Surviving the Health Care System: 5 Money-Saving Tips

I actually had a pleasant trip to the dentist once.   

Years ago, after a routine teeth cleaning, I was given a pricey estimate for a necessary dental procedure. Since the cost exceeded my insurer's maximum annual coverage, I would have to pay $1,000 out of pocket. Desperation and fear made me speak up.  

"Can we reduce the price somehow?" I asked, with the dental bib still affixed to my shirt. 

That's when things took a turn for the better. My dentist discussed the request with his staff and suggested we do the second half of the procedure in the new year, which was only a month away. That way, with my insurance renewed, more of the cost would be covered. Asking my dentist for financial guidance -- something I didn't realize I could do -- saved me $300.  

It's a small example of how self-advocacy can lead to better financial results, including medical savings. And, as health care costs continue to climb, we need to practice this now more than ever. In the last five years, more than half of US adults say they've gone into debt from medical or dental bills. 

The advice was echoed on my podcast when I spoke with Emily Maloney, author of Cost of Living, a book that chronicles her painful observations and experiences as both a medical professional and a patient battling mental illness. 

In our conversation, Maloney cited the many dysfunctions within our health care labyrinth that can lead to giant medical bills and other problems for patients. For example, at one hospital where she worked, the facility had $54 million in debt (common for small, high-use health care centers), which led to medical shortcuts, fewer staff and dated equipment, as well as billing errors and misdiagnoses. "That debt creates rationing, and then that rationing, of course, trickles back down to patients," Maloney said.

5 tips to reduce health care costs and stress

Since the burdensome costs of medical care largely fall on us as individuals, Maloney offered these critical pieces of advice that can help to save us money and stress.

1. Have the 'money talk' with your doctor

As my experience at the dentist proved, doctors have a "fiduciary responsibility" as part of their Code of Medical Ethics to promote their patients' best interest and welfare -- that includes financially. 

But we have to proactively mention that we want to save money. If your doctor doesn't bring it up on their own, ask about lower-cost generic drugs. Ask them to review your health insurance to get a better sense of what's financially feasible. Be sure your physician includes the correct medical billing codes for your visit to ensure proper health care coverage, as well. Before booking a procedure, you can compare prices on sites like Health Care Blue Book and Fair Health Consumer and see if your doctor can match or beat the lowest listed price.

2. Question your medical bills

Many medical bills contain errors, so you may want to hold off on paying right away."Usually, it's not correct or it hasn't been sent through all the insurance, so you end up with a bill that may not be actually accurate," said Maloney. 

You can work with a billing specialist or advocate that may come provided through your employer to review the costs and diagnostic codes. Or, call the health care provider and ask for a fully itemized breakdown of all the billable components of the visit to detect possible errors. If your bill is correct and you need more time to pay, ask the medical office to create a payment plan. 

3. Review debt law

If a medical bill goes unnoticed and is turned over to a credit agency, there are protections in place to give Americans up to one year to clear their outstanding medical bills before they're posted on credit reports. Also, in 2023, the three major credit bureaus -- Equifax, Experian and Transunion -- will end reporting all medical collections below $500.

If your medical debt has gone into collections and it's difficult to pay even the minimums on large medical bills, review your state's statute of limitations on collecting that debt. For medical debt, the legal window for creditors to sue you for unpaid balances ranges from three to 10 years. In Maloney's case, she learned about this through a collection agent who informed her that her debt had essentially "expired" and would be canceled. It would mark the end of her five-figure medical debt saga.  

4. Seek medical allies 

It may sound obvious to say that you want a doctor who you feel comfortable with, but that's not a given, especially if your insurance doesn't allow for a wide choice of providers, Maloney said. "It's really important to find providers you can trust, and that's something that I think can be a challenge."

A lot of women aren't taken seriously, so it's often hard to find compassionate health care, according to Maloney. As well, she said, people of color and LGBTQ patients may face significant discrimination. Seek references from friends, family, colleagues and even social media groups. You can also read patient reviews on sites such as Zocdoc before making appointments.

5. Get a friendly advocate

No matter where you end up receiving care, for more serious or involved appointments, have a friend or loved one accompany you for both technical and emotional support. 

"The experience of being in the physician's office can be really stressful," said Maloney, who sought out support when she was trying to find appropriate care. "Don't be afraid to bring someone with you. They can take notes. They can be your advocate. They can hang out with you in the waiting room."

Seeing the bigger societal picture

To improve the health care system, Maloney insists that we need improved health literacy across the country so that, for example, patients know when to visit the emergency room versus urgent care or a physician's office. Our country also needs more doctors and medical practitioners, as well as a standardized, electronic medical record system to ensure patients receive consistent and correct care wherever they turn, she noted.

As for a more fundamental change, Maloney proposes single-payer or universal health care where the government foots the entire bill. "There should be a system for everyone to receive care." In her view, it's a myth that this kind of system will be more expensive. "It's just a question of who ends up paying for that care," she said.