SmartMoney: Patient Power
06/18/2002
Dow Jones News Service
(Copyright (c) 2002, Dow Jones & Company, Inc.)

To control information flow down the line, ask your doctor to release only the part of your records that's relevant to your specific situation. "Often, it's just easier to send the whole [file] because it doesn't require much thought," says Richard Sorian of the Center for Studying Health System Change in Washington, D.C. You may even convince your doctor to keep a certain condition or treatment off his notes entirely if he doesn't think it will compromise your future care. Just remember that any treatment for which you filed a claim is on your insurance record for good.

How To Bargain With Your Doctor

Skyrocketing health care costs are forcing more people to put pocketbook before pride. A recent poll by research firm Harris found that 17 percent of consumers asked for a discount on a medical bill in the past year, and about half of those obtained one.

While you could hire a professional advocate (find one near you at www.claims.org), you can often do fine on your own. First, determine a negotiating base. Check out www.hcfa.gov/stats/carrpuf.htm, which shows how much Medicare pays for different procedures. If you'll need several components -- a consultation, blood test, sonogram -- then negotiate a bundled rate with your doctor; all-inclusive charging usually works out cheaper. You can also offer to make a down payment or pay cash in exchange for a discount. Like most businesses, doctors and hospitals don't like to wait for payment. Finally, settle terms early in your treatment, says Larry Gelb, of California patient- advocacy firm CareCounsel: Don't talk "to a surgeon about what he's charging the morning before he operates on you."

How To Boost Your Mental Health

Coverage With coverage often limited, mental health has long been the neglected stepchild of health insurance. Yet even the strictest plan may have some wiggle room if you know where to push.

But push you must. A common trick by some insurance companies, says Gelb, is to pressure its clinicians to limit the number of sessions per patient: Even if your plan literature says you're entitled to 20 sessions, your doctor may be told by your health plan administrator that you're authorized for only eight. In such cases, Gelb says, first talk to your therapist, and if that fails, file a grievance with the plan.

It's harder, though not impossible, to get more coverage when you have actually used up your benefit limits for the year. Here, look for potential tradeoffs. For example, if your bouts with anxiety aren't serious enough to land you in a hospital, try to exchange your in-patient mental health days for outpatient visits, suggests Allentown, Pa., psychologist Ed Lundeen. "By doing that, a patient managed to see me twice a week all year despite a [plan] limit of 30 annual sessions." Some therapists will also negotiate a discounted fee, depending on your situation.

How To Get The Best From The Web

You see an ad on TV for a new drug or read about an intriguing new procedure for osteoporosis that might help your mother -- so as 100 million Americans do every year, you turn to the Web to do some research. And quickly get overwhelmed.

When perusing any one of the approximately 20,000 health Web sites, check first who's behind it, says John Mack, president of the watchdog Internet Healthcare Coalition. The most reliable ones are sponsored by government agencies or reputable medical institutions (say, the Mayo Clinic). A good starting point: the Department of Health and Human Services' free site, Healthfinder (www. healthfinder.gov), whose content has been carefully screened. To learn about cutting-edge developments, look at CenterWatch (www. centerwatch. com) and Acurian (www.acurian.com), both of which can send you free e-mails about new government and private clinical trials and recently approved drugs in your areas of interest. For other pharmacological information, Drugs.com details a drug's uses, compounds and possible interactions. To buy drugs online, make sure a site is certified by the North American Pharmacy Accreditation Commission. (Pillbot.com is one, and you can buy generics, too.) Finally, to protect your privacy, avoid giving your name to any site unless you have to.

How To Milk Your Flexible Spending Account

It's easy to confuse Flexible Spending Accounts and Medical Saving Accounts. Both are accounts overseen by the IRS that you can fund with pretax dollars to pay prescribed medical expenses.

They're almost always a good deal, considering the tax savings, but if you have an FSA, there's a catch: Money deposited has to be used by the end of that year, or else you lose the rest. (In an MSA, you can carry a balance.) With either plan, put in enough to cover your annual out-of-pocket fees (our worksheet below can help you find that figure). To avoid giving money back on an FSA, schedule eye exams or other low-risk checkups for the end of the year so you'll have plenty of cash for unplanned expenses. And if you do end up forfeiting money, remember, it wasn't taxed. For instance, if you're single, have a $100,000 salary and put $2,000 in an FSA, you save $600 in federal taxes alone. As long as you give back less than that, you're still ahead of the game.

With reporting by Noah Rothbaum