Tips to Control Your Costs

Health insurance helps you pay for the medical care you need. However, health insurance has become more expensive as health care costs have risen. In fact, the Kaiser Family Foundation reports that health costs have increased 78% since 2001. The high cost of health care has created financial difficulty for millions of Americans. Contact Your Elected Officials

However, there are steps you can take to help control your health care costs.

Choose the right plan.

When choosing health insurance, make sure you understand all the options and the terms (see chart below). Think about what kind of care you needed in the past and what you might need in the future. That will help you decide whether you need an insurance plan with a lot of options or if one with fewer options would work for you. Fewer options generally mean you pay less. So, for example, HMOs are generally less expensive than PPOs but have more rules.

You also need to think about what you can afford to pay each month in premiums and what you can afford for co-pays each time you go to the doctor. So, for example, a plan with higher premiums will generally have lower co-pays.

It's also important to ask about a plan's limit on out-of-pocket expenses. This is the total amount of your money you would have to pay. Without such a limit, you could end up with large medical bills if you need to be hospitalized or need expensive care.

The most important thing is to ask questions. Don't sign up for a plan you don't understand. If you have insurance through your job, the human resources staff should be able to help answer your questions.

Understand what your insurance covers.

Different types of insurance plans cover different things. Generally the more a plan covers, the more you pay in premiums. The types of care that the plan will pay for are called "covered services." Most plans require that you get approval ahead of time for certain services. If you don't get pre-approval, you generally have to pay for them out of your own pocket.

Most plans also have a list of services they will not pay for. You have to pay for these out of your own pocket too.

It is important that you understand exactly what is - and isn't - covered by your plan. If you aren't sure, don't assume that something will be covered. Call your insurance company and ask.

Understand your right to appeal a denied claim.

When an insurance company decides not to pay the bill for a service you've received, it's called denying a claim. You are then responsible for paying the bill yourself. (This is why it's a good idea to make sure you know exactly what your plan covers.)

If your insurance company denies your claim, you have the right to challenge the decision. This is called appealing the claim. Before you decide to appeal, read your insurance company's appeal process. This should be explained in your plan's handbook. Also, ask your doctor for his or her opinion. If your doctor thinks the service was medically necessary, he or she may be able to help you with the appeal.

Improve your health as much as possible.

People with poor health need more medical care. Often they have to pay more for health insurance too. If you take care of your health, you can save money.

To stay well, don't smoke. If you smoke, quit. Eat a healthy diet and exercise. If you are overweight, talk to you doctor about losing weight. Also, if you have a chronic condition, such as heart disease or diabetes, work with your doctor to manage your illness and prevent more serious problems.

Don't use the emergency room like a doctor's office.

The emergency room is the place to go for life-threatening emergencies like a heart attack or stroke. For problems like the flu or an earache, your doctor's office is probably a better choice.

Make sure you know what to do if you need your doctor in the middle of the night or on a weekend. If your doctor's office isn't open at these times, ask about other options like urgent care or after-hours clinics. These appointments may cost a little more than a visit to your doctor but are still less than a trip to the emergency room.

If you need help deciding whether to see a doctor right away, you can get advice from 24-hour telephone hotlines. Most insurance plans and many local hospitals provide this service. Find one in your area and keep the number by your phone.