Save Thousands on Your Health Care

WebMD Feature from "Prevention" Magazine

By Julian Kesner

10 surprising - and easy - ways to trim costs on everything from your yearly physical to specialized surgery.

After a car accident left Michelle Katz, a Washington, DC, nursing student, with persistent back pain and numbness in 1998, she consulted a neurosurgeon, who told her she'd need an operation to repair her slipped disk. Katz, then 26, didn't have health insurance, so she did the only thing she could think of: She negotiated.

Katz offered to pay her surgeon and anesthesiologist a portion up front in exchange for a hefty discount and arranged a payment plan for the rest. When she got her hospital bill, she haggled with the billing department to drop some charges. All told, she ended up paying just half of the original $28,000 estimate.

"Before this, I didn't think you could negotiate with your doctor," says Katz, 35, now a corporate health care consultant and author of Healthcare for Less, which was inspired by her own experience. "But all you have to do is ask."

And ask you should--repeatedly. In 2007, a family of four covered by a typical preferred provider organization insurance plan (PPO) is expected to receive an average of $14,500 in medical services. If you fit that profile, about $5,100 of that will be your responsibility--in the form of premiums, co-pays, and deductibles. That's an increase of more than 8% over last year, following 5 straight years in which costs jumped more than 9% annually.

With a little research and some hard bargaining, though, you can cut that figure by half or more. Here are 10 ways to get started, along with the savings you can expect.
1. Shop for Tests

Need an expensive test that's going to cost you a hefty out-of-pocket sum? It might be worthwhile to compare prices among different labs and clinics; fees can vary widely. To compare prices, you need to know the CPT (Current Procedural Terminology) code, a universally accepted number that corresponds to an MRI, a specific lab analysis, or any other billable service. The American Medical Association's Web site, ama-assn.org, has an easy-to-use CPT search engine. Once you have the code, you can get price quotes from several providers. You may be surprised at how well you'll do. "For a CT scan, the price could range between $500 and $1,500 at two different facilities," says Devon Herrick, PhD, a senior fellow at the National Center for Policy Analysis in Dallas.
Save: 20 to 66%

2. Negotiate Your Hospital Bill

For patients with insurance, the hospital co-pay or deductible can represent a very large amount of money. Some insurance companies will deduct this amount from the hospital's contracted rate. The unpaid portion is then your responsibility. Here's a fact many hospitals won't openly admit: They're often willing to waive or reduce an account balance if a patient can demonstrate that the co-pay or deductible is a hardship. But you have to ask. "The patient can go back to an account administrator and say, 'This is really difficult for me. Is there anything you can do?' And we can," says Ruth Levin, vice president for managed care at Continuum Health Partners in New York City. "The number of payers, including patients and insurance plans, who pay hospitals 100% of our charges is probably less than 2%."
Save: 10 to 30%
3. Question Follow-Up Appointments

"When a doctor tells you to come back, whether it's in 3 weeks, 6 months, or a year, ask why. A phone call might suffice," says Arthur Garson Jr., MD, dean and vice president of the University of Virginia School of Medicine and author of Health Care Half Truths: Too Many Myths, Not Enough Reality.

When a specialist orders a test, such as an x-ray or MRI, ask your primary-care doctor if it's necessary. Seventeen percent of US adults say their doctors have ordered duplicates of medical tests, according to a recent survey by the Commonwealth Fund, a nonpartisan health care foundation in New York City. If you're going for a second opinion, sign out your x-rays or MRI scans from your doctor and bring them with you.
Save $20: (office visit) to $300 (your share of the average cost of an MRI under an insurance plan that reimburses only 80%)
4. Ask for Cheaper Drugs

Doctors aren't always aware of how much medication costs. "We don't know which drugs are covered and which aren't when we discuss them with patients," says Doug Farrago, MD, a family physician in Auburn, ME. Ask your physician if there's a less expensive but equally effective alternative to the drug you're prescribed.
Save: Up to 75% (the difference between a "preferred" drug and one not covered by insurance)

Caveat "Just be sure your doctor is intimately familiar with the benefits and risks of the alternate drugs for your condition," says Jerome P. Kassirer, MD, distinguished professor at Tufts University School of Medicine in Boston and author of On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health.
5. Plead Your Case Directly with Your Doc

If you're experiencing serious hardship, talk directly to your doctor: They are in the profession because they want to do good and tend to be more forgiving of outstanding balances than many billing managers. "They are the ones who can direct their billing department to give the patient a break," says Levin.
Save: Up to 70%

6. Arrange Independent Lab Work

Cut the cost of blood and urine analyses by using MyMedLab.com. Once your doctor gives you a prescription for a test, have blood drawn at one of 3,000 collection sites nationwide; the vials are then mailed to independent labs. "You can get more than 30 blood readings and analyses starting at about $95--around 75% less than getting the same tests at a hospital," says Herrick. The lab will mail the results to both you and your doctor. (State laws prohibit this service in California, New Jersey, New York, and Rhode Island, according to the site.)
Save: 50 to 80%

Caveat "Ask your doctor to confirm the reliability of an 'outside' lab's performance before using it," says Kassirer.
7. Hire an Advocate

The gap between what an out-of-network doctor charges for a procedure and what your insurance will pay can often be considerable, and it's usually your responsibility to make up the difference. The result: a three-way dispute. Patient-advocate services are skilled at resolving such conflicts. Philadelphia-based Healthcare Advocates Inc. charges from $50 to $400 per case--about $300 on average.
Save: Varies widely

Caveat "Ask a representative if he's had success with your particular type of dispute," advises Kassirer. "With some claims, insurance companies never back down."
8. Fill Prescriptions with Big Retailers

Mail-order pharmacies such as Drugstore.com, Drugs.com, and Costco.com typically beat the prices of neighborhood drugstores hands down. You can do your own price comparisons at Rxaminer.com, which was founded by a cardiologist and has the reputation for independence from special interest groups.
Save: 10 to 20% for name brands, 20 to 40% for generics
9. Split Pills

Most drugs are not priced according to strength, points out Fred Brock, a Kansas State University journalism professor and author of Health Care on Less Than You Think: The New York Times Guide to Getting Affordable Coverage. Some popular cholesterol drugs come in at least three strengths-- why not split the 40 mg pill in half if you only need 20 mg per dose, and have the prescription last twice as long? Some pharmacy benefit managers will even give pill splitters to customers at no cost.
Save: Up to 50%

Caveat Splitting pills may not always provide the optimal dose of the drug, so check with your doctor first.
10. Try Bartering

"I've had electricians, plumbers, caterers, gardeners, and decorators offer services in exchange for health care," says Farrago. "If I had a solo practice, I'd do it in a second--though I'm blown away by electricians charging more than I do!"
Save: Varies widely

Caveat None--"as long as you do a good job for the doctor!" says Kassirer.

No insurance? Bargain with cash
If your medical coverage lapses and you need to see a doctor or have a procedure done, offer cash up front. Doctors are often willing to discount their fees in return for guaranteed payment and being able to forgo the hassle of paperwork and administrative costs. Or, offer to match what Medicare would pay--typically about 20% less than what a private insurance plan would provide. Medicare reimbursement rates can be found on the AMA Web site, ama-assn.org.

10. Try Bartering continued...

E-shop for the best plan
It is possible to price-shop for health insurance: Both ehealthinsurance.com and vimo.com offer simple price and coverage comparisons among policies in each state. But never sign up for an insurance plan online. Always talk with a representative before buying, advises Michelle Katz, author of Healthcare for Less. "Get their names and numbers so you can go back to them if you have any questions about the information you've seen on the Internet."

Decrease in Cancer Risk for Pill Users

Study Shows 12% Decrease in Cancer Risk for Women Taking Oral Contraceptives
By Salynn Boyles
WebMD Medical News
Reviewed by Louise Chang, MD

Sept. 11, 2007 -- More than 300 million women have used oral contraceptives since they were introduced in the early 1960s. Now a 36-year study shows a slight decrease in overall cancer risk in users of the pill.

In one of the largest and longest follow-up studies ever to examine the issue, researchers found a 12% decreased risk of any cancer in oral contraceptive users compared with women who never used birth control pills.

The study included 46,000 women followed for almost four decades from the late 1960s through 2004, when most were in their early to late 60s.

An increase in cancer risk -- especially cervical cancer -- was seen among women who took birth control pills for eight years or longer.

Researcher Philip Hannaford, MD, of the University of Aberdeen, says comprehensive cervical cancer screening, which is the norm today but was not in the early years of the study, can minimize this risk for long-term oral contraceptive users.

The findings appear in the latest online issue of the medical journal BMJ.

"The overall message is that women should not be frightened of the pill," Hannaford tells WebMD. "This is a very effective and safe method of contraception, especially when combined with regular cervical cancer screening."
The Pill and Cancer

Numerous studies over the years have examined the impact of oral contraceptives on cancer risk.

The consensus, based on the bulk of the research, is that contraceptive pill users have a slightly increased risk of breast, cervical, and liver cancer while they are on the pill and for a few years after.

Oral contraceptive users have also been found to have a lower risk for ovarian and uterine cancer, and that the protection lasts for at least 15 years after women stop taking oral contraception, Hannaford says.

The current study was done, he adds, to examine the overall pattern of cancer risk associated with oral contraceptive use.

The average age of the women in the study was 29 at recruitment between 1968 and 1969. Roughly half used oral contraceptives and the other half did not.

The women were followed for an average of 36 years, during which time the University of Aberdeen researchers recorded a 12% reduction in overall cancer risk, based on data from a large subset of the women derived from national cancer registries.

That translates to one fewer case of cancer for every 2,200 women who took the pill for a year, Hannaford tells WebMD.

Specifically, contraceptive pill users had significantly lower rates of colorectal, uterine, and ovarian cancer.
'Benefits Outweigh the Risks'

The researchers reported a 22% increase in overall cancer risk among women who took the pill for eight years or longer, including a 2.7-fold increase in cervical cancers and a fivefold increase in rare central nervous system and pituitary cancers.

They had no explanation for the increase in the latter cancers, but noted that the cervical cancer association has been well documented.

Most of the women in the study took the first generation of birth control pills, which contained much higher doses of hormones than are used in the oral contraceptives available today.

Hannaford says it is not clear if the risks and benefits are the same with the newer, lower-dose pills most women take today, but he suspects they are.

"I think these findings do have relevance for today's users, but I am pushing the boundaries a bit to say this because there isn't a lot of research," he says.

The researchers conclude that for most women who take birth control pills, "the cancer benefits associated with oral contraception outweigh the risks."

American Cancer Society epidemiologist Carmen Rodriquez, MD, does not disagree with the statement.

"We know that there is a small increase in breast cancer risk among women who take oral contraceptives, and this cannot be ignored," she says. "But we also know that oral contraception use lowers the risk of ovarian cancer. Since this cancer is so deadly and since we don't have good ways to screen for it or prevent it, I think it's fair to say that the benefits outweigh the risks."

Vitamin E May Lower Blood Clot Risk

Study Shows Vitamin E May Prevent Deep Vein Clots
By Salynn Boyles
WebMD Medical News
Reviewed by Louise Chang, MD

Sept. 10, 2007 -- Vitamin E proved to be a bust for preventing heart disease and cancer in a widely publicized study in women, but intriguing results from the same trial suggest a role for the vitamin in reducing the risk of life-threatening blood clots.

Researchers warn that the findings must be confirmed, and they say no one taking prescription blood thinners to prevent deep vein blood clots should stop taking them.

But Harvard Medical School professor of medicine Robert J. Glynn, PhD, says vitamin E shows promise for preventing the potentially deadly clots in high-risk patients who aren't on prescription blood thinners like warfarin.

"Warfarin is very effective, but it has a lot of side effects and people must be monitored closely when they are on it," Glynn tells WebMD.
Vitamin E and Deep Vein Clots

Clots that form in the arteries lead to heart attacks and strokes, but deep vein clots become deadly when they break off and travel to the lungs, causing pulmonary embolisms. Deep vein clots and pulmonary embolism from blood clots are known collectively as venous thromboembolism (VTE).

That is what happened to NBC reporter David Bloom, who died in 2003 after spending days in a cramped military vehicle while covering the invasion of Iraq.

Spending long periods in a confined space without moving greatly increases a person's risk for developing deep vein blood clots, as do obesity, pregnancy, advanced age, oral contraceptives, and hormone therapy.

The American Heart Association (AHA) estimates that about 200,000 new cases of VTE occur in the U.S. each year, with 30% of cases resulting in death within 30 days. Another 30% of people develop new clots within 10 years.

In the newly published study, Glynn and colleagues reviewed data from the Women's Health Study, which included just under 40,000 women aged 45 and older who took either 600 international units (IU) of vitamin E or a placebo every other day and were followed for an average of 10 years.

During the trial, 213 women in the vitamin E group and 269 women in the placebo group developed venous thromboembolism.

Overall, women who took vitamin E were 21% less likely to develop venous thromboembolism than women who did not, but the reduction was more than double this (44%) among the women who had a history of clots.

And taking vitamin E appeared to cut the clot risk in half among women with genetic mutations that increased their risk.

The study appears in the Sept. 25 issue of the AHA journal Circulation.

"The puzzle fits together in a way that is really interesting, suggesting a possible benefit in precisely the people who need it most," Glynn says.
Vitamin E 'Not Ready for Prime Time'

The American Heart Association does not recommend antioxidant vitamins like vitamin E, C, and beta-carotene for preventing heart attacks and strokes, and a 2004 analysis of 14 studies suggested that taking 400 IU of vitamin E a day or more increased the risk of death.

But Glynn says no significant side effects were seen among women in the study who took vitamin E for an average of 10 years.

He says more study is needed to confirm the findings, and New York University cardiologist Nieca Goldberg, MD, agrees.

Goldberg directs NYU's women's heart program and is a spokeswoman for the AHA.

"This is very interesting, but it isn't necessarily ready for prime time," she tells WebMD. "People on strong blood thinners like warfarin should absolutely stay on them, and anyone else who might consider taking vitamin E for this reason should discuss it with their doctor first."

The Secret Causes of Insomnia: What Every Woman Should Know About Sleep Problems - 2

A hectic lifestyle isn't the only thing keeping women up at night. Here are some key causes of sleep problems in women.
(continued)
Sleep Problems and Your Hormones

If you're like many women, it may not be your lifestyle that's sabotaging your sleep but your own body -- primarily, your hormones. It all begins, say experts, with your monthly menstrual cycle.

“More than 70% of women complain of sleep problems during menstruation, when hormone levels are at their lowest,” says Amy Wolfson, PhD, author of TheWoman’s Book of Sleep: A Complete Resource Guide.

Indeed, experts say that not only does your period affect sleep quality, any menstrual symptoms you may experience can also keep you up at night. In fact, research reveals that menstruating women often report bloating significant enough to disturb their sleep at least two or three days during each menstrual cycle, according to the NSF.

If this rings true for you, talk to your gynecologist. There are treatments that can help some of your menstrual-related symptoms, which in turn may help solve these sleep problems.

Be aware, however, that as you enter perimenopause and eventually menopause, hormonal changes are back in the picture, disrupting your bedtime yet again.

Generally, post-menopausal women are less satisfied with their sleep, with more than half reporting insomnia symptoms,” says Wolfson, who is a spokesperson for the Better Sleep Council.

The oft-cited causes of sleep problems include hot flashes, mood disorders and sleep-disordered breathing like snoring, all common and sometimes severe even in post-menopausal women.

Again, talk to your doctor about symptom relief that can do double duty by also helping you sleep better.
Could You Have a Sleep Disorder?

You do all the right things -- relax before going to sleep, and get to bed on time -- but somehow you still can't get a decent night’s rest. When this is the case, a sleep disorder could be at the root of your sleep problems.

Sleep apnea. “There are 88 known sleep disorders,” says James Maas, MD. “From apnea to restless leg syndrome, these are one of the major reasons why people lose sleep.”

Among the most frustrating of these problems is sleep apnea.

“Sleep apnea is a pause in breathing during sleeping,” says Rosekind. “The interruption to sleep occurs because the body has to wake itself up again in order to get the oxygen it needs.” The longer the pauses in breathing and the more often they occur, the less sleep a woman gets.

“In some cases, apnea can occur five or 10 times a night,” says Rosekind. “In other cases, it could be hundreds. Studies suggest that apnea is more prevalent in men than in woman, but the NSF survey leads us to believe that apnea could be much higher in women than we realize.”

What's key here, however, is that most of the time you won't be aware of the momentary wake-ups -- so you end up feeling tired, and you don't know why.

Snoring. Another nighttime issue: snoring, yours or his.

“We know snoring is symptomatic to apnea,” says Rosekind. “A woman wakes up to breathe and she is gasping for air, and it comes out as a snore.” If your snoring wakes you, that’s a clue there’s a problem, but in many cases you won’t have a clue what’s going on unless a partner tells you.

Could You Have a Sleep Disorder? continued...

Snoring can also cause sleep problems even if you’re not the one doing it. “Snoring can be a problem when it’s the spouse who has the issue,” says Rosekind. “The audible noise plays a role in keeping her up at night.”

In either case, talk to your doctor -- there are a number of new stop-snoring remedies that can help.

Restless legs syndrome (RLS). Among the sleep disorders garnering more attention these days is a frequently undiagnosed neurological disorder known as restless legs syndrome (RLS).With RLS, you may experienceunpleasant sensations in the legs and an uncontrollable urge to move them to relieve the feelings, according to the NSF. Lying down and trying to relax makes the feelings worse, making it hard to fall and stay asleep.

“And the more frequent the episodes, the more likely a woman is to experience insomnia, daytime sleepiness, consume caffeine, and use sleep aids,” says Rosekind.

If your sleep problems persist despite your best efforts -- if you are consistently tired during the day, you are snoring, your partner says you are moving a lot at night -- it’s time to talk to your doctor, and maybe think about seeing a sleep specialist as well.

“Go see a sleep disorder center accredited by the American Sleep Medicine Association for an evaluation,” says Mass. “Your sleep is well worth it.”
The Sleep Solution

Fortunately, getting a good night’s rest usually requires simply paying better attention to a few key factors. First and foremost: Make sleep a priority.

“You need to value your sleep,” says Maas. “The biggest mistake women make is to put sleep last. By making sleep a priority, you can be a more effective mom, wife and career-woman.”

What can also help: Making a few changes to your nighttime routines. Mass offers these suggestions:

* Stress -- physical and mental -- is a major cause of insomnia. If something is bothering you, try to deal with it during the day, so it doesn't keep you up at night worrying.
* Avoid alcohol after 6 p.m. at night and caffeine after 2 p.m. Both can keep you awake nights.
* Keep your bedroom cool rather than warm, dim rather than bright, and dry rather than humid for optimum sleeping conditions.
* Make certain your bed is adequately sized for you and your partner, and that it offers proper support so you feel comfortable and relaxed while sleeping.
* Take some time choosing a pillow that really feels good. A pillow that’s too soft or too hard can cause sleep problems.
* Don't bring your work or your laptop into bed at night. Instead, look to do something that helps your mind unwind -- like reading or listening to relaxing music.

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The Secret Causes of Insomnia: What Every Woman Should Know About Sleep Problems - 1

A hectic lifestyle isn't the only thing keeping women up at night. Here are some key causes of sleep problems in women.
By Heather Hatfield
WebMD Feature
Reviewed by Louise Chang, MD

Whether you're living the sizzling life of a "Desperate Housewife" or you're a stay-at-home mom with four kids and a dog, there's a good chance you may be tired -- and with good reason.

When it comes to catching some zzz’s, it seems women just aren’t making the grade. From careers, to kids, to social and family events, life comes first, sleep comes last.

“Where you are in your lifestyle has an affect on how much sleep you get,” says Mark Rosekind, PhD, a board member of the National Sleep Foundation (NSF).

Throw biology into the mix -- like a woman’s menstrual cycle -- and insomnia becomes even more common. Sleep problems can make it even harder to get the recommended 7.5 to 8 hours of shut-eye necessary to perform your best.

But you don’t need to lose sleep over the fact that you’re losing sleep! To understand insomnia, learn what's keeping you up at night. According to experts from the National Sleep Foundation, here are the most common reasons why you may be burning the candle at both ends.

Insomnia and Your Lifestyle

According to a "Sleep in America" poll released by the NSF in March 2007, if you're a single working woman you probably spend the least amount of time in bed -- sometimes fewer than six hours a night. And if you're like many women in the survey, you probably also wake up feeling tired at least a few days of every week.

One of the primary reasons you aren’t sleeping? It could be something as simple as spending a bit too much time socializing with friends instead of hitting the sheets earlier in the evening. When this is the case, the solution involves a little self-discipline -- force yourself to hit the hay earlier a few nights a week, and you're likely to feel better overall, says Rosekind.

Stay-at-moms aren’t much better off, however. The NSF survey found that three-quarters of the women in this category experience symptoms of insomnia. What’s keeping moms up at night? It could be the kids -- worse, the dog -- bunking in with you. Or maybe it's a lack of quiet leisure activities to help you unwind at the end of the day. If your evening is spent primarily on chores or kids’ activities, that could lead to sleep problems.

Last but not least is the Wonder Woman -- and you know who you are. Married, with school-aged children and working full time, if you fall into this group it's almost a sure bet you aren't getting enough sleep, says Rosekind, who is also president and founder of Alertness Solutions. These women, he says, are usually getting fewer than six hours a night.

In addition to being overloaded with work and family obligations, you may not have enough time to exercise or relax -- or have sex -- which can help a girl when the sun goes down. Often, the solution here is as simple as making just a little more time for yourself at the end of every day.

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Women Prefer Working Outside the Home

Poll Shows Slight Preference Among Women for Working Outside the Home
By Miranda Hitti
WebMD Medical News
Reviewed by Louise Chang, MD

Sept. 6, 2007 -- If you were free to take a job outside the home or stay at home to take care of family and house, what would you prefer?

The Gallup Organization posed that hypothetical question to about 1,000 U.S. adults last month in a telephone poll about work.

Among women, 58% said they would prefer to work outside the home, 37% indicated that they would rather stay at home, 3% said they wanted to do both, and 2% expressed no opinion.

The percentage of women who would prefer working outside the home is slightly higher than the 54% who voiced that preference two years ago.

But there hasn't been a radical change in women's work preferences in Gallup's poll for many years. The last time that a "substantial majority of women" preferred staying at home was 1974, according to Gallup.

Gallup's poll also shows that among men, 68% preferred working outside the home. Another 29% said they would rather stay at home, 1% wanted to do both, and 2% had no opinion.

The percentage of men who say that if they could, they would rather stay at home is up from 17% a decade ago and 24% in 2001.

Having kids changed the results somewhat. Among mothers, 48% said they would rather stay home. So did 35% of dads.

The poll has a 3% margin of error.

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