10 Smart ways to slash your health care bills; Before you fill that prescription or enroll in an insurance plan, read this guide on how you can trim thousands from your medical costs—without compromising your care

Shape, July, 2008 by Anne Marie O'connor

CO-PAYS. DEDUCTIBLES. OUT-OF-POCKET EXPENSES. It may feel like you need to empty your savings account to stay healthy. You're not alone; One in six Americans spends at least 10 percent of his or her annual income on prescriptions, premiums, and medical care. "Many women assume these costs are nonnegotiable," says Michelle Katz, author of 101 Health Insurance Tips. "But it's easy to save hundreds of dollars on your bills each year by speaking with your doctor or choosing another insurance plan. "Here, learn why you're paying too much--and how you can put that money back in your pocket.

(1) Choose a plan carefully When it comes time to re-enroll this year, don't blindly check the box next to your current policy. "Re-evaluate your plan annually to ensure it meets your current needs," says Kimberly Lankford, author of The Insurance Maze. The first question you should ask is whether you have a favorite doctor or a medical condition that requires a specialist's care. If you answered yes to either, your best bet may be one of the pricier preferred-provider organization (PPO) or point-of-service (POS) plans, which give you the freedom to visit any physician, says Lankford. Generally, an in-network doctor will charge $10 to $25 per visit; out-of-network M.D.'s bill you for 30 percent of their fees. But if you only see your physician a few times a year, a health-maintenance organization (HMO) may be a better fit. These offer a limited selection of doctors for cheaper premiums and co-pays.

If you're self-employed or your employer doesn't offer medical insurance, check out Web sites like ebealth insurance.com, which offers price and coverage comparisons by state. "Take into account your prescriptions, regular care needs, and mental health and vision expenses," says Lankford. "Also consider if you're planning on becoming pregnant within the year, because not all plans cover those costs." Once you've pinpointed all the services you'll require, crunch the numbers with an online calculator such as money-zine.com. "Don't be scared off by policies with high deductibles, the amount you have to pay out of pocket before insurance coverage kicks in," says Lankford. "Those plans have cheaper monthly premiums, so they may be worth it if your medical needs are minimal."

(2)Question your tests "Doctors aren't necessarily aware of what screens and exams are covered by your insurance," says Katz. To avoid pricey surprises, bring a list of approved labs to your first appointment with a new physician. Also check with your insurance provider before you schedule any treatments or tests, such as X-rays, MRIs, and breast ultrasounds; you may need to get written or verbal approval beforehand. Write down everyone you talk to and the time and date you spoke," says Lankford. "A paper trail is crucial if there are any questions or disputes later on."

(3)Bargain with your doctor If you're paying your bills out of pocket, don't be shy or embarrassed to ask your doctor for a discount. "Explain your situation," says Katz. "Say, 'You're not in my network, but I wouldn't trust anyone else to handle this. Is there any way you can adjust your fee for me?'" This tactic worked for Katz: As an uninsured graduate student, she asked a well-known local neurosurgeon to treat her injured back. "At my first appointment, I discussed my financial concerns with him," she says. Not only did he refer her to the least expensive hospital for her surgery, he also agreed to perform an operation for half his usual fee. What's more, he allowed her to pay off the cost on a monthly schedule, saving her a total of $14,000. "The key is establishing a personal relationship with your doctor and the staff," says Katz, who recommends arriving on time for your appointments and always expressing your appreciation.

(4) Know what to do in an emergency When a crisis occurs, hospital and doctors' fees are probably the last thing you're thinking about. That's why it's crucial to review your policy in advance. "Check to see if you need preapproval before going to the emergency room and note which hospitals in your area are considered innetwork and what constitutes an emergency," says Lankford (you can find this information in your insurance policy booklet or on the company's Web site). You'll protect yourself from an unexpected bill: Health insurance companies deny 20 percent of all emergency care payment requests that require prior authorization, according to a recent study published in the Annals of Emergency Medicine.

"If it's urgent, urgent, don't hesitate to call an ambulance," says Lankford. But for non-life-threatening situations, such as a broken bone or a fever below 103[degrees]F (unless you have stomach pain, which could signal appendicitis), ask a friend or family member to give you a ride to the hospital.

(5) Review your hospital bill Most women scrutinize their credit card statements every month, yet very few even glance at their hospital invoices. But they should: Experts estimate up to 90 percent of hospital bills contain errors. Before you check out, request an itemized bill. "Each treatment you receive is assigned a numerical code," explains Katz. "So somebody accidentally typing in the wrong code could mean a difference of hundreds or even thousands of dollars." Before leaving, scan your bill for any unusual charges. Then, at your next appointment, ask your physician or someone on her staff to go over anything you don't recognize.