“Doctors aren’t trained to take finances into account when prescribing treatments,” says James F. Fries, MD, rheumatologist and professor of medicine at Stanford University. Here are some ways you can help your doctor keep costs in mind, thinking of you as a patient and a customer.
1. Keep your doctor grounded in your reality. Talk with your doctor openly, not only about the best way to manage your arthritis, but also about what you can afford. Your doctor might, for example, be able to stretch the interval between lab tests to accommodate your wallet and your health.
2. Do get an early diagnosis. Don’t be penny wise and pound-foolish. Studies show early diagnosis and treatment can cut down substantially on the progression of the disease, which, in turn, will keep down the costs of pain management and potentially avoid disability down the line. Sometimes, though, diagnosing many forms of arthritis and related conditions takes time and, of course, money, but it is worth it in the long run.
3. Ask for generic. “If you tell your physician you can’t afford to spend a lot on pricey brand-name drugs, he can usually find a less expensive generic substitute,” says Mary Ryan, a nurse practitioner with Internal Medicine and Rheumatology of Kansas City, Kan. To encourage this, insurance companies are reducing co-payments, or co-pays, for generic drugs and raising them for brand name drugs. Generic drugs may require only a $5 co-pay, whereas brand name drug co-pays are moving as high as $25 and $30.
4. Don’t be test happy. X-rays, computed tomography (CT) scans and magnetic resonance imaging scans (MRIs) are of limited medical value in managing arthritis, according to Dr. Fries, but patients often pressure their doctors to perform the tests anyway. Ask your doctor to be judicious about testing, and you can reduce your tab.
5. Monitor referrals. Some primary care doctors refer patients to specialists freely. If yours seems to lack confidence to treat even common complaints, you could save money by switching to a better-skilled doctor to avoid an extended string of $10 or $20 doctor visit co-pays.
6. Take control. Don’t head to the doctor every time you have pain or a medical concern. Some pain can be managed inexpensively at home. Some questions can be answered via phone or e-mail. During your appointment, ask you doctor to be specific about which situations are appropriate for self-care, which require a call and which an appointment. Also, your doctor may be willing to write a prescription for a pain reliever there’s a good chance but no certainty you’ll need, saving you a trip back in.
7. Do get a second opinion. If you’re facing an expensive procedure, get help in making a big decision. A knee replacement can cost $6,000 for the surgeon alone. So paying another $20 co-pay to compare notes with a different doctor in your plan’s network – or dishing out $100 or more to see an out-of-network physician you trust – is worthwhile to see if you have other options or can forestall the expensive procedure.