How to cut costs of heart disease, cancer, diabetes and other chronic conditions
Source: David Nganele, PhD, president of DMN Healthcare Solutions, a health-education company based in New York City. He is founder of Harmony Health Communications, where he developed award-winning disease-management programs in cooperation with doctors, drug companies and community groups. He is author of several books, including The Best Healthcare for Less. John Wiley & Sons. www.thebesthealthcareforless.com.
A chronic disease can be financially devastating even for someone who has health insurance. Benefit limits often are reached before the condition is under control.
People without insurance may be forced to borrow money or sell assets when faced with such conditions as recurring cancers, heart disease, depression and diabetes.
Making lifestyle changes – quitting smoking, improving your diet and exercising – can reduce the need for medication for many conditions. In addition, sufferers can eliminate some costs entirely by understanding how hospitals, drug companies and doctors do business. Most effective cost-saving strategies…
AT-HOME CARE…
● Become an expert. Learning all you can about your illness may help you discover lower-cost treatments and aspects of the condition that even your doctor may not know about. You’ll als benefit psychologically from putting yourself in charge instead of relying solely on your doctor.
● Contact association specializing in your condition. They can help you to locate low-cost treatment centers and suggest ways to prevent your condition from worsening.
Example: Adding supplemental chromium, magnesium and vanadium to your diet may help with diabetes.
Associations for several common illnesses…
● American Cancer Society, 800-227-2345, www.cancer.org.
● American Diabetes Association, 800-342-2383, www.diabetes.org.
● American Heart Association, 800-242-8721, www.americanheart.org
● American Kidney Fund, 800-638-8299, www.kidneyfund.org
● Depression and Bipolar Support Alliance, 800-826-3632, www.dbsalliance.org
If you’re unsure of the appropriate organization, contact the American Medical Association for a referral (800-621-8335, www.ama-assn.org).
● Investigate alternative treatments, such as acupuncture and biofeedback. Many now are covered by insurance. Even if they’re not, they may cost less and be more effective than conventional treatments. For information, contact the federal government’s National Center for Complementary and Alternative Medicine at 888-6444-6226, www.nccam.nih.gov.
● Buy drugs in large quantities to save on copayments. Most insurers charge a copayment for each prescription, regardless of the drug’s cost. Copayments today can be as high as $50.
Ask your doctor to write 90-day prescriptions, instead of 30-day. You will reduce your copayment by two-thirds.
Example: If you take eight prescription medicines – not unusual for someone with a chronic condition – and have a $30 copayment, your cost will fall by $1,920, or two-thirds – from $2880 (8 x $30 x 12) to $960 (8 x $30 x 4).
If your insurance company won’t allow more than a 30-day supply of a drug from a local pharmacy, ask your health insurer if it uses a mail-order drug service. They typically supply 90-day quantities. Most insurers prefer that you order by mail because it holds down their costs.
● Ask your doctors for free samples. Pharmaceutical companies give away billions of dollars worth of samples for doctors to pass on to patients. Don’t be embarrassed to ask. If your doctor doesn’t have samples, ask him to prescribe generic drugs. For all but a very small percentage of patients, generics are just as effective as brand-name drugs. If you do have insurance, you may have a smaller copayment with generic drugs.
Example: A patient who suffers from depression and doesn’t have drug coverage typically pays about $647 for 90 tablets of Prozac in 40-milligram (mg) strength. The generic equivalent represents a saving of 30% or more.
● Take part in a clinical trial. Each year, thousands of people with chronic ailments receive free treatment by taking part in trials designed to assess new drugs and procedures. The drug industry or National Institutes of Health (800-41101222; www.nih.gov) coordinates most of these trials.
Important: Participants are given a consent form explaining the trial. Read it, and ask questions before signing.
Some trials are open – all the participants are given the medicine being tested and are informed about the results of the trial at each stage.
Other trials are double-blind – some participants are given the treatment while others receive a placebo. This prevents test results from being skewed by psychological factors. Patients – and often the doctors who administer the drug – aren’t told who has received the drug and who has received the placebo.
Despite the risk that you won’t receive any treatment, don’t rule out a double-blind trial. If you take part in one, you have about a 50-50 chance of receiving cutting-edge medication.
Even if you get the placebo, doctors typically take you out of the trial if your condition worsens, so you can resume treatment on your own.
HOSPITAL-BASED CARE…
● When you are hospitalized, put your primary-care physician in charge. Doctors who are unfamiliar with your health history might recommend costly, unnecessary procedures.
Primary physicians, as a rule, recommend fewer procedures than other doctors at a hospital. Your primary doctor already is familiar with your condition and may have tried a variety of treatments for you in the past.
You even might ask your primary physician to help check your hospital bill for inaccuracies. As a patient with a chronic illness, you need to be vigilant about not reaching insurance policy limits sooner than necessary.
● Consider treatment at a teaching or government-run hospital or clinic. These institutions usually charge patients according to their ability to pay. They can make sense for people with limited incomes, especially those who lack insurance or have passed their insurance limit.
Information: Health Resources and Services Administration, 800-400-2742. www.hrsa.gov.
● Negotiate with the hospital and other providers. Pay what you can now, and work out a payment plan for the rest. Or ask for a fee reduction. A hospital or doctor nearly always will compromise because reducing the bill may be cheaper than paying a collection agency or not collecting at all.
● Get the opinion of more than one doctor before any procedure. Second opinions increase your chance of finding less expensive – and perhaps more effective – treatment.
Example: Cancer treatments vary greatly in cost and outcome. Since few doctors are experts in all procedures, it’s best to weigh the options with different specialists.
Many chronic disease sufferers don’t get more than one opinion because they thing that their insurance will not pay for a second opinion. In fact, most policies will pay for two or three consultations as long as the doctors are in the insurer’s network of approved physicians.
A chronic disease can be financially devastating even for someone who has health insurance. Benefit limits often are reached before the condition is under control.
People without insurance may be forced to borrow money or sell assets when faced with such conditions as recurring cancers, heart disease, depression and diabetes.
Making lifestyle changes – quitting smoking, improving your diet and exercising – can reduce the need for medication for many conditions. In addition, sufferers can eliminate some costs entirely by understanding how hospitals, drug companies and doctors do business. Most effective cost-saving strategies…
AT-HOME CARE…
● Become an expert. Learning all you can about your illness may help you discover lower-cost treatments and aspects of the condition that even your doctor may not know about. You’ll als benefit psychologically from putting yourself in charge instead of relying solely on your doctor.
● Contact association specializing in your condition. They can help you to locate low-cost treatment centers and suggest ways to prevent your condition from worsening.
Example: Adding supplemental chromium, magnesium and vanadium to your diet may help with diabetes.
Associations for several common illnesses…
● American Cancer Society, 800-227-2345, www.cancer.org.
● American Diabetes Association, 800-342-2383, www.diabetes.org.
● American Heart Association, 800-242-8721, www.americanheart.org
● American Kidney Fund, 800-638-8299, www.kidneyfund.org
● Depression and Bipolar Support Alliance, 800-826-3632, www.dbsalliance.org
If you’re unsure of the appropriate organization, contact the American Medical Association for a referral (800-621-8335, www.ama-assn.org).
● Investigate alternative treatments, such as acupuncture and biofeedback. Many now are covered by insurance. Even if they’re not, they may cost less and be more effective than conventional treatments. For information, contact the federal government’s National Center for Complementary and Alternative Medicine at 888-6444-6226, www.nccam.nih.gov.
● Buy drugs in large quantities to save on copayments. Most insurers charge a copayment for each prescription, regardless of the drug’s cost. Copayments today can be as high as $50.
Ask your doctor to write 90-day prescriptions, instead of 30-day. You will reduce your copayment by two-thirds.
Example: If you take eight prescription medicines – not unusual for someone with a chronic condition – and have a $30 copayment, your cost will fall by $1,920, or two-thirds – from $2880 (8 x $30 x 12) to $960 (8 x $30 x 4).
If your insurance company won’t allow more than a 30-day supply of a drug from a local pharmacy, ask your health insurer if it uses a mail-order drug service. They typically supply 90-day quantities. Most insurers prefer that you order by mail because it holds down their costs.
● Ask your doctors for free samples. Pharmaceutical companies give away billions of dollars worth of samples for doctors to pass on to patients. Don’t be embarrassed to ask. If your doctor doesn’t have samples, ask him to prescribe generic drugs. For all but a very small percentage of patients, generics are just as effective as brand-name drugs. If you do have insurance, you may have a smaller copayment with generic drugs.
Example: A patient who suffers from depression and doesn’t have drug coverage typically pays about $647 for 90 tablets of Prozac in 40-milligram (mg) strength. The generic equivalent represents a saving of 30% or more.
● Take part in a clinical trial. Each year, thousands of people with chronic ailments receive free treatment by taking part in trials designed to assess new drugs and procedures. The drug industry or National Institutes of Health (800-41101222; www.nih.gov) coordinates most of these trials.
Important: Participants are given a consent form explaining the trial. Read it, and ask questions before signing.
Some trials are open – all the participants are given the medicine being tested and are informed about the results of the trial at each stage.
Other trials are double-blind – some participants are given the treatment while others receive a placebo. This prevents test results from being skewed by psychological factors. Patients – and often the doctors who administer the drug – aren’t told who has received the drug and who has received the placebo.
Despite the risk that you won’t receive any treatment, don’t rule out a double-blind trial. If you take part in one, you have about a 50-50 chance of receiving cutting-edge medication.
Even if you get the placebo, doctors typically take you out of the trial if your condition worsens, so you can resume treatment on your own.
HOSPITAL-BASED CARE…
● When you are hospitalized, put your primary-care physician in charge. Doctors who are unfamiliar with your health history might recommend costly, unnecessary procedures.
Primary physicians, as a rule, recommend fewer procedures than other doctors at a hospital. Your primary doctor already is familiar with your condition and may have tried a variety of treatments for you in the past.
You even might ask your primary physician to help check your hospital bill for inaccuracies. As a patient with a chronic illness, you need to be vigilant about not reaching insurance policy limits sooner than necessary.
● Consider treatment at a teaching or government-run hospital or clinic. These institutions usually charge patients according to their ability to pay. They can make sense for people with limited incomes, especially those who lack insurance or have passed their insurance limit.
Information: Health Resources and Services Administration, 800-400-2742. www.hrsa.gov.
● Negotiate with the hospital and other providers. Pay what you can now, and work out a payment plan for the rest. Or ask for a fee reduction. A hospital or doctor nearly always will compromise because reducing the bill may be cheaper than paying a collection agency or not collecting at all.
● Get the opinion of more than one doctor before any procedure. Second opinions increase your chance of finding less expensive – and perhaps more effective – treatment.
Example: Cancer treatments vary greatly in cost and outcome. Since few doctors are experts in all procedures, it’s best to weigh the options with different specialists.
Many chronic disease sufferers don’t get more than one opinion because they thing that their insurance will not pay for a second opinion. In fact, most policies will pay for two or three consultations as long as the doctors are in the insurer’s network of approved physicians.
posted by Kathie Bracy at 12:37 PM
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