10 ways to save on hospital bills

By Carlos Gonzales, MoneySense magazine

Posted at Sep 21 2009 11:03 PM | Updated as of Sep 23 2009 03:44 AM

Do you feel hospitalization costs are out of whack? Here are three areas you can control:

Your health insurance
You must absolutely be insured. Richard Ferrer, CEO of Makati Medical Center, says, “The best way really to save on hospital bills is to get insurance, either from PhilHealth or from private medical insurance firms.”

Savings Tip #1: Use your PhilHealth benefits. At the very least, make sure your employer remits your PhilHealth contributions regularly. If you are self-employed, be a voluntary member. This is one government service that you won’t regret paying for (and at just P100 a month, it’s definitely affordable).

PhilHealth lowers your hospital bills by covering a portion of your room and board (P200 to P400 per day, depending on the hospital category), drugs and medicines (from P1,500 to as much as P16,000, depending on the hospital and the type of illness), lab fees (P350 to P14,000), professional fees (maximum of P600 to P2,500), charges for the operating room (P385 to P3,490), and the surgeon’s and anesthesiologist’s fee (maximum of P16,000 and P5,000, respectively). One other important benefit: if you are giving birth, you shave off around P15,000 for the operation.

Savings Tip #2: Get private insurance. Dr. Oscar Torio, who runs private clinic Sta. Lucia Polyclinic and is affiliated with a number of provincial hospitals, says, “Secure medical insurance, that is, an HMO. Big and some small private companies provide this benefit to their employees.”

Health maintenance organizations (HMOs) are becoming the popular alternative. One of your company benefits will more likely include participation in a group plan. It’s one of those benefits that you may take for granted but can actually save you a lot of money. Dr. Oscar says, “This is the business of HMOs to offer big savings—eventually that is—to the insured individual in case he or she in the future would ever need hospitalization for a reasonable monthly fee deducted from their monthly salary, a large percentage of the hospital fee is then shouldered by these HMOs.

If you’re not a member of an HMO, however, join one. The primary advantage is that there are no cash outlays, unlike traditional health insurance plans, which require you to pay first and then claim for reimbursement (although newer plans now offer no cash outlays for select hospitals). There is also greater emphasis on preventive care, hence the annual trips for free physical exams and full coverage for out-patient benefits like doctor’s consultations and lab fees, which are not fully reimbursable under a traditional plan.

It is also a little cheaper than a traditional health plan. Insular Life’s plan with a private suite for the 31-35 age group, for instance, has an annual premium of P15,930 versus P23,464 for Blue Cross’s standard plan with a suite. But limits for HMOs are much lower: P150,000 for this specific plan of Insular Life as against P3,000,000 for Blue Cross. Other HMOs limit coverage between P100,000 to P200,000.

Savings Tip #3: Consider getting a traditional health insurance plan. Of course, premiums can be more expensive. Select Access, an insurance plan with maximum coverage of P1.5 million from Blue Cross with no cash outlay for select hospitals, for instance, costs P27,479 if you’re in the 21-40 age bracket. But it pays more. Room and board and miscellaneous hospital expenses, which include drugs and lab fees, are covered as charged, for example. The limit is P180,000 for the surgeon’s fee and P60,000 for the anesthesiologist’s.

If you are relatively young and healthy, you can get by with an HMO, but as you grow older and your health risks increase, getting a traditional health insurance plan makes a lot more sense. Besides, the premiums you pay now may pay off huge when you need medical care the most. Richard explains, “It is better to amortize payments through an insurance company than to pay everything during emergencies.”

Savings Tip #4: Stay within your network. The other advantage for a traditional health insurance plan is you typically have more flexibility in choosing your own doctor and hospital, unlike with an HMO that forces you to avail of service providers within your HMO’s network. This means that if you are an HMO member, make sure everyone who will be treating you (surgeons, anesthesiologists, radiologists, pathologists) participates in your HMO. You also have to know which hospitals are accredited by your HMO. Otherwise, you’ll pay out-of-pocket for out-of-network providers.

However, if it’s an emergency, your HMO may probably reimburse you. So carefully check your plans exceptions and exclusions.

Your hospital
Even if you have a health plan that fully covers room and board, you still want to make sure you are within your maximum coverage. Membership in a plan is not a license to spend on health care benefits on a whim.

Savings Tip #5: Choose a more reasonably priced hospital. Your choice of hospital of course should not be based on how affordable the room rates are but do make that one of the key factors for your decision. Don’t always equate fancy rooms with the quality of care. If another hospital provides the same quality for a more reasonable price, then go for it. Ask for room rates and choose one that fits your budget. You can also opt for a training hospital. “You could choose to be admitted to a government hospital that is primarily a training hospital which offers a substantially lower hospitalization rate,” says Dr. Oscar.

Once you do pick the hospital, there are various room options to choose from. Private rooms, of course, provide the most ideal comfort and privacy, but even private rooms vary in rates. Choose a smaller-sized room with the same amenities and save hundreds if not a few thousands of pesos. A standard 14-sq.m.-private room at The Medical City, with a TV, telephone, fridge, and bench bed costs P2,100. Upgrade to a bigger 24-sq.m.-room with a sofa bed and you’ll pay P3,300 per night. Throw in the works (sofa bed, dresser, waiting sofa, lounge, coffee table, dining table, TV and DVD player, fridge, phone, microwave oven, and Internet access) for the Presidential Suite and pay P15,000 a night.

Savings Tip #6: Switch rooms. You will be charged for the operating room and other hospital department services based on your room rate on the night before your operation. So if you are staying at an expensive suite, expect to pay more. So check in at a lower-priced room the night before your operation and just move to a better and more expensive room right after.

Savings Tip #7: Time your stay. If you want to avoid an extra, unnecessary stay (and save one day off your room and board), get your schedule right. Your doctor will tell you when your surgery will take place. Talk to your doctor about your preference. Ask to be scheduled first or at the earliest time possible to so you can get out of the hospital quicker. Alternately, ask to be scheduled in the evening so you just have to check in the morning of your operation, not the night before.

Savings Tip #8: Check your bill for errors. Hospital staff can make mistakes, including errors in your bill. Before you automatically pay your bill, make sure you thoroughly review the details of your itemized bill. You might be charged for services you did not receive. You can consider doing a log of all tests, medications, and treatments during your stay, or ask a companion to do it for you.

Savings Tip #9: Bring in your own medicines. Expect to pay more for medications that you can buy at cheaper prices outside. You can bring in and use your own medicines. “Hospitals routinely allow patients to purchase medicines outside their premises. The considerable savings more than offset the burden of having to go outside and buy them,” says Dr. Oscar.

But make sure you inform the hospital staff, who should administer the drugs themselves. Richard explains, “For in-house patients, we do the dispensing because if not, we will not be able to guarantee the safety. It will open us to risk.”

As for bringing in lab tests done outside the hospital, Dr. Oscar says it can be cheaper “because bigger hospitals have bigger overhead costs to maintain than small clinics, thus the higher expenses for the same medical procedures.” If your own doctor recommends an outside clinic that may be less costly, then that is fine. But be selective in doing so as there is a possibility the hospital might not recognize the results. And certainly don’t do it without your doctor’s go signal. “It’s not simply a matter of cost because then the question is the reliability of the results. And if there is a difference, it will be very small. It will be better to go to the hospital for the tests,” says Richard.

Your doctor
We often hold doctors with such high esteem—and rightly so—but we risk accepting everything they say, and charge, without question.

Savings Tip #10: Negotiate with your doctor. “By all means haggle,” says Richard. Professional fees aren’t set in stone. In fact, while they may have standard fees, doctors do adjust fees as they deem fit. Health plans have limited coverage so it pays to negotiate. And if you’re not insured at all, then negotiating becomes very critical.
Dr. Oscar explains, “Here in my locality, some patients undergoing elective surgery are forthright enough to ask the surgeon for professional fee discounts citing shortage of cash. Though some doctors tolerate this practice, some also tell patients that they don’t encourage it.” Certainly there’s no harm in trying.

From the 2007 edition of MoneySense, the country’s first and only personal finance magazine. You can read more financial tips and stories at www.moneysense.com.ph.