office. Start out by being nice but insist on knowing the name of the person you’re talking to. Also keep a pad of paper near your to write down “who” told you “what” (and at what time). Be agreeable but be insistent. If someone doesn’t give you the answer you want at your doctor’s office ask for their supervisor’s name. If you can’t be seen in a reasonable period of time make sure you speak to someone in authority and document when you called, whom you spoke with and what you were told. You will often be seen the very same day—but remember to be nice but insistent.

Rule #2: If something is wrong at 2 PM don’t wait until 5:30 PM to call the office

The first thing one generally hears on a voice recording after 5 PM is the following: “if this is a medical emergency go directly to an emergency room.” Often your condition may not appear until the middle of the night and an emergency room may be your best alternative. But if you begin noticing troubling symptoms at lunch time don’t wait until the end of your work day to call your physician’s office—it’s the end of her work day too!

Rule #3: Question the need for lab work

Question the need for lab work—if you have 2 doctors getting the same lab work there’s money being wasted somewhere. If you want to make things simple on yourself and your doctors keep a 3 ring binder with a copy of all of your lab work. With today’s easy on-line access to your own medical records it’s easier than ever to keep track of your own labs.

Rule #4: Just ask

Doctors—especially older physicians—need a little time to adjust their thinking to the new health care paradigm. For much of the past 35 years co-pays for office visits and prescriptions have been relatively low, there were no “high-deductible” insurance plans until recently. Many physicians don’t understand what your particular insurer or plan does or does not cover.

All you need to do is let your physician know right up front that you’re concerned about the price of office visits, procedures, tests and prescription drugs. We often know of ways to reduce costs. It is a perfectly reasonable request to figure out the least expensive remedy to ever-increasing health care costs.

Rule #5: Know as much about your own health care history as possible and write it down

When you do go for an office visit keep yourself well-organized. Here’s a list of things you might want to keep on a word document and update before an office visit—especially if it’s a new doctor or health care provider. This will often shorten the length of your visit and help to save you money. Make sure it’s legible—word documents are best. Be prepared to give your provider a list that includes the following:

  1. All of the medications you are taking including name, dose and frequency of administration.
  2. All your allergies—especially to medications and latex.
  3. All hospitalizations including the reason for and dates of admission.
  4. All your surgical or other procedures including the name of your treating physicians.
  5. All of your chronic medical problems (hypertension, diabetes, smoking history, gout, cancer, migraine headaches).
  6. Pertinent family history including a family history of heart disease, strokes, breast cancer, uterine cancer, cervical cancer, ovarian cancer, lung cancer, colorectal cancer.
  7. All your current physicians including their contact information.

Rule #6: Be able to state succinctly why you’re visiting the provider today

Often it’s obvious why you’ve made an appointment. You may be coming in for a scheduled annual examination or to have a breast lump checked. For many women, however, they may have a variety of vague symptoms including fatigue, generalized achiness, sporadic abdominal pain, indigestion or a sense that “something isn’t right.”

Try to be as specific as you can be about the reason you called to make this appointment.

  • What is your most troubling symptom and when did it start?
  • What are you most worried about? Are you concerned that the abnormal period you just experienced is a sign of menopause? Are you worried that it’s cancer?

Try to organize your thoughts as best as you possibly can. If feasible write it out so that you can present it to your physician. This may take you some time but it will allow your physician or provider to get a clear understanding of your symptoms and will save you time and money at the doctor’s office. If you have a second “issue” you wish to discuss with your provider organize it in the same way. If you’re well-organized you are more likely to have both issues addressed that day. If not, you’ll likely get a second appointment—and more expense.

Rule #7: Understand the different between “wants” and “needs”

This can be a “touchy” area. Some women “insist” on having “bio-identical” hormones for hormone replacement therapy. Their daughter may insist on a “name-brand” birth control pill or a well-advertised sleep-aid. New drugs are often expensive and uniformly lack long term data to prove they really are worth the money. With many pharmaceuticals it pays to seek out generics instead. Before you are sold on the “latest and greatest” “natural” hormone take some time with your provider and do some on-line research. Avoid company websites. There are many good websites available to the public such as or Other worthwhile websites are sponsored by the government and include and where you can find wonderful search engines that will allow you to explore a host of topics including anxiety, domestic violence, breast cancer, HIV/AIDs, endometriosis, infertility and more.

The bottom line is to go to your physician’s office armed with as much information as possible. Try to organize your information and your “needs”.

Rule #8: Don’t “insist” before you listen

A woman was recently surprised to learn that the cervical cultures she “insisted” on having cost over 300 dollars. There was no reason for the cultures—the woman hadn’t been sexually active in a year. The laboratory fees came as quite a surprise because her other doctor neglected to talk to her to determine whether or not she really “needed” those tests in the first place. The woman was about to start a new relationship and wanted to make sure she was “clean.” For considerably less money I’d have been happy to send her to the Monroe County Health Department where she could have gotten her cervical cultures for free!

Doctors don’t like to say no—it’s usually our nature to be accommodating. But be sure that you really need 300 dollars’ worth of reassurance before you “insist” on it.

Rule #9: Is this what you would recommend if I were your wife, daughter, mother or sister?

CMDRC Mrs WortmansThis is an important question to ask your physician if she is contemplating a minor or major surgical procedure for you. Physicians have to consider many issues before making a recommendation. Traditionally such considerations include signs and symptoms, your overall health, risks that are procedure-specific as well as potential benefits. But it’s perfectly fine to ask them to consider your personal financial picture as well. See Rule #4.

Rule #10: Determine whether or not your procedure can be done in an office-based setting.

Many procedures once performed in a hospital or outpatient department setting can now be performed in an office. In fact many instrument manufacturers have produced devices and methods that can be performed in an office setting. Click here to learn more.