How to Cut Your Medical Costs

THE price of a visit to the doctor has almost quadrupled since 1967, from an average of $11 to more than $40. In that period, the average cost of a day in the hospital has gone up more than sevenfold, leaping from $34 to $255. Although health insurance policies are more generous than ever, you may well face some sizable medical bills if you or a family member becomes ill or injured. But you can negotiate with your doctor, save on drugs and use other safe strategies to trim the bills that your insurance does not pay.

One means of cutting your costs is simply to ask your doctor to lower his price if you consider it out of line or if you think your steady patronage entitles you to a discount. Physicians' fees are surprisingly negotiable.

Many hospitals offer discounts on the costs of fitness checkups. The examinations range from stress tests to full scale physicals. To cite just a few examples from around the country: the Trinity Lutheran Hospital in Kansas City will test your fitness by checking such things as body fat, blood pressure and heart rate. The examination will cost you only $90, compared with $300 if you had all the tests done individually. At the Park side Sports Fitness Center in Park Ridge, Illinois, you can also get a fitness profile for $45. Plus, they will give you a custom designed exercise plan. You also can save on drugs. Health insurance may pay up to 80% of your prescription drug bill. But you will pay 20% of a smaller amount if you buy generic drugs. They are virtually identical to brand name drugs in all but a handful of instances. Ask your doctor to write out the generic name or indicate on his prescription that the pharmacist is at liberty to substitute a generic equivalent of a brand name drug.

When you buy either kind of drug, remember that you will likely get a better price from a chain drugstore than from an independent druggist. That's because chains can buy in bulk. So can mail order outlets, which are another good alternative.

Almost one out of two Americans have dental insurance, so it is helpful to know that comparison shopping for a dentist can produce significant savings. In New York, for example, you can pay as little as nothing or as much as $75 for a routine cleaning.

One way to save, at least on simple procedures, is to let dental students practice their skills on your teeth at a clinic of any of the 58 U.S. dental schools. Clinics do work at fees that are roughly half what you would pay a regular dentist. Students are in the final two years of their four year dental school education and you will be relieved to know that they are closely supervised. Trouble is, they may subject you to three times as much time in the chair as experienced dentists.

A less trying way to reduce costs may be to seek out a dental clinic run by a hospital. These clinics are staffed by new graduates. They are faster, less error prone and command higher fees than students. Still, they charge as much as one third less than private practitioners.

As for psychotherapy, medical insurance usually does not cover more than half the cost, and psychiatrists in private practice charge $50 to $100, sometimes even more, for a 45 to 50 minute session. Fortunately, there are less costly and equally beneficial options.

Psychologists and specially trained social workers can treat people with emotional problems for less than what psychiatrists charge. For anything other than private, individual treatment in the therapist's office, you usually can save money. The same therapist might charge you only half as much to treat you in a clinic as in his own private office.

Another way to save is group therapy. Many therapists and clinics hold group sessions, in which several patients talk with a professional for about 90 minutes. The cost may run from $30 to $50 a session, and group therapy is often used in conjunction with private sessions. If you suffer from a well defined problem, such as anxiety about a new job, so called brief psychotherapy might be your best course. The treatment aims to accomplish a specific goal in a limited number of sessions, typically 20.

Still another expense you can reduce is that for eyeglasses or contact lenses. Ophthalmologists provide the contact lenses that they prescribe, but usually you must take an ophthalmologist's prescription for eyeglasses to an optician. He or she grinds the lenses and sells frames but has no set training.

Ophthalmologists charge $30 to $65 for a routine examination and up to $250 for a pair of soft lenses, But if you don't have complex vision problems, investing in an exam by an ophthalmologist is like retaining a Nobel Prize winning economist to figure your taxes. For a routine eye exam, an optometrist is good enough. Optometrists prescribe and sell both eyeglasses and contacts. Including eye exam, a pair of glasses bought through an optometrist is roughly 10% lower than a pair prescribed by an ophthalmologist and bought from an optician.