Advice, Health & Science

Keep Medical Costs Low


One of the worst things about being in the United States is how costly it is to be sick or get treated here. Sometimes people can sink into tremendous debt to the point where they lose their homes.

 It is sad that it is that way but maybe one day it can change, especially if we unify toward that change.

A key factor in keeping your medical costs low is, of course, maintaining a healthy lifestyle but outside of that what can you do? One of the top things I recommend is understanding whatever health insurance policy you have. They can be quite confusing and it may take several calls into the company to understand your plan.

It is better to question and reach a full understanding than to learn you didn’t have to pay $50 copay anymore to see your specialist because you already fulfilled your premium requirements from some expensive procedure you had to get done earlier in the year. If that statement sounded completely foreign to you, don’t worry, you aren’t alone! Be sure to ask questions of your health insurance company until you do.

One of the easiest ways to make sure you aren’t paying too much when you didn’t have to is to get a list, if you can, of the ICD-10 codes that your insurance does cover. What are the ICD-10 codes? ICD stands for the international classification of diseases. The 10th is merely the version that we are currently on. ICD-11 probably won’t be implemented until sometime in 2022.

There is a code assigned to every issue and disease you can think of. From something as simple as lower back pain to fourth stage cancer.

Your doctor will evaluate you and then put these codes on the billing sheet as what you were seen for. There is a set price for each symptom/disease and this ends up being what you pay for. Depending on what insurance you have, they help cover the costs up to a certain percentage and you are responsible for the rest. The problem is that some issues such as shortness of breath and dyspnea have different codes but basically describe the same symptom.

So imagine if your insurance covers dyspnea ICD-10 code R06.00 but doesn’t cover shortness of breath ICD-10 code R06.02. Your office bills you with shortness of breath rather than dyspnea and you end up not getting help on any of the medical bills. Despite them being the same thing!

Know the codes that your insurance will cover and when you are at your doctor’s office ask what codes they are applying to your medical bill. If they are billing you for something that isn’t covered by your insurance then you can ask if there is another code to bill for the same issue that your insurance does cover. Similar to the example I presented above.

Another important thing to keep up with is your medical records. Anytime you see the doctor or have a procedure done, be sure to get a copy of the records, films or disk.

That way you don’t end up paying for another procedure when you already have one for a new specialist or doctor to reference.  The months and years run together and you could easily forget that last year you had a CT scan done. The new doctor you are seeing knows nothing about it and orders you to have another one. Although it may still be useable for an issue you are having now, they don’t know about it and you end up paying for a CT you didn’t need. That’s just a hypothetical scenario but it’s best to avoid paying twice for something you can still use.

The last thing to consider is rewards or incentives that some health insurance companies may offer you.

For example, some companies may offer $200 dollars in rewards if you get your physical done that year.  A $75 dollar reward if you quit smoking. Another $100 for improving your blood cholesterol levels and health stats. These are all examples and not all health insurance companies offer these rewards or programs.

But if this example were your policy then you would be missing out on $375 of free money for just taking care of yourself! The $375 would go into your health savings account to be used for future medical expenses. It is worth it to ask if your health insurance company offers any rewards. 

I used to work in a hospital as part of the front office staff. I would schedule appointments, procedures, and handle putting them into the billing circuit. I saw plenty of things both good and bad through my time there but all in all, it was a great experience. I hope these tips help someone who may be in need!


©JustTalkingShep 2019