Managing medical bills? Here’s why you need to speak up

CLEVELAND — For millions of Americans, the cost of healthcare isn’t just stressful — it’s a barrier to getting the care they need. Patients skip medications, delay specialist visits, and put off procedures, all because of what it costs out of pocket.

“Just in the last couple of weeks, I’ve had patients say, ‘hey doc, can I hold off on going to the specialist because my copay is pretty high,’ or ‘hey doc, I can’t afford this medication that you’ve prescribed me.’ As a family doctor, I see this every single day — and it breaks my heart,” said Dr. Jennifer Caudle, a family physician and associate professor at Rowan University.

But there’s something most patients don’t realize — and it could change the conversation with your doctor entirely.

When a physician writes a prescription or orders a test, they often have no idea what it will cost the specific patient on the other end.

“Sometimes, as physicians, when we prescribe medications or prescribe an X-ray or send you to a specialist, we don’t know what copays you might have, what it might cost, where your deductible is. We won’t know and don’t know unless you tell us,” Dr. Caudle explains.

That’s why speaking up is the single most important thing you can do.

“If you are having trouble or something’s too expensive, we don’t want you to pay more than you need to for any of this stuff. Let us know so we can try to help,” she said.

Discount cards and prescription savings programs exist for a wide range of medications — and your pharmacist can often run them for you on the spot. Don’t be afraid to ask before paying full price. Pharmacists can also sometimes suggest lower-cost alternatives you can bring back to your doctor.

Mail-order prescription services are another option that can significantly reduce costs, particularly for medications you take regularly.

Many insurance plans offer more than just coverage — they include incentive programs that reward healthy behaviors with gift cards, cash back, or other perks.

“For my own insurance, if I do a certain number of things — walk so many steps — at the end of the year I can get a gift card with a couple hundred bucks on it. Those incentives really matter,” said Dr. Caudle.

An annual physical is one of the most valuable and underused tools in preventive care — and it frequently comes at no additional cost.

“Get your yearly physical. Oftentimes, insurance companies don’t charge a copay for that. And staying on top of your preventative care — your mammograms, your colonoscopies — will help keep you healthy, and that’s going to help the whole picture,” said Dr. Caudle.

If you receive a large bill after an ER visit, urgent care visit, or procedure, don’t assume the number is final.

“If you get a big bill — call the billing office. Sometimes you can negotiate those bills down. Talk to the office manager. Call and do what you can, because oftentimes hospitals and other centers can negotiate,” said Dr. Caudle.

Also, be sure to ask for an itemized bill and check it for errors.  If you can’t negotiate the price down, ask about financial assistance or charity care programs you may qualify for.  If a payment plan is your best option, set one up that is interest-free.  Always avoid using a high-interest credit card for payment.

You could also try using tools like Healthcare Bluebook (now Valenz Bluebook) to compare costs ahead of time.  You need an access code for the website that you typically find on your organization’s benefits website, materials, or by contacting your benefits manager. For mobile app access, you may be required to enter a specific mobile code provided by your employer.  You may also try reaching out to your HR manager or your insurance company to see if you have access to this.  

You can also try Fair Health Consumer, which is easily accessible online to check pricing.

The bottom line: you likely have more options than you think. But getting access to them starts with one simple step — speaking up.