Your Coverage & Care
Your Coverage & Care
 
Paying for Care

10 Tips for Managing Arthritis Care Costs

1. Learn the Jargon

Understanding the complex terms of health insurance and medical billing can be a struggle.  But what you know can save you money.  The Arthritis Foundation, the billing specialist at your doctor’s office, your benefits manager and patient navigators provided by the health exchanges are information sources you can turn to.  Get started by visiting arthritis.org/healthcareglossary or calling our patient helpline at 1-844-571-HELP (4357).

2. Run the Numbers

If you haven’t been tracking your expenses, it’s time to get started. Use an excel spreadsheet, online expense tracker or app.  This will help you to do a health expense audit before open enrollment. Use this information to choose the best plan and to get the most benefit from financial tools.

3. Choose Carefully

Here are four must-ask questions before choosing a health plan:

  • Are my doctors in the plan’s provider network?
  • Is there a medical care and a prescription drug deductible?
  • What formulary tier does my medications fall under?
  • What’s my total out-of-pocket cost for the plan year?

4. Don't Assume

It’s possible that your preferred providers leave your plan’s network during a plan year.  Always check before scheduling an appointment.  Also, it’s important to follow up with the provider’s office to make sure that benefit verification and prior authorization procedures are completed before any consultation, procedure, surgery or lab test.

5. Prioritize Paperwork

Keep track of medical records, lab tests, medication lists, expense receipts, explanation of benefits and all insurer communications. This will help you to:

  • prevent billing errors or duplicate medical services and prescriptions
  • stop taking or make changes to medications
  • alert new doctors or ER professionals of health issues that may turn into costly expenses
  • monitor health plan changes (e.g. a provider leaving the network or a change in the formulary tier for your medication)
  • maximize tax savings
  • prevent or appeal claim denials

6. Discuss Cost

Your doctor and pharmacist can help you manage cost.  But they need to understand the issues that affect treatment adherence and your wallet.  Review the details of your health plan and how to balance the best care with your budget limitations.  Always bring a list of all medications you take to every appointment. Discuss the date you started and the dosage to identify changes that may reduce your expenses.  Also, you should remind your doctor about your provider network if other healthcare providers (e.g. an anesthesiologist) need to be involved with a procedure.

7. Get Financial Assistance, Claim Management and Appeal Support

Nonprofit associations, drug manufacturers, state and federal sources give free or reduced-fee care and medications. Some insurers and drug manufacturers have employees that help with benefit verification, claim management and appeals.

8. Always Comparison Shop

Prices for medical procedures and medications can vary widely depending on the provider, pharmacy, location and whether you order by mail or from an online vendor.  Big box stores offer a no-frills pharmacy experience that can save you money.  Publications like Consumer Reports do a great job of comparing drug prices at different retail and online vendors.  Using an urgent care center instead of the emergency room can save time and money.  Ask other patients for information too.

9. Use Financial Tools

Pay for out-of-pocket qualifying expenses with pre-tax dollars and reduce your tax bill by taking advantage of financial tools. These include flexible spending or health saving accounts, medical tax deductions and health reimbursement arrangements.

10. Invest in a Healthy Lifestyle

Being proactive about being healthy is an important way to manage healthcare costs.  Closely follow your preventative health and disease management plan, be physically active, reduce stress, eat nutritious foods and have healthy sleep habits. Talk to your doctor about possible comorbidities that may occur with your arthritis and how to reduce your risk.

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