Health Care - Savings Ideas

Finance
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Health Care is about 20% of GDP. We should all be looking for ways to save costs.

A couple of starting questions:
For those with long-term medications, have you figured out how to avoid having to pay for regular doctor visits that are essentially just quick check-ups and then taking a prescription? I find paying $800/year just to see a doctor quickly and say “yep, still doing great!” is a large waste of money.

Dental care - dentists are notorious for pushing high-profit care with a poor risk/benefit ratio. Dental exams/cleanings are already pretty cheap - they are like the oil changes of the car industry which gives dentists a chance to tell you need some major work. Has anyone figured out how to get common dental procedures like fillings, sealants, root canals, etc for “cheap” but safe? I currently have a $3000 estimate for some bridge work - there has to be a way to get that done at a fraction of that cost but still safely.

Physicals / check-ups - I also suspect there’s a way to get the basic care of a doctor visit and symptom assessment without paying a $100+ office visit. I get annoyed with a generic doctor visit because it’s usually covered by a PA yet I pay as if I’m going to a doctor. I hope that home-use health sensors and data analytics will usurp this role - is this already possible?

There are many common scenarios requiring antibiotics. What’s the cheapest way to get an antibiotics prescription vs. a doctor visit which is typically $100+?

Some tips I know:

Insurance agreed rates are not always the best, especially with prescriptions! I save $100s a year by just using Sam’s Club or Costco’s member discount programs. I’m not sure of their privacy policies, but if you are concerned with your insurance knowing every medical issue, this also avoids having your prescriptions added to the main insurance company’s records.

The Surgery Center of Oklahoma https://surgerycenterok.com/ is famous for its price transparency and affordable procedures. It’s worth checking out their costs vs your insurance costs, especially as many more people are now on high-deductible plans which basically means you’re paying out of pocket all year unless you have some major medical issue.

It would be awesome to know if there are any places like OK that have a similar model for dental, routine visits, etc - so we could price compare with our insurance plan rates. I’ve also heard international care can be a fraction and worth the travel costs (medical tourism), but I don’t know how to actually compare that…

I hope there are some tricks here to save $100s and $1000s on costs we almost all deal with! Please share!

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Let me second Costco (or equivalent) for medication. I have found that it often it is cheaper (especially for generic) than the rate my insurance is. When my employer switched from BlueCross to Cigna, when in my area Cigna negotiates much worse than BCBS it made a huge difference.

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I heard some pharmacy chains have discount plans you can join for an annual fee, and often they offer drug prices for cheaper than the insurance rates. Worth checking, savings can be substantial.

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For dental, my suggestion is to establish a relationship with a dental hygienist you trust and whom the dentist they work for trusts rather than just jumping around all the time. The hygienist I go to knows that my teeth are generally good and that even something slightly questionable is probably not worth treating unless she sees it a few times.

Why do I say hygienist and not dentist? Because I’ve found the more experienced ones to be the real care providers. They typically remember you better, spend more time with your teeth, and make the recommendations to the dentist. Most dentists I’ve been to will basically agree with the hygienist on the overall plan of care.

How does this save you money? A good hygienist and dentist team who are interested in your long term health will be more willing to delay treatment until they’re more sure you need it. They’ll be more interested in finding simpler solutions that will save you money because they know you’ll be coming back.

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Thanks. What I’m hoping for on dental are things like - dental school programs that offer large discounts for more basic procedures, or finding a place like OK Surgery Center with affordable transparent pricing on routine procedures, or even traveling internationally for work maybe in Canada/Mexico with a respected dental practice?

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Don’t have employer health insurance and have an expensive medical procedure that can wait until January?
Because of the way the ACA wanted to make accommodations for the problems with provider lists and other reasons, the deadline to change health plans is December 15 for January coverage and January 15 for February coverage. This means you can have two different plans and coverage in one year. Signup by December 15th for a zero deductible low coinsurance PPO plan that take effect in January and have your procedure done. It could be hernia, colonoscopy, CT Scan, whatever. If it needs pre-authorization, you will have to make sure it gets approved AND you can get scheduled to have the procedure done in one month before the end of January.
By January 15th, sign up for your usual plan with coverage starting in February. HMO, PPO with higher deductible, etc. for lower premiums the rest of the year.

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I can second GoodRx.com. Stupidly it is somehow cheaper than going through my insurance sometimes.

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It should be stated in this thread, that by far the biggest health care savings is taking care of your body. That means having a good healthy diet (read eating green leafy vegetables) and exercising on a regular basis, at least 30 minutes of good sweaty exercise 3-4x a week.

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Biggest healthcare savings idea for the average American is to lose weight and quit smoking. Obesity and cigarette smoking cause a significant proportion of medical problems.

Another consideration is to get off any long-term medications you’re on. Antidepressants are unnecessary for most people if you handle the underlying cause of the condition. Something around 25% of Americans are on antidepressants today. These pills have only existed for a relatively short period of time, yet a quarter of Americans need them. Statin drugs are a sham. There’s no hard evidence that links cholesterol to heart disease. There is evidence that statin drugs reduce testosterone in men, because the cholesterol that statin blocks production of is a metabolic precursor to testosterone.

Don’t take antibiotics unless you’re near death or are very, very old with a weak immune system. This saves not only the cost of the unneeded drug but the office visit. In 99% of cases in America, people take antibiotics unnecessarily. If you’re feeling ill and go to a doctor, emergency department, or urgent care, and ask for antibiotics, the provider will write you a prescription even though it’s impossible to tell if the illness is due to bacterial or viral vectors. It would take a few days in the lab to culture your blood/sputum to figure it out, and by then, the illness will likely subside on its own. Also, antibiotics wreck your gastrointestinal system. “Good” bacteria living in your gut facilitate digestion. When you holocaust them all out of existence with antibiotics, then “bad” bacteria are free to move in and take over.

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Great thread idea!

This year I’m trying a boutique health care practice. I pay $200 a month, and I see a fantastic doctor as often as I need, for anything I need, who refers me as needed. Practice of three, keeps one admin assistent, outlources lab tests, and doesn’t bill insurance.

Very different model. I pay a little more up front, but the expertise I get is well worth it.

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How did you find that?

And what else do you get besides “unlimited” office visits? I would need to visit a doctor at least twice a month to have this pay off for me, which I wouldn’t do. If I could somehow cut my insurance premiums by taking this model, it might make sense financially - but I don’t have a way to cut insurance premiums just because I won’t do office visits on the plan…

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What Dave is talking about is referring to concierge medicine or direct primary care. They don’t take any insurance, but do what doctors used to do, treat people.

In my town, there is a provider that charges $60 per month, $10 per child/month, and meds are at a small upcharge, and they are getting other providers onboard for reasonable prices…for instance, I was quoted $45 to get xrays read if needed. They bill things out at cost with a small markup, but payment is done immediately. The doctor did say that if her patient has to go to the hospital, she has the ability to go and make sure things are going correctly as well.

I doubt this is how all of the concierge medicine providers work, but this is just one model of many.

I feel like medicine used to be practiced in this manner, then it got jacked up, and now people are going back to this way of doing things.

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The common practice here in DC is that you pay a yearly fee (for example $300) to have access to a group of doctors, they do not accept anyone that did not pay the fee. In return they see fewer patients, guarantee to answer your emails/calls and next day appointment in case of need.

Contrary to Dave’s they still bill your insurance and you are still responsible for you co-pays and so on.

My doctor of many years turned concierge this year and if I wanted to continue use him I needed to pay the fee. I elected to go elsewhere, but in the process realized that in DC there aren’t many high quality doctors that do not require a concierge service.

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Since administrative costs are ~25% of healthcare in the US (larger than world average of 10-20%), avoiding the insurance “system” gives an instant cost savings that will hopefully be passed on to customers as they happen.

It would be nice if there was an option in most insurance plans to exclude primary care - then it could reduce the premium cost a bit to put towards something like concierge meds / direct primary. Having lived in places with national health care, I can say that primary care is the one area that is drastically overpriced here and disincentivized to receive care and a medical opinion before issues get out of hand.

I bet that technology starts taking over much of primary care. Sensors + big data analytics would do a better job than a 30 minute office visit costing $100+.

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A doctor friend referred me. The outfit is called “Seattle Premier Health” (googleable), and I’ve been delighted with them. They handle all aspects of primary care,and they have a great informal network of contacts they refer to when you need more specialized care.

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Do you have this in addition to typical insurance? Or were you able to somehow reduce your insurance premiums to offset the fact you’re using concierge as your primary?

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LOVE GoodRX !
And if you live in new york, there’s the BIG APPLE RX CARD…another discount card.

Also, google ‘your drug name + coupon’ and see what comes up.
there are many companies that offer pharmaceutical discounts.

Finally, go to the pharmaceutical site itself and search ‘patient assistance’ or ‘corporate/social responsibility’.
Most pharma sites offer some kind of major discount.

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$60/month is insanely cheap. In Manhattan, concierge medicine will cost you thousands of dollars.

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I do have it in addition to regular insurance, alchemista. I understand that many HSA administrators consider these qualifying charges (as well they should), so that would be a good way to take this option.

It would be nice if more insurers would credit a policy holder for getting their care this way.

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In principle that sounds great; in practice I question the feasibility. Where I am you can’t buy a PPO under the ACA for love or money - they were all discontinued immediately when Obamacare took effect due to the adverse selection risk of expensive people just like your scenario.

Also, at least in my case, if you knew you were going to have an expensive year, it made barely any difference in your total OOP cost if you went with a Bronze vs Platinum plan - you paid more in premiums vs deductible depending on which, but the total was within $1-2k of the same. Not that there might not be $1k in savings if you plan perfectly, but there’s going to be a big OOP/deductible cost in the scenarios I looked at and the possible savings of having the optimal plan were a small fraction of that.

For me, if I knew I would have a serious procedure, I would be looking first at which doctor I wanted and if they were covered by any of the ACA networks available. Many ACA networks, ie BC/BS, are much much smaller than the normal networks you might associate with the group health plans the same company offers to employers nationwide.