As we all know, today’s cost of medical care has risen dramatically over the last few decades. Most Americans are paying more for health care than they would like. Healthcare costs can be expensive, even with health insurance coverage, and the last thing anyone wants is to be dealing with medical debt.
If you consider the doctor’s visits, copays, premiums, and prescription drug costs, the amount of money spent on healthcare adds up. Even though you are legally required to pay pre-determined copays, there are many ways that you can save money on your healthcare.
Below is some essential information that can help you save money when you need to visit the emergency room, seek urgent care, or see your primary care doctor.
Emergency Room Visits
A visit to the emergency room can be a stressful time. You are aware that something is wrong with yourself or a loved one but do not know what it is or what to do about it.
Learning how the ER works and what you can expect help reduce those feelings of stress and anxiety and ensure a smoother process if you or a loved one requires a visit to the emergency room.
• If you have a health plan, find out if they offer a toll-free advice line. Many plans have the option to speak with a nurse who can help decide if an emergency room visit is needed. If you have health insurance, out-of-pocket costs for an emergency room visit usually consists of a copay, ranging from $50 to $150 or more, which is waived if the patient is admitted to the hospital. The American College of Emergency Physicians suggests that you keep a file containing insurance cards, medication list, any chronic conditions you have, operations you have had, allergies, particularly drug allergies that you have. Keep these things handy in the event you need them for an ER visit, as they are things that will be necessary.
• If you are without an insurance plan, an ER visit can range from $150 to $3,000 or higher, depending on what services need to be administered. If you have Medicaid, it helps with costs for people with limited income and resources. It also offers benefits not typically covered by Medicare, such as nursing home care, personal care home services, and rehabilitation center care.
• Emergency room care at a large hospital is divided into different units such as pediatric ER, trauma services, or observation units. Some ERs offer a “fast track” option for those patients with less severe problems. You will be assessed by a triage nurse who will take a history of your condition unless you arrive by ambulance with a life-threatening injury. He or she will measure vital signs such as blood pressure, temperature, pulse, and respiratory rates to prioritize your case in terms of urgency.
• The average cost for an ambulance trip without insurance ranges from $350 to $2000, depending on how long the trip is and what services are provided in the ambulance. If you have a health insurance plan, out-of-pocket costs for the use of an ambulance service usually consist of a copay of $15 to $100 or more, and possibly a coinsurance payment of 10% to 50%. If you have a chronic condition that requires frequent ER visits, using the emergency services at the same hospital can help speed your treatment as they will have access to all of your medical history.
• Note that hospitals can staff their emergency rooms differently. Some hospitals employ board-certified emergency physicians only. Others will use physicians from other specialties to cover the emergency room. If this concerns you, find out in advance if your preferred hospital staff only board-certified emergency physicians.
• Most emergency rooms have staff on hand to help you resolve insurance issues, health plan approvals, etc. Make sure you ask about out-of-pocket costs. Even if the hospital you are being treated at is an in-network hospital, meaning it is approved by your health plan, the doctors they employ may not participate in the plan. You may receive a bill for the services of an ER doctor, radiologist, or pathologist if they are not in-network providers under your plan.
• Most emergency room physicians will need time to assess the most critical patients first before evaluating less urgent issues. The ER is the first entry point for serious medical conditions. Oftentimes, people do not know that you can restrict your choice of an ER facility if you choose to call an ambulance. Ambulance drivers are required to take you to the nearest ER facility that is accepting patients. Many situations can pose a threat to life. The paramedics arriving on the scene will begin treating your emergency before arriving at the hospital. It makes calling for an ambulance safer than attempting to arrive by car.
• When you receive the hospital’s itemized statement for services, go through each individual charge and compare it to the explanation of benefits (EOB) provided by your insurance company. Check for medical billing errors. If you are unsure of your communication skill, hire a professional advocate to assist you.
Urgent Care Visits
An urgent care visit is the ambulatory medical care outside of an emergency room visit. It is also an unscheduled, convenient walk-in appointment. Urgent care centers primarily treat patients with an illness or injury requiring time-sensitive care but do not warrant a visit to the emergency room. An urgent care visit requires treatment for conditions that cannot wait until the next day for the primary care physician to treat when their office is open.
• Urgent care facilities often offer discounted rates for cash or self-pay for patients paying out-of-pocket. Though it is not required, you can ask about a discounted rate to help negotiate getting services at a lower cost while still receiving high-quality care. It is recommended that anyone without insurance but has a medical need visit an urgent care center rather than an emergency room. Urgent care centers do not charge as much as the hospital emergency room, but they charge a fee for their service.
• An essential visit to urgent care without an immunization, procedure, or medication can cost between $75 to $250 without health insurance. The cost depends on the illness or injury treated, the geographical location, the urgent care affiliation, and if additional testing is required. The typical copay for an urgent care visit for a patient with health insurance is between $25 and $75, depending on the insurance. Remember that it is the insurance company that sets the copay, not the urgent care center. The average cost for the three most common ailments treated in urgent care is $155.
• An urgent care center can provide care for illnesses such as flu, sore throat, minor coughs, and colds. They can also offer more advanced medical imaging, lab work, immunizations, laceration care, and orthopedic care. An urgent care center will have an on-site pharmacy to provide medications if necessary.
• While an emergency room is open 24/7 every day of the year, an urgent care center is open every day for a limited time, typically from 7 am to 7 pm.
• As discussed earlier, an ER visit’s cost is high, typically a $50 to $200 copay, compared with the cost of an urgent care visit, $20 to $75 copay, with insurance. Many urgent care centers will provide care to patients with no insurance if they suffer a minor injury such as a broken bone or a cut requiring stitches. Some will offer inexpensive x-rays to diagnose a broken bone.
Primary Care Physician Visits
Most of us will go in for preventive visits to our primary care doctor at least once a year. But for those with a chronic illness that requires more frequent care, the costs involved can be high. Prescription costs, copays, lab work, and other fees can add up during a visit. Let’s see what can be done to lower some of these charges.
• If you have no insurance, many doctors will charge a lower rate. You do need to ask for this discount, however. If you can pay in advance, that will help you to save money. For example, if you can pay for the delivery of a baby in advance, rather than paying afterward, it will save you money. Explain to your doctor and all medical providers that you see that you are a cash-paying patient. You can negotiate lower balances and payments on your medical bills.
• A doctor’s office visit without health insurance will cost between $300 to $600 depending on the services and treatment needed and the type of doctor’s office. If you have health insurance, almost all private insurers will require the insured patient to pay a copay when visiting his doctor or any healthcare provider. The amount charged will depend on the insurance plan. For example, if you need to visit your doctor for signs of poison ivy or pain management therapy, the typical copay will range from $15 to $25.
• While a visit to your dentist will often be the same copay as your doctor, a visit to your orthodontist will be more. Most orthodontic plans have a fixed copay of $1,000 to $1,200. You would pay the copay, and the insurance company will pay the remaining charges throughout the treatment. If medical care is required due to an accident obtained in the workplace, the services of a work injury lawyer will probably be needed. The costs of copays, etc., will no doubt be borne by the employer.
• If your physician has you on medication for a chronic condition, make sure you ask if there is a suitable generic alternative. Many plans will charge a significantly higher copay if using a brand name versus a generic brand. Going with a generic prescription will result in significant savings for you. When shopping for your prescriptions, don’t forget the big box stores, such as Walmart or Target. They offer very low prices on generic medications.
• Consider purchasing your prescriptions through mail order. You can also save money by doing this. For example, buying a three-month supply of a drug, you will pay two copays instead of three. Over the course of a year, this can result in significant savings. Ask your doctor if there is an over-the-counter alternative. If it is a supplement, such as a prenatal vitamin, iron pill, or medication to treat a gastrointestinal condition, it can save money if there is an alternative.
• Consider using Telehealth services. Many people are discovering the benefits of telehealth due to the pandemic. Most employers are offering virtual doctor’s visits as part of their employee health coverage. Telehealth can cost less than visiting the doctor’s office, urgent care center, or the emergency room for respiratory issues, fever, flu, cough, urinary tract infection, pink eye, or rashes.
• Telehealth can save you money in several ways.
o The visits cost a lot less than in-person visits
o Virtual visits save time and provide 24/7 availability
o There is expanded access to behavioral health physicians, which is the fasting growing use of telehealth, as no physical or lab work is needed
o Help for other types of care and management is available
• The national median cost for a video-based virtual visit is $50, compared with $85 for low-severity treatment in the office, $130 for an urgent care visit, and $740 for an emergency room visit. The savings can be significant if you must pay the full cost before reaching your insurance deductible.
• If your doctor suggests an MRI or lab test, you have the option of calling other testing sites to see what their charge would be for the procedure. There is a wide range of pricing for the same procedure across the country or even within the same city. Depending on where the procedure is done, it could be significantly less or significantly more.
There are ways the consumer can effectively save money while still getting the practical and professional medical care they desire. Remember, don’t be afraid of discussing the cost of treatment wherever you are receiving it. You do have choices.