8 tips for managing healthcare costs

Experts advise to help make the most of your plan

The cost of health care is something that concerns everyone, from patients and doctors to the people who work for health plans like Blue Shield. In 2018, Covered California announced that there would be an average 8.7% rate increase for 2019 because of rising health costs and legislative changes, but that doesn’t mean you can’t retain some control over the cost of your care. Many of the decisions people make about what type of plan they have, where they see a doctor, and how often they get checkups can affect what they pay out of their own pockets. Here are eight tips from experts on controlling healthcare costs to help you get off on the right foot.

  1. Understand your plan
    When you’re picking a new health plan, look at more than just the monthly premium price to understand the whole picture, including deductibles, copayments, coinsurance, and out-of-pocket maximums. “Usually, you want to pick a plan that has copayments (a specific amount per visit) instead of coinsurance (a percentage of the total bill),” says Meghan Nechrebecki, founder of Health Care Transformation, which helps educate people about the U.S. healthcare system. “People who know they’ll use less health care in the coming year usually opt for lower premiums and higher deductibles, but you have to analyze your expected usage to find what works for you.”

  2. Choose value
    Two of the most common types of plans are HMOs and PPOs. With a PPO, you can go to any doctor you want as long as that doctor takes your insurance, but that flexibility brings higher premiums. With an HMO, you have a primary care physician who coordinates your care among a fixed network of doctors. “The value of the relationship with a primary care provider is what HMOs are all about,” says Amanda Attaie, a product director at Blue Shield who focuses on the cost of health care. “Your doctor will guide your care rather than your going to different specialists trying to figure it out on your own.”

  3. Seek preventive care
    Going to the doctor more often can actually help reduce healthcare costs in the long run, because preventive care and screenings help you deal with small health problems before they become big ones. “Go see your primary care physician at least once every 12 months so you build that connection and have a healthy baseline for your results,” says Tami Reid, clinical program manager for healthcare value solutions at Blue Shield. “Get your physicals, get your screenings, and talk to the doctor about your family health history so if something runs in your family, you can catch it early.” Blue Shield members can log in to their online accounts and access Find a Doctor to find a provider nearby or download the mobile app and do it on the go. 

  4. Use HSAs if available
    If you choose a plan with a high deductible, consider pairing your plan with a health savings account (HSA), especially if your employer offers a contribution. HSAs allow you to save money tax-free that you can use for healthcare expenses. “We see a lot of employers contribute a sum to the HSA as their premium contribution,” Attaie says. “That can help ensure you get the care you need when you have a high deductible.”

  5. Ask your doctor questions
    Your doctor wants to do everything he can to help you get better, but sometimes that can include procedures or tests that have high out-of-pocket costs without offering much change to your overall health. That’s why it’s important to ask questions about how your care will affect your health, and if there are alternatives, you should know about it. “Blue Shield is actually the first health plan in the country to require shared decision-making between a patient and a physician,” explains Henry Garlich. “For something like surgery, this helps patients understand the risks and benefits of the procedure, and whether there are any alternatives that could not only have a lower out-of-pocket cost, but also improve quality of life.”

  6. Go to the emergency room (ER) only for emergencies
    “We know that roughly half of all ER spending is for non-emergency cases like headaches, back pain, or other conditions that could be treated more effectively and affordably somewhere else, like an urgent care center,” Garlich explains. That’s because many people think the ER is their best option if they can’t get in to see their regular doctor right away. “If it isn’t an actual emergency, look for the nearest network urgent care centers; it will be much more affordable,” Necherbecki of Health Care Transformation says. Most people have an urgent care center nearby that accepts walk-in patients for their plan’s standard copay. Blue Shield members can find the closest urgent care center by using the mobile app.

  7. Use tech to get in-home or remote care right away
    Thanks to innovations in health technology, you might not even need to visit an urgent care if you want to see a doctor right away for a non-emergency issue. Many of Blue Shield’s plans allow members to use their smartphones to connect directly to a doctor without leaving the house. Using HealTM, doctors conduct visits in patients’ homes for the same copay as an office visit. Blue Shield also covers Teladoc, which allows you to get a Skype-like video consultation with a doctor over the phone. And if you’re not sure what kind of care you need, you can always call NurseHelp 24/7SM, a 24-hour help line where a nurse can evaluate your symptoms and recommend the right care for your condition. Services like these not only cost less, but they’re also more convenient than spending hours in a hospital waiting room. “I’d recommend people get registered for services like Heal and Teladoc ahead of time,” Reid says. “Then, when you do get sick it’s even easier to get the care you need.” Blue Shield members don’t have to remember NurseHelp’s phone number because they can call directly from Blue Shield’s mobile app, and have this resource handy for any situations. 

  8. Know the cost of treatments before scheduling them
    Blue Shield members who are covered by a PPO plan can use the Treatment Cost Estimator. The online tool provides the information to make the best decision about your health care.  When logged in as a registered member you will be able to find important information such as costs for procedures, treatment timelines, and more, about a variety of conditions.  


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