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Health Care Costs

Nonprofit Helps Patients Tackle Medical Costs

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"With more people getting health insurance under the Affordable Care Act, there's still often a gap between what is covered, what isn't, and how to pay for what isn't covered," says host Barbara Lewis.

Patient Advocate Foundation, a nonprofit foundation, helps patients with issues related to finding care, medical debt and job retention. Erin Moaratty, chief of mission delivery at PAF, speaks on the organization and how people can manage health care costs. 

How to lower your health care costs

"I think we need to look at making the most of your insurance plan. Getting to know what your benefits are, and how you can best utilize them to ensure affordability. Today we have preventive services that are covered under the Affordable Care Act, typically at a no-cost level. And as you go through treatment or care that you might need. If there are other items that arrive that have a co-pay or a large out-of-pocket cost, is to seek out programs that are charitable or programs that are geared to help patients when in need."

Particular items to focus on

"You really should know what your deductibles are; your out-of-pocket maximums; if there are any tier drug expenses that you may be subject to. Overall, out-of-pocket costs... If you do choose to go outside of your plan, you could be subject to higher out-of-pocket costs. Sometimes patients don't even recognize that is actually taking place..."

Talking to your doctor about cost concerns

"Here at the Patient Advocate Foundation, we do that frequently. It's an opportunity to negotiate your out-of-pocket costs. Also, you might be prescribed to a medication or treatment, and by talking to your provider and by expressing any type of financial concerns that you might have, there may be alternatives that exist or generic options that help shave those costs and help make it more affordable for you."

When calling insurance companies

"When you're calling, be precise and clear on what you are trying to understand and learn. When you are talking to your insurer, you are going to be asking about what your coverage benefits are. And if you have a question about a bill, why it might not have been covered or not paid at the level you believe it should have been. You have all the rights that exist to question those types of things. Call and ask before a procedure as form to get an estimate of that procedure so that you are more prepared and more educated as a consumer."

Negotiating health care costs before treatment 

"Normally negotiations are typically with the provider at the facility. If you have insurance, there is a contracted rate that they have already negotiated on the benefit itself. If using a network provider, that's been agreed upon. So you can look into other facilities if there's a lower cost by using them. But you have to be comfortable and feel like that's something that you would prefer to do, because if you are with a certain doctor they may only practice in certain hospitals. But if you can go in, and you know what you think your out-of-pocket cost is based on estimations and your conversations, and you have a large out-of-pocket amount of money that you could negotiate with a provider or facility, those are times for negotiations as well. Sometimes facilities do request up front deposits or payments before you have treatment, and those are always negotiable. You don't always need to pay the full amount they are saying. Often if you tell them the hardships are or what you are able to afford, they tend to work with you on what would be beneficial for you to get that treatment."