Reducing Medical Costs


We all agree that healthcare is inappropriately expensive but at this point there is little we can do about how much we are charged. 

Instead, let’s figure out how we as consumers can game the system a bit for discounts!  None of us would buy a car without looking for deals or shopping around and yet we have all been hypnotized into believing we have no options in healthcare.   Maybe we need to spend less time with grocery coupons and more time trying to figure out ways to shave bigger dollars off our healthcare bills.

Prescriptions are by far the largest healthcare expense for most people over a lifetime and are the largest portion of the U.S. healthcare dollar spent.  Let’s breakdown potential drug savings into 3 categories; cheap drugs, expensive drugs, drugs you may not need.  

Cheap drugs (aka generic drugs) have a HUGE scam potential.  Many generic drug prescriptions cost LESS than your 1st tier copay.  Older, or better yet, “proven” generic drugs can cost $5-10 for an entire course, yet your copay is $20-$40 per prescription.  Herein lays the scam. The pharmacy is more than happy to charge you the $40 copay and make an extra $35 profit rather than tell you to just not use your insurance and simply pay out of pocket.  Also, don’t be afraid of generic drugs! The more time a drug is on the market, the more we know about it’s safety.  Pharmacies are no different than any other retail store. They don’t have an ethical obligation to give you a fair deal and like any retail store, employees/pharmacists may be pressured to maximize profits for the company.

Newly released expensive drugs are the bane of any doctors existence.  One economic concept prevails here: “pharma” makes 99% of their money off of “on-patent” or “drug monopolies.” The day their drug goes generic, it becomes cheaper due to free market competition.  The fact that there are TV commercials selling the latest new drugs to lay people is mind-blowing to me. If you have a doctor you need to “tell me about drug XYZ”, get a new doctor.  The reality is this drug may not be better at all, but is merely an attempt for Pharma Inc. to make more money.  This particular pharma scam usually comes in one of 3 shapes:

  1. Create different “convenient” dosing of the same medications and obtain a new patent on it so they can charge new drug prices.
  2. Take a known “older” drug and tweak one molecule, patent it and convince you it is more effective. To put this in perspective, if they can prove there is a “statistical difference” in effectiveness, the drug gets approved and the $15 medication course now increases 5000%. FYI- “statistical significance” can be defined by a small chance of improved effectiveness, and not improved for all patients.
  3. Combine 2 older drugs to make a shiny new expensive drug. After all, the inconvenience of taking 2 pills is worth $100’s right?!

I will be the first to admit that doctors can be influenced by marketing or accessible information, just like anyone else.  Do your homework and ASK YOUR DOCTOR if there are cheaper acceptable alternatives to what you are prescribed.

Next, facility fees are healthcare system’s response to poor insurance reimbursement. These charges can be hidden and can be devastatingly expensive for some patients.  These are the fees that are tacked on to your bill if the procedure or lab work occurs in a “health care facility.”   For example, it may be cheaper to get lab work done at a designated lab or an Xray done at a radiology center rather than at a hospital or urgent care facility.  ASK if there will be a facility fee associated with your testing and then call your insurance to see if they have designated places you can go where this charge is not applicable.

Lastly, much of healthcare is not “urgent” and has some time flexibility. If your doc suggests a surgery, X-ray, or bloodwork ask if they are time flexible and if so get them done AFTER you have met your deductible for the year.  If you have a colonoscopy or elective surgery coming due next year try and have it scheduled early and within the current insurance year to maximize your deductible-free period.

The era of blindly accepting medical costs is coming to an end.  Take charge of how you spend your healthcare dollars, help your doctor fight with your insurance company, and ignore those drug commercials!

Undercover Doc
I am a double-boarded specialist who has worked with patients of all ages in the office, hospital and ER realm for almost two decades. I will be your unbiased source for information that healthcare teams don’t normally discuss with patients due to time of other constraints. From alternative therapies and medico-legal quandaries, to uncovering the mysterious world of medical costs and billing, I’ll focus my articles on topics you don’t see in the mainstream media or health system websites. Stay tuned for my next installment!

Comments are closed.