Rising insurance premiums, surprise medical bills, unfair drug price hikes—if you read the headlines, our collective anxiety over health costs is well-founded. Medical bills are the biggest cause of bankruptcies in the US and medical problems are behind 50 percent of home foreclosures.
A recent poll from the Kaiser Family Foundation found that the public cares more about controlling the high price of prescription drugs than making changes to the controversial Affordable Care Act. But with President-elect Donald Trump and both the House and Senate controlled by the GOP, Obamacare likely won’t be around in the coming years. Changes to who will be protected, services that will be covered, and the costs of prescription drugs means that knowing how much health services cost is key to setting your healthcare budget.
When, even in the most certain of times, you have very little control over the cost of insurance, treatments, and procedures, what can be done? According to David Vivero, CEO and co-founder of consumer healthcare company Amino—a free service that lets you find experienced doctors, estimate your healthcare costs for 78 procedures, and book appointments online—there are a few things you can do to budget for healthcare expenses and plan ahead.
I recently sat down with David to get his take on how the newly-elected administration might further highlight rising healthcare costs and what consumers can do to manage their healthcare costs—now and in the future, regardless of the potential changes on the horizon.
Jennifer (J): There’s been a lot of talk this year about health insurance costs going up. Why is this such a huge issue facing Americans?
David (D): The rising costs of healthcare continue to push Americans further into debt and force them to consider risky trade-offs. There’s no other industry where you blindly purchase something so significant, of uncertain quality, without knowing the price ahead of time.
A few years ago, I had to switch insurance companies and find a new in-network doctor that treated my hereditary hemochromatosis. It was painfully complicated to find a different plan and a new doctor, and make sure I could afford the treatments. I had no context or resources to confidently make a decision about where to find care and how to budget for it. I realized we all need better information about our healthcare options—and cost information was at the top of my list.
J: What needs to be done—and can be done—to address concerns people have around cost?
D: I think putting cost information in front of people who need care will dramatically improve the healthcare system. I started Amino so that all Americans could begin to estimate their health costs and find affordable, in-network care.
Of course, improving transparency needs to come from the top-down, too. It needs to be the top priority for state and federal government, pharmaceutical companies, insurance networks, hospitals, doctors, and any other healthcare organization—now more than ever before.
Controlling healthcare costs is a fairly bipartisan issue (see Florida’s recent healthcare price transparency bills and ongoing support from GOP leaders like Sen. Chuck Grassley), so we’ll have to see what the upcoming administration's priorities are in this area.
J: Is there anything that people can do to take an active role in managing their healthcare costs?
D: We have this phrase at Amino: "Know before you go." It’s a good habit we follow in other aspects of our lives that we should carry over into our healthcare experiences. Researching every decision—from complex healthcare treatments to preventative care—helps you understand your options and choose what’s right for you and your wallet.
The first thing to consider is getting the right health insurance plan. A good rule of thumb is that if you’re healthy and don’t anticipate that you’ll need to see the doctor often, choose a high-deductible plan. Your monthly payments (premiums) will be lower, and unless there’s an emergency, you probably won’t pay too much out-of-pocket.
If you have a chronic condition, if you’re pregnant, or if you’re planning a major procedure in the next year, a low-deductible plan might be best—higher monthly payments, but lower out-of-pocket costs overall if you hit your deductible quickly. Given the GOP’s and Donald Trump’s well-publicized commitment to dismantling the Affordable Care Act, we might see a very different health insurance market in a couple years. Either way, you should identify what you need for coverage, and try to stay insured to prevent surprise bills.
Next, continually seek out information about the cost of appointments, procedures, diagnoses, tests, and prescription medications. Choosing Wisely is a great way to identify which procedures or tests might be unnecessary, and companies like GoodRx and Blink Health can help you find the best deals on prescription drugs.
Spend some time on your insurance portal. While they might be clunky to use and not very easy to log into, some have tools to help you estimate costs, and most will give you a real-time update on the four numbers you need to estimate your healthcare costs.
Even researching ahead of time won’t prevent billing errors (it’s estimated that there are billions of dollars in overcharges each year), which is why it’s great to see companies like Remedy Health and Copatient helping people fix billing problems and recoup expenses.
Finally, vocalize your concerns about cost as much as possible—to your doctor, hospital, insurance company, and local policy makers.
J: How can patients work with their doctors to help tackle this problem?
D: Unfortunately, doctors are often in the dark. Healthcare costs are often determined by an insurance company’s negotiated rate and not easily visible to doctors or their office staff. In addition, while the cost of a procedure includes the doctor’s charges, it may also include the charges of anesthesiologists, labs, and facilities where the doctor’s own staff is not involved in negotiation.
That said, you should always, always do research online and bring up cost early on in your conversations with doctors. Going into an appointment armed with information can help facilitate discussions for things like generic prescriptions or alternatives to costly imaging services.
Many doctors are also giving their patients the option of paying cash up-front at a discount for a service or procedure, instead of going through insurance. If you’re on a high-deductible plan, this might save you money—ask your doctor if they offer cash discounts, see where you’re at with your deductible, and talk to your insurance company to compare the difference and make a decision.
J: At PolicyGenius, we know how big a role technology can play in helping people get insurance coverage. How can healthcare consumers use technology to control their costs, too? What else can help?
D: Technology isn’t a silver bullet, but it can do a lot. Right now, it’s improving the way healthcare is delivered and accessed in America.
The healthcare system that’s set up today is asymmetrical. One side (big pharma, insurance companies, hospital systems) has more leverage—information, resources, influence, negotiation power—than the other. This puts us, the patients, at an extreme disadvantage. Case in point: the recent frenzy over EpiPen pricing.
Tech companies need to be putting more information and easy-to-use tools in front of consumers in convenient ways so that they can become more informed and make smarter healthcare decisions.