If you have health insurance or not, these tips can help lower medical bills

Discussing financial concerns during a medical visit can lead to cost-saving options. 
(National Cancer Institute photo, Unsplash)

Over the past five years, insurance premiums, deductibles, co-insurance and drug costs have all surged, leaving many Americans with medical debt or choosing to forego needed treatment or medication because it's too expensive. 

But there's a healthier approach to medical treatment that can lead to substantial cost savings -- talking to your doctor about your costs and the need to seek budget-friendly options whenever possible, write professors Helen Colby and Deidre Popovich for The Conversation.

"Why don’t more people have conversations about cost? One study shows that cost conversations occur in only about 30% of medical visits," Colby and Popovich explain. Talking to your doctor about costs "can be crucial when a recommended procedure has multiple alternatives. . . . Speaking up about price can help patients stay healthier and avoid the all-too-common trade-off between medical care and household expenses."

Instead of delaying treatment or going through with a treatment and then worrying about its cost when the bill arrives, Colby and Popovich suggest ways to ask your medical provider for help and flexibility to lower costs. 

Ask for a generic drug or an alternative medicine if no generic is available. They write, "Research on physician–patient cost conversations shows that switching to lower-cost, clinically similar alternatives within the same drug class is a common strategy for reducing out-of-pocket spending without compromising care." 

Ask your doctor or pharmacist whether any manufacturer coupons or co-pay assistance programs are available. Sometimes, being willing to have your medicine shipped by mail can also save money.

Seek out information about hospital programs or charity options that help cover costs. While some aid options may be linked to Medicaid programs, many are administered by state and county groups. "Patients can often find these programs through hospital or health system websites, which typically include financial assistance or 'charity care' pages," Colby and Popovich add. "Nonprofit organizations and patient advocacy groups may also offer or list assistance tailored to specific conditions or medications."

Don't be afraid to ask, "What will this cost me, and are there other options?" they advise. "This question also opens the door to alternatives. . . . A brief, honest conversation about cost can lead to more affordable and more sustainable care." 

Independent primary care doctors see banding together as one way to remain solvent and keep their autonomy

Valley Medical Group joined an IPA to help regain its
financial footing. (New England Public Media photo)

As the number of primary care doctors in the U.S. continues to decrease, the number of independent primary care practices has also fallen. A practice in the Connecticut River Valley, Valley Medical Group, has sought to maintain its independence while boosting its bottom line by joining with other independent primary physicians, reports Karen Brown of New England Public Media.

Founded during the 1990s, Valley Medical Group has become one of the "largest independent practices in western Massachusetts," Brown writes. But the practice's patient volume and focus on quality family medical care haven't shielded it from the financial pitfalls of the American insurance payment system, which rewards specialists and physicians who perform procedures over primary care.

Valley Medical Group owners found themselves stuck in insurance contracts that didn't pay well or accurately. "In January, the practice laid off 40 employees — 10% of its 400-person staff — mostly in support positions," Brown writes. "Thousands of primary care practices, a key gateway to the medical system, are fighting to remain financially viable — and independent."

VMG doctors also wanted to avoid selling their practice to a hospital, which would likely take away some of their clinical autonomy. Instead, the group opted to join an Independent Physician Association. Brown explains, "Like a union, an IPA combines individual primary care offices, giving them power in numbers when negotiating contracts with Medicaid, Medicare, and private insurance companies."

While not all IPAs are equal -- some are owned by hospitals or private equity funds -- most help level the financial playing field for smaller practices. According to Brown, when independent practices band together, they can accept insurance contracts that pay them a per-patient allotment rather than billing for each visit or procedure.

Chris Kryder, CEO of Arches Medical IPA in Cambridge, Massachusetts, told Brown, "If we keep people out of the ER, keep them out of unnecessary hospitalizations, we save money for the system. . . And we create more income for the primary care providers, which is dreadfully needed."