<![CDATA[Money - Health.com]]>

<![CDATA[Money - Health.com]]> en daily 1 <![CDATA[14 Must-Know Facts About Medicare Open Enrollment]]>

<![CDATA[Laid Off? You Have 62 Days to Get Health Coverage, So Here's What to Do]]>

…One hour
You’re stressed and scared, and not in any mental state to make decisions. Take a few minutes to collect yourself and relax as much as possible. Take slow, deep breaths. In the coming days and weeks you’ll have to make a slew of decisions regarding your health care and personal finances, and you’ll need to stay calm.

…One day
Whether security is waiting to walk you out the door or you have time to clean out your desk, grab the paperwork related to your employer-issued benefits. Carefully read over the fine print on your contract and the terms of your health-insurance plan. Then ask someone from human resources:

Am I entitled to a severance package?
When exactly will my health benefits expire? (Some health plans expire on the day you are laid off; others might continue until the end of the month.)
Is there any room for negotiation? (You may be able to exchange severance pay for extended health benefits.)
Do you have any advice for me? (A sympathetic HR employee can be your best ally.)

Don’t leave without asking for a certificate of creditable coverage. This document includes the dates that your health insurance began and ended, and proves that you were covered during that time. You’ll need this to apply to other health-insurance plans.

…One week
If your health benefits haven’t expired yet, make doctor’s and dentist’s appointments for you and your family if you're due. Refill prescriptions. Try to squeeze in as much essential health care as you can before the expiration date, because it will almost certainly be more expensive once you lose your employer-provided insurance. If your doc is booked, explain your situation and ask to be notified about cancellations. (Don’t overdo it, however. If you get too many unnecessary tests and checkups in a short period of time, your premiums will likely be higher if you decide to buy health insurance on the open market. And if a checkup turns up a serious health problem, you may even be denied coverage altogether.)

Plan to spend down your flexible spending account (FSA), if you have one, on new glasses, cold medicine, acupuncture—on whatever you can, so your former employer doesn't get to keep your hard-earned savings. Unlike health savings accounts (HSAs), which are portable from job to job and roll over, FSAs are always administered by your employer and must be spent by the end of the company’s “plan year” (plus a 2 ½-month grace period).

Next Page: One month

…One month
Enroll in your spouse’s employer-sponsored plan, if you can. Under the Health Insurance Portability and Accountability Act (HIPAA), you and your dependents can do this ASAP, without waiting until the next enrollment period. Here's the catch: You must request this so-called special enrollment within 30 days of losing your previous health benefits.

…Two months
If you're single or can’t get covered by your spouse, sign up for a COBRA extension. Under the Consolidated Omnibus Budget Reconciliation Act, you and your family have the right to extend your current health plan for up to 18 months after you are laid off. (If your former employer has fewer than 20 employees, you may not be eligible for a COBRA plan.) You will have to pay for 100% of the coverage rather than sharing the cost with your employer, but it is still usually cheaper than buying an equivalent policy on your own.

Keep an eye on the mail. After your employer notifies the insurer that you’ve been terminated, the insurer must inform you of your COBRA rights in writing within 14 days. Once this notice is sent by your insurer—not once you receive it—the clock starts ticking: You have 60 days to enroll in the plan. (If your existing coverage expires after the notice is sent, you have 60 days from the expiration date.)

…62 days
And we really mean 62 days. Under HIPAA, if you go without health insurance for 63 days or more, you will be subject to a preexisting-condition exclusion. When you enroll in a new health plan, the insurer can exclude from coverage any health condition—cancer, heart disease, diabetes—for which you received treatment in the six months leading up to your enrollment. This exclusion period can last for up to 12 months (or 18 months if you join the health plan late), but you can offset it by producing your certificate of creditable coverage, which you remembered to ask for on day 1. If you can prove that you’ve had continuous health insurance for more than 12 months without a gap of 63 days or more, the new health plan will not be able to impose a preexisting-condition exclusion.]]> A layoff doesn’t have to be the end of health-care coverage. (ISTOCKPHOTO) <![CDATA[Cost-Cutting Tips for Seniors]]>

<![CDATA[13 Tips for Saving Money on Prescription Drugs]]>

<![CDATA[How to Survive a Bad Economy]]>

1. Make your $$ work hard
Women who see their life savings dwindling are understandably “scared, angry, and confused,” says financial expert Suze Orman, author of Suze Orman’s 2009 Action Plan. But “fix-it-now” decisions can put long-term financial security in danger. Her advice: “Resist the temptation to stop investing in stocks. If you have time on your side—and that means at least 10 years, preferably longer, before you need the money—keep a large portion of your retirement money in stocks.” Why? Once you move your money out of stocks, you give up any chance to recoup your losses, Orman says. Sure, a safe and stable fund may inch along with a 3 to 4% gain a year, she says, “but chances are that’s not enough to help you reach your long-term investment goals.”

2. Hang with happy people
A new Harvard study shows that happiness is contagious, spreading from one person to nearby family members, neighbors, and friends. “One happy person can increase the happiness of others she comes into contact with by 8 to 34%—and the effect can last up to a year,” says Health’s life coach M.J. Ryan.

3. Get paid to be healthy
If you need a carrot dangling in front of you to get you moving, there’s good news: Many companies are offering incentives for healthy behavior. Even in a recession, you can get paid as much as $200 to $300 a shot for doing what’s good for you, from taking a weight-management or stop-smoking course to getting your heart attack risks appraised. At companies like Aetna, employees can earn more than $1,200 a year for participating in health-and-fitness activities and programs. Ask your human resources department what they’ll pay you to get fit or stay well.

4. Be good to yourself
Financial uncertainty takes a toll on your health, says Andrew Weil, MD, director, Arizona Center for Integrative Medicine. In fact, a recent study following healthy unemployed people found that 80 percent were diagnosed with a new health problem within 18 months of being laid off. The key to staying well in bad times? “Get enough rest, sleep, and physical activity, and have fun,” Dr. Weil says. He also recommends eating an anti-inflammatory diet that includes fish oil (2 to 3 grams a day), taking a good multivitamin or multimineral, and doing deep-breathing exercises.]]> Istockphoto <![CDATA[9 Ways to Save Money and Stay Fit]]>

But taking care of yourself will only save you money in the long run, so it's important to find ways to stay active and healthy even when you may not be able to afford top-notch training or first-class fitness clubs. Here are nine easy ways to get started without breaking your budget.

1. Join now
If you do have enough money in your budget to pay for a gym membership, act now to take advantage of New Year's savings. Many fitness clubs slash their membership rates in January to draw in people who make weight-loss resolutions; for example, the Los Angeles Times reported this week that the upscale SportsClub/LA recently invited past members to restart their membership at a savings of almost $1,000. Other chains offering reduced rates for the new year include Bally Total Fitness, Curves, and Gold's Gym. Paying a whole year's dues up front, instead of month per month, may also save you money—but only if you're sure not to give up or cancel your membership.

2. Renegotiate your rate
If you've lost your job and relied on a cheaper corporate gym rate, talk to your membership coordinators and see if it's possible to keep the same rate, rather than paying full price; fitness clubs are also hurting from the economic crisis and may be more willing to give you a discount rather than lose you as a customer. You may also find that you're eligible for discounts at a gym by being active in other community organizations, such as food co-ops or volunteer groups, or through your insurance plan. If you're hurting for cash, ask about limited membership options for less expensive rates, which may limit the hours or areas of the gym you can use. One Gold's Gym in Green Brook, N.J., for example, is offering a free 8 a.m. to 3 p.m., Monday through Friday membership for the month of January to people who have recently been laid off, BusinessWire recently reported.

3. Bike to work
If you're close enough to ride a bicycle to your job instead of driving or taking public transportation, you may save in more ways than one. Spending less on gas or train and bus fare is an advantage, of course, but some employers are actually starting to reward bike riders with monetary reimbursements as well. In 2007, Google began giving free bikes and helmets to its employees, and since then several other companies have begun to follow suit, providing various forms of compensation for those who pedal to work. And we may soon see more widespread rewards: Last year's Energy Improvement and Extension Act, which went into effect on January 1, 2009, makes it legal for cycling commuters to apply for a $20 per month reimbursement. Visit BikeLeague.org's FAQ page for more information.

Next Page: Modernize your home gym

4. Modernize your home gym
Strength-training at home no longer requires a huge, bulky weight-lifting contraption that costs thousands of dollars and takes over your living room. Today's home fitness equipment is portable, storable, and best of all, affordable. Hot this season is the Iron Gym ($30 online and in retail and fitness stores), an as-seen-on-TV gadget that becomes a pull-up bar when secured in a doorway, a push-up and dips bar when used on the floor, and an ab toner when used with the attachable arm straps. For a slightly higher price, you can get the higher-tech GoFit Gravity Bar ($100), which also includes resistance bands that let you work your legs and lower body, along with a training DVD and laminated exercise booklet. Pair these workouts with an outdoor walk or run and you'll take care of both your cardio and strength-training needs without setting foot in a real gym.

5. Lay off your personal trainer
If you've had the luxury of investing in a personal trainer for the last several months or years, you may find that your individual sessions will have to be the first thing to go when money gets tight. But instead of letting go of this valuable guidance completely, ask about group sessions that might make training more affordable. You might also turn to virtual coach programs such as PlusOneActive.com, active video games such as Wii Fit (which contains a personal trainer program), or computerized gadgets that can track your heart rate, daily number of steps, or calories burned.

6. Join a fund-raising team
It always helps to have a concrete goal when trying to get in shape, and signing up for an organized run, walk, or triathlon is one of the best ways to stay focused. Entry fees and transportation can be expensive, but often you can sign up with nonprofit organizations that cover your event-related costs (and provide free training sessions and advice from experienced coaches) as long as you raise the required amount of money for their cause. Chances are you'll be responsible for producing a good chunk of cash, but people will be more willing to help if they know their tax-deductible contribution is going toward a good cause. Some of the larger organizations that coordinate athletic fund-raising include the Leukemia & Lymphoma Society, Susan G. Komen for the Cure, the March of Dimes, Autism Speaks, and the American Heart Association.

Next Page: Let the Internet do your bargain hunting

7. Let the Internet do your bargain hunting
Thrifty online shoppers know that you can often get great deals without the hassle of crowded malls and pushy salespeople—if you know when and where to look. Sign up at ShopItToMe.com/running and they'll email you when workout clothes or shoes in your size go on sale at various sites all over the Web.

8. Consolidate your goals
The social networking site 5k5k.org is a free online program designed to get people in shape to run a 5K while saving or paying off $5,000. The site's members (about 100 as of this week) share stories and help to motivate each other toward these long-term goals, while its founder—a fourth-grade teacher and former U.S. marine—checks in often with helpful tips and blog posts.

9. Know when to splurge and when to save
A good pair of walking or running shoes, an easy-to-use heart-rate monitor, or a portable MP3 player will be a valuable investment if you know that you'll use them often, but a lot of fitness products are pricey just because of the name brand, or contain high-tech features that will only get in your way. Don't be afraid to check retail stores like Target and Wal-Mart for basic lightweight, breathable workout apparel, or secondhand sports stores for fitness equipment. Do your research ahead of time, talk to experienced salespeople, and know exactly what you need—and beware of anyone trying to sell you something with more expensive bells and whistles. Here's a great primer on what's worth spending and what's worth saving.

So far this year, I've signed up for a triathlon that would have cost more than $300 for registration, for just a $75 Team in Training initiation fee and a pledge that I'll raise money for the Leukemia & Lymphoma Society. My boyfriend discontinued his out-of-the way and seldom-used gym membership after he tested out the GoFit Gravity bar and some cold-weather running gear I got him for Christmas. We've cooked up some delicious healthy meals for less than $10. And I've even found that working out in the morning keeps me more awake in the afternoon—and less likely to rely on the caffeine-and-calorie-packed $4 drinks that I otherwise crave from Starbucks. I have a feeling that staying fit is going to help save me money all year—and whenever it does, I'll keep you posted.]]> <![CDATA[43 Ways to Live Healthier for Less Money]]>

Times are tough, money is tight, but that doesn’t mean you need to give up your healthy lifestyle. Sure, eating organic food can be more costly, and working out with a personal trainer ain’t cheap—but there are easy steps you can take that will shave hundreds or even thousands of dollars off your monthly expenses.

From free home-gym equipment to discount prescription drugs, cheaper medical procedures, and health insurance that pays you back, the opportunities to save money on healthy living are plentiful. Here’s how to take advantage of them today.

Eat organic (cheaply)
Buy organically grown: You don’t need certified organic, just organically grown. Some farmers use organic farming practices but have chosen not to become certified organic because of the added red tape and expenses. This means you can often buy organic fruits and veggies from these farmers for around 50 percent less than what the certified farmers charge.

Plan around your protein: Look for sales on free-range or naturally-raised meats and buy them first, says nutrition educator Amanda Louden of Gold River, California, who writes EatYourRoots.org. You’ll save twice: You will get your protein on sale and be able to better plan (and buy less) to fill out your meals.

Be super-choosy: You don’t need to buy organic when fruits and veggies have a protective layer that you don’t eat (like bananas and watermelon) or when they’re unlikely to have been sprayed heavily with pesticides (like blueberries and kiwi). Check out this chart for guidance:

Do Buy Organic	Don't Buy Organic
Apples	Asparagus
Celery	Bananas
Grapes	Blueberries
Lettuce	Broccoli
Peaches	Cauliflower
Strawberries	Kiwi
Potatoes	Onions
Tomatoes	Watermelon

These are not your mother's coupons
Here’s the modern way to cut costs with coupons: Sign up for a service that sends you exactly what you need—from discounts on healthy frozen entrees ($2 off five Lean Cuisine meals at Target, for example) to organic, gluten-free, or all-natural foods—for a small handling fee. Try TheCouponClippers.com or TheCouponMaster.com.

Shopping for a new piece of exercise equipment? Google the item you’re interested in and search for coupon codes issued by the manufacturer or the retailer you intend to buy from. Yes, even your high-end elliptical trainer may have a coupon or discount! You can often shave off 10 to 20% with a single promotional code—or at least get free shipping.

Skip eating out
Cooking a meal at home that serves four to six people will cost as little as $7 to prepare, compared with the average restaurant meal, which is $40.78 per person in New York City. That’s if you’re a smart shopper and buy a month’s worth of groceries at a time, says Nanci Slagle, author of The Freezer Cooking Manual from 30 Day Gourmet. For meal-plan ideas, visit 30DayGourmet.com.

Waste not
Embarrassed by how much past-its-prime food you toss each week? That waste can add up to hundreds of dollars a year! Cut your losses by using the Reynolds Handi-Vac Vacuum Sealer ($9.99 for starter kit; retailers nationwide), which preps meats, fruits, and vegetables for long-term freezer storage. Simply defrost the frozen ingredients when you’re ready to use them. Or stock up on EvriFresh sachet disks ($3.99): They neutralize the food-spoiling ethylene gas that produce releases in the fridge as it ripens.

When to buy big
If you have a freezer buy good-for-you grass-fed meat straight from the farm; use a site like EatWild.com to find local farms.

“You can buy a quarter, half, or even a whole cow for an average of $5 to $6 per pound—far less than what you would pay for naturally-raised meat at the grocery store,” nutritionist Amanda Louden says.

When to buy small
Any time you clip a coupon use it to buy the smallest size allowed in the coupon restrictions—and you’ll save even more! How does that work? A buck off of a 10-ounce, $2 box of rice, for instance, provides more savings (you pay $1 for 10 ounces) than a buck off of a 20-ounce, $4 box of rice (you pay $3 for 20 ounces, a whole $1 more). Save while you sweat
Kettlebells: Can’t afford a trendy class at the gym this year? Get a full-body workout at home with kettlebells. Try our Kettlebell moves.
$155 strength-training class versus $20 kettlebell and DVD—You save $1,301 a year!

Boot camps: Often held outdoors, in a group, with minimal equipment—boot camps are cheap and hot: They burn as many as 600 calories an hour! In an urban area, a boot camp might cost $31 an hour, compared with $90 to $125 for a personal trainer.
$125-per-hour trainer versus $31-per-hour boot camp—You save $4,230 a year!

Exergaming: Who doesn’t love the Wii Fit, which lets you ski, aerobicize, improve balance, and monitor weight in the privacy of your own home? To save even more, rent games from GameFly.com or your local library.
$1,181 annual gym membership versus $340 Wii system and Wii Fit—You save $841 a year!

Four ways to set up a home gym for next to nothing
Check area gyms for cast-offs. Pro machines are often better built, so they have lots of miles left on them. And you may be able to buy them for a small fee.

Check CraigsList.org or other local Web sites. You’ll find motivated sellers who are tired of their equipment. Some don’t even want any cash—just someone who’ll come and take it away. That’s how Vanessa Richins of Provo, Utah, snagged an elliptical machine, treadmill, weight set, and Weider total-body gym. She found her freebies (worth about $1,500) through Freecycle.org, which connects people who have unwanted items with those who want them.

Cruise consignment and resale stores. Places like Play It Again Sports often sell their used workout equipment for as much as 40 to 70% off retail.

Find out if your equipment is a medical necessity. If you’re using it to rehab a knee or because a doc suggested it, your insurance may cover all or part of it. Or it may be a reimbursable under a Health Savings Account (HSA) or Flexible Savings Account (FSA).

The cheapest fitness DVDs
Thanks to the lousy economy, it’s come to this: You may have to choose between your Spinning class or your twice-a-month cleaning service. Both are good for your mental and physical health, but here’s the thing—there’s no video substitute (that we know of) for a good cleaning service and there are lots of great DVDs available to get you moving. Here, the cheapest ways to Spin or do yoga or whatever you heart desires at (your clean) home.

Hit the library. It’s a cheap way to try out a routine or instructor (on DVD) before plunking down your cash.

Swap with friends … or online at SwapADVD.com. You list the DVDs you’re done with, and members can request them from you. Mail them, get a credit for each one, and then use those credits to request exercise DVDs from others. The only cost is a couple of bucks for shipping.

Pay half price at Half.com (through eBay), where fellow DVD owners sell the ones they’re done with for a fraction of the retail price. Get your insurance company to pay you
Would you be more willing to make a healthy change in return for a lower health-insurance premium or some cold, hard cash? The majority of women said yes, according to the National Women’s Health Resource Center’s 2008 annual health survey. See if your insurance plan offers discounts or cash perks for your healthy behavior. (If they don’t, get friends or fellow employees to lobby them.)

How does it work? Excellus’s HealthyBlue plan, for example, gives discounts and rewards to subscribers for activities like taking the stairs at work. And Humana offers supplemental health rewards (similar to a frequent-flyer program) and financial incentives to participants who complete a health assessment or participate in preventive services.

Tarina Joy Love of Indianapolis earned $125 in gift cards in just two months of participation in her company’s health-rewards program, through Virgin HealthMiles. Love pays $5 a month to track her fitness activities and receives points for walking, taking a health assessment, lifting weights, and maintaining a healthy weight. Each year she can earn up to $500 in cash or in gift cards for stores like Amazon, Best Buy, and Target.

Take a trip—and cut your doc bills
Medical tourism could save you 40 to 85% on health care. U.S. health-care costs are rising at a rate of about 8% a year. It’s no wonder, then, that an estimated 750,000 Americans traveled abroad for medical care in 2007. (Some even made a vacation of it.) The amount spent on medical tourism is expected to rise to $6 million by 2010. But is it really worth it? It depends on your coverage.

Fully insured Americans will likely have no reason to travel overseas for medical treatment covered through their insurance companies. But for minor elective or cosmetic work that’s not covered, such as dental restoration or breast reconstruction, a quick flight to Mexico or Costa Rica will save you 40 to 60%, on average, says Steven Gallegos, MHA, founder of Medcentrek LLC. The close proximity of Mexico, Colombia, and Costa Rica (in addition to their nice weather) make them popular choices for a variety of medical procedures. For more complicated surgery, such as a hip replacement or an organ transplant, Gallegos suggests countries like Singapore and Thailand, where you’ll spend as much as 85% less than you would on the same operation in the United States. (Hip replacement in India saves you $99,000!)

Of course, there are risks no matter where you get medical treatment. The safety and quality of care overseas is more carefully monitored these days. But insurance, malpractice, and after-care protocols may differ from the those in the States. And it’s always wise to research the doc and facility thoroughly. Check out the nonprofit Joint Commission International’s list of accredited hospitals and labs. Four ways to save on meds
With prescription-drug costs rising every year, consumers are taking matters into their own hands. But rather than split pills (dangerous) or forgo meds altogether (even more dangerous), there are better options for your health and your pocketbook. Here are a few that could save you some big bucks.

Sign up for a prescription-savings program. Many pharmacies offer programs that give you cheaper meds for a small annual cost. For an enrollment fee of $10, for instance, CVS allows you to fill a 90-day prescription for one of more than 400 generic medications for $9.99 each. At Wal-Mart, you can buy a month’s worth of generic meds for $4 each (or a 90-day supply for $10) with no up-front fee.

Find special offers. Before you pay for your next prescription medicine, visit the pharmaceutical company’s or medication’s Web site. Many companies offer money-saving coupons and special offers online. You can also get good deals at a site like InternetDrugCoupons.com.

O Canada! You can save an average 35 to 50% or more on some drugs across the border. Why? Canada’s federal government controls the prices of new drugs. To avoid getting scammed or sold poor-quality medication, stick with online drugstores that are certified by the National Association of Boards of Pharmacy and display the Verified Internet Pharmacy Practice Site seal.

Check payment-helper sites. Visit TogetherRxAccess.org or PPARX.org to find out if you qualify for free or nearly free meds.]]> <![CDATA[Q and A: Get Healthy About Money]]>

finance coach Lynnette Khalfani-Cox.

Q: My husband and I constantly fight about money, especially when things are tight. How can we get on the same page?

A: Money battles are a frequent source of frustration for couples. The biggest culprit generally isn’t how much is in your bank account, but your clashing money styles (you’re a spender, he’s a saver, and so on). Another huge problem is lack of communication. Let’s face it: Most of us aren’t comfortable talking about money—even with our spouse.

But it doesn’t have to be that way. Have a nonconfrontational “monthly money date” with your husband. Adopt this mantra: disclose, discuss, and decide. Start by disclosing the debts, assets, income, savings, pension benefits, and loans you each have. Then get at what drives your arguments by each completing this sentence: “What stresses me out (or scares me) most about our financial situation is …” Is it really about a lack of money, or is it something else? For instance, perhaps you’re handling all the financial affairs, and it’s totally stressing you out. Once your fears are out in the open, you can discuss your financial priorities. (I suggest setting them in this order: paying off debt, building savings, and setting aside funds for specific goals.) Then you’ll be able to decide together where to save and where you can splurge.

Q: I’m stressed about not having money for my kids’ college education. What’s the best plan?

A: There are lots of options, but the best one, hands down, is the 529 Plan. These are state-sponsored college-savings accounts that let you sock away as much as $250,000 for tuition, fees, books, supplies, equipment, and room and board by investing in mutual funds. Earnings are tax-free, and your children can attend virtually any school in the country. You can sign up for any state’s plan, but check out your own first, because many states offer juicy tax breaks for residents—Connecticut, for example, allows 529 tax deductions for up to $5,000 a year for individual filers and $10,000 for joint filers.

You can make saving easy by setting up monthly automatic deductions from your bank account into a 529. Grandparents and other relatives can contribute, too (some states even offer them tax breaks for it). To learn more about 529 plans, go to www.savingforcollege.com.

Q: I make more money than my friend, and she often can’t afford to go to the places I choose. How can we have fun without the money thing hanging over our heads?

A: One solution is to scale back on the fine dining and expensive outings with this friend. (What’s motivating you to choose places she can’t afford, anyway?) Save the pricey plans for nights out with a friend who has more disposable income. But you can also get creative. Suggest lunch instead of dinner at that hot new bistro. Tell your friend “let’s grab some appetizers”—and mean it. Seek out complimentary or inexpensive wine and food tastings (try www.localwineevents.com), or snag a pair of discounted theater tickets at www.theatermania.com.

And try letting her take the reins with plans sometimes. Yes, she may pick restaurants or activities that wouldn’t top your list. But if you keep an open mind, you may be pleasantly surprised by a new cuisine you never thought to try, neighborhoods you hadn’t discovered, or fun places that are also easy on the wallet.

Lynnette Khalfani-Cox, is the author of Your First Home: The Smart Way To Get It and Keep It. Find out more about Lynnette online at www.themoneycoach.net.]]> <![CDATA[14 Smart Ways Seniors Can Cut Medical Costs]]>

<![CDATA[6 Ways to Save on Prescription Drugs]]>

1. Follow your formulary
Your formulary is a list of prescription medications covered by your health-insurance plan. Drugs are organized into tiers with different co-pays, from $10 or so for generics to much higher amounts for some name-brand drugs. You should also check the generic co-pay against its retail price; sometimes your co-pay can actually be higher than simply buying the generic retail.

Because formularies vary from policy to policy, the patient can really help himself by showing it to the doctor, notes Edward Jardini, MD, a family physician and the author of How to Save on Prescription Drugs: 20 Cost-Saving Methods. The formulary can usually be downloaded from your insurance company's website or requested by phone.

Next Page: Go generic

2. Go generic
If you didn't have your formulary with you at the doctor's office, or you don't have a prescription plan, ask your doctor or pharmacist if there is a generic equivalent or a similar medicine that may be available as a generic, advises Sarah Ray, a spokesperson for the American Pharmacists Association. Generics, which are legal copies of brand-name drugs whose patents have expired, use the same active ingredients, are shown to work the same way in the body, and can cost a fraction of their brand-name counterparts. They’re less expensive because generic manufacturers don't have the investment or marketing costs that new drugs require.

While generics are available at all pharmacies, certain generics are also available at mass retailers including Target, Wal-Mart, and Kmart for very low prices. (Target and Wal-Mart offer a 30-day supply of generics for $4 or a 90-day supply for $10; Costco charges $10 for 100 pills for most generics; and Kmart charges $10 or $15 for 90 days' worth.) It's worth checking to see if your drug is on any of their lists. Be careful, though, advises Vibhuti Arya, a spokesperson for the American Pharmacists Association; the megastore prices for brand-name medications can be higher than normal, possibly making the total price of your medicine needs higher than average.

Other lower-cost options you should ask your doctor about are older drugs that might be just as effective (but less expensive) or a less-expensive version of a drug that’s in the same class.

Resources you can use to help you look for generic and other low-cost alternative medications are available at Rxaminer and Consumer Reports' Best Buy Drugs Guide.

3. Shop around
When one of Dr. Jardini's patients was checking prices for generic Prozac, he was quoted amounts of $153, $125, $119, $80, and $41 for a 30-day supply at five local drugstores. It pays to compare prices at websites, too. For instance, the cheapest prescription for a 30-day supply of 20-milligram capsules of generic Prozac at DestinationRx, a website that compares prices at online pharmacies, was recently $4, while the least expensive option from RxUSA was $12.

As of 2007, 10 states (and counting) were maintaining websites to help consumers compare drug prices at in-state pharmacies. A list of states with these price-comparison sites is available in a 2008 report by the Center for Studying Health System Change.

If you need more than one medication, make a list of all your medicines and their doses and find out the total cost for your entire list at a variety of pharmacies and websites; pick the place that offers the best deal on your total medicine package, rather than getting one medicine here and another one there. It is important that all your drugs ultimately come from the same pharmacy, so the pharmacist there has all of your information and can advise you if one of your medications will interfere with another, Ray says.

Next Page: Split your pills

4. Split your pills
"If there's the same co-pay for a higher strength medicine, you can split the pill in half and save money," points out Arya. Ask your pharmacist if the medicine is suitable for splitting, since some medications—particularly time-delivery drugs—are not. Invest in a pill cutter (available at drugstores for a few dollars) to ensure an accurate dosage.

5. Buy a three-month supply
Usually, it's less expensive to get a 90-day supply instead of buying one month at a time, says Ray. For instance, a 30-day supply of 5-milligram tablets of simvastatin, a cholesterol medicine, costs $18 at drugstore.com, while a 90-day supply costs $43, saving you about 20% over the long term.

However, if it's a new prescription you just started, Ray recommends just getting one month's supply at first. If the doctor decides to change your dosage, "you may be stuck with pills you can't use."

6. Review your meds
If you take more than a couple of drugs on a regular basis, schedule periodic review visits with your doctor to reevaluate each medication, advises Dr. Jardini. You may find that some are superfluous or are not working anymore and can be discontinued. He cites one patient, a breast cancer survivor, who was taking Fosamax, which slows bone loss. But studies show that while there are still some benefits to taking the drug for more than five years, staying on it past the five-year point did not decrease patients' number of fractures. His patient discontinued it, saving herself a considerable cost. You can’t always rely on your health-care providers to call you in for a consultation to alert you to such changes, so be proactive about asking your doctor to review your medication on a regular basis.

Also, ask a pharmacist if your drugstore offers medication therapy management, which will reappraise your entire medication list, make sure you need all of them, and recommend less expensive options, says Arya.]]> You may be able to cut prescription costs by opting for a higher dose and splitting the pills. (ISTOCKPHOTO) <![CDATA[5 Proven Ways to Reduce Your Medical Bills]]>

murky world of medical billing, there is often room for negotiation. If you’re paying providers from your own pocket—because you have no insurance, have maxed out your insurance, or are seeking treatment out-of-network—it’s worth asking for a discount on services. Hospitals and doctors will sometimes consider accepting less than the full list price—after all, they routinely give substantial discounts when the payer is Medicare, Medicaid, or an insurance company. Even with an overdue bill, the provider may be persuaded to be flexible. Here are some bargaining strategies you can try.

1. Pay today. Go to the billing office and offer to pay with cash or by credit card on the spot. “I would try for a 20% discount,” says Larry Gelb, CEO of CareCounsel LLC, a health-care advocacy firm. “Often they will be obliging because they have a big incentive to get it settled rather than to go through a long, drawn-out collection. If you tie it to a little bit of a hardship story, you will increase your chances.”

2. Disclose your family income. You may be uncomfortable volunteering information about how much money you make, but if you’re facing, for example, a $10,000 bill from a specialist, it might help to explain that your family of four lives on an income of $50,000. “Compared to the person with a net family income of $250,000, the health-care provider will look at those two people very differently,” says Marty Rosen, a former Aetna U.S. Healthcare executive and a cofounder of Health Advocate, a provider of health-care advocacy services to businesses and individuals. This is not a good strategy, Rosen notes, for families in an upper-income bracket.

3. Pile on the compliments. “A lot of doctors really respond to schmoozing,” says Laura Valentine, director of client services at CareCounsel. When she approaches billers on behalf of a patient, she appeals to doctors’ egos with a bit of flattery. She suggests saying something like, “I really wanted to have my cancer treatment here because my friends and colleagues all say you’re the best and the brightest. But I have limitations on my pocketbook. Is there any type of discount or anything that you can do?”

4. Use Medicare rates to your advantage. Finding out what Medicare pays doctors and hospitals to perform a specific medical procedure will take a bit of research, but it is a gambit professional patient advocates frequently use. To do it, read carefully, because these steps are complicated: First ask your doctor’s office for the procedure’s CPT code, which stands for “Current Procedural Terminology” and is a code set developed and maintained by the American Medical Association (AMA) to ensure uniformity in describing medical, surgical, and diagnostic services. Next, go to the AMA website’s CPT search engine to look up the Medicare payment for that procedure in your geographical area. (For example, the CPT code for one type of breast reconstruction surgery is 19361. Searching for the state of New York and the city of Manhattan, with the five-digit CPT code 19361, turns up a Medicare payment of $1,688.74 for the procedure.) You can use that information in negotiating your non-Medicare rate, which you should do before the procedure. “Whatever you can do up-front is the best,” advises Valentine.

Not only will you have more bargaining leverage pre-procedure, but then, should anything change during or after the procedure, the hospital will also have a record that they cooperated with you before and will more likely be willing to cooperate again. For both hospital and doctors’ bills, a reasonable offer would be 25% above the Medicare rate, suggests Nora Johnson, the vice president and director of education and compliance for Medical Billing Advocates of America. If you are thinking about negotiating a hospital bill, however, consider hiring a professional advocate, since hospital bills are considerably more complex, Johnson adds.

5. Use your emotional state to your advantage. You may be feeling a lot of stress, but calling an administrator from the hospital an idiot is not going to get you very far. Instead, say something like, “I am just so frustrated right now. My spouse is ill, and I’ve been trying to deal with my health plan, but I really want to make sure you get paid too.” Chances are, “because of human nature, they will try to help you, unless you get someone who is very hard,” says Valentine. ]]> When trying to settle medical bills, don't be afraid to negotiate. (ISTOCKPHOTO/HEALTH) <![CDATA[Who Can Use Health Savings Accounts and Flexible Spending Arrangements]]>

difference between them? And most important, can they save you money? The answer to the last question is: absolutely. Here’s what you need to know about health savings accounts and flexible spending arrangements to help pay your health-care bills.

Flexible spending arrangement
What it is: A flexible spending arrangement (FSA), often called a flexible spending account, is a benefit that may be offered by large employers. It allows you to put aside money from your paycheck before it is taxed to pay health-related expenses that aren't covered by your insurance. By using pretax dollars, "you're effectively buying health-care services at a significant discount," explains Wayne Farlow, a certified financial planner, whose firm Financial Abundance LLC, is based in Westminster, Colo. How big a discount, of course, depends on your tax bracket. The higher that is, the more your savings. For the average wage earner, it translates into at least a 30% savings on your health-care expenses.

The money taken out of your paycheck is put aside in an account that your employer (or a subcontractor hired by your employer) oversees. You might be issued a debit card to pay for expenses directly, or your company might require you to submit receipts for each reimbursement. The legal limit of the account is $5,000, though some companies may have lower maximums.

Next Page: The catch

There is one catch: You must use the entire amount of the FSA by the end of the benefit period or the funds go back to the plan, which your employer typically uses for other benefits. This "use-it-or-lose-it" feature often scares people away from signing up for FSAs, says Jerry Ripperger, director of consumer health for the Principal Financial Group in Des Moines, Iowa. To determine how much you should set aside in your FSA, go through a typical year's records—not one in which you incurred a lot of unexpected expenses—and tally your health-related costs not covered by insurance. If you’re close to losing money, try to move up an elective procedure that you may have been planning for the following year.

What it can be used for: Money in your FSA account can be used for a broad range of medical expenses, such as acupuncture, braces, eyeglasses, hearing aids, insurance co-pays, medication, and deductibles.

How you save: "The FSA may be the most underutilized tax-advantaged vehicle the government has given us," says Ripperger. Since the money you put in the account is not taxed, there is more of it—100%, rather than the 70% or so after taxes—to spend on health-care needs. And because the money is subtracted from your pay before taxes, your overall taxable income is lowered, reducing the amount of taxes you owe at the end of the year. The savings are significant: Someone in the 25% tax bracket, for instance, will get a discount of about 37% on health-care costs that are paid with the money in their FSA.

Bottom line: If your company offers an FSA, sign up. "[But] don’t get overly aggressive on your calculations," Farlow advises. Try to be realistic and conservative about how much money you will spend each year so you don’t end up losing any money left in the account.

Next Page: Health savings account

Health savings account
What it is: A health savings account (HSA) also allows you to save untaxed income to pay for health-care costs, both in the short- and long-term. To be eligible, you must be enrolled in a high deductible health plan (HDHP), which the IRS defines as a plan with an annual deductible of at least $1,100 for individuals or $2,200 for families. To help offset the high deductible, you (or your employer) can deposit money into an HSA maintained by a financial institution, up to a maximum of $2,900 for an individual account and $5,800 for a family account. (Individuals 55 and older can deposit an additional $900.) You can use those funds to pay for medical expenses until you reach your annual deductible, and, after that, to pay for expenses that aren’t covered by your health plan. To use your HSA funds, you are issued a debit card that subtracts money directly from the account, although in some cases you may be required to submit receipts to the account trustee for reimbursement.

Almost anyone with an HDHP is eligible for an HSA, with some exceptions (such as people on Medicare). Importantly, unlike an FSA, any money that’s left over at the end of the year in your account can be carried over and used for future medical expenses. You can have both an HSA and certain types of FSAs, if your company offers both.

What it can be used for: In addition to routine medical expenses like doctor’s visits, prescriptions, and lab work, you may also use the money in your account to pay for medical expenses not covered by your insurance. You can also pay for long-term-care insurance premiums, and health-insurance premiums when unemployed or when receiving continuation coverage (such as COBRA). You cannot use an HSA for a Medicare supplemental policy such as Medigap.

Next Page: How you save

How you save: “The funds are triple tax-free,” says Dan Perrin, president of the HSA Coalition in Washington, D.C., and the author of HSA Road Rules. You save three times over since taxes aren't taken out of the money you put in, interest earned by money in your account is tax-deferred, and no taxes are owed when you withdraw the funds to pay for qualifying medical expenses.

HSAs most clearly benefit either very healthy people or people with chronic illness. The high deductible health plans that an HSA must be paired with usually have lower premiums than traditional ones, so if you are young and healthy and don’t incur many medical expenses, you can save with the lower premiums. And any money you put into your HSA that is not used can be considered part of your savings. HSAs are often compared with IRAs because the more money you leave untouched in your HSA, the more money will accumulate in your account that you can then use for the greater health-care expenses that will likely come in your retirement years.

You can still save with an HSA even if you have high medical expenses and you need to use the funds. Perrin points out that, with an HDHP, once you’ve met your deductible, the plan covers 100% of in-network health expenses, whereas some traditional health-insurance plans only pay 80% of your in-network medical costs. The remaining 20%, plus deductibles and co-pays, can add up to more than you’d pay with an HSA and high-deductible plan if you have a chronic or catastrophic health problem—for instance, if you have type 2 diabetes or are diagnosed with breast cancer and require chemotherapy and surgery.

Bottom line: If you are young and healthy or do not have access to an employer-paid plan, in all likelihood an HSA is a good idea. It also may be recommended if you have a chronic or serious medical condition and an insurance plan that does not cover 100% of your expenses. If you can afford health insurance now, you can afford to refinance your account, advises Perrin, who adds that he would recommend an HSA for anyone who feels comfortable being in charge of his or her own health care—that is, deciding what to spend your money on without the help of an insurance program. ]]> HSAs and FSAs let you save by using pretax money for health care costs. (ISTOCKPHOTO) <![CDATA[How to Give to Charity the Right Way]]>

Charity Navigator, the nation’s largest evaluator of charities—not exactly the most efficient use of your hard-earned dollars. Plus, scams abound during the holidays when, swept up in the spirit of giving, people tend to give willy-nilly. Here, our surprising do’s and don’ts of donating will help you give wisely.

Do concentrate your giving
While we hate to say a few dollars won’t help, a $5 donation may barely cover the cost of processing your credit card. Resist the urge to spread your cheer by giving $25 to four different agencies and, instead, focus $100 on one charity, Berger suggests: “More money will reach the cause.”

Do check out how each dollar is spent
According to Charity Navigator, financially healthy charities spend 75 cents of every dollar on programs and services; no more than 15 cents toward administrative costs, and no more than a dime to fund-raising. The American Institute of Philanthropy (AIP), another charity watchdog, agrees. The groups on its “Top-Rated Charities” list, typically allocate 75 percent or more of their budgets.

Do ditch telemarketers
“If you want your dollars to go straight to the charity’s programs, don’t give to telemarketers,” says MSN Money personal-finance columnist Liz Pulliam Weston, author of Easy Money: How to Simplify Your Finances and Get What You Want Out of Life. Indeed, AIP estimates that only about a third of the money given through professional fund-raisers actually makes it to the charity.

When you get a call from a telemarketer, ask for the charity’s Web site. Check them out online or through an independent charity-watchdog group like GuideStar.org. If you’re satisfied by the GuideStar report, you can donate through the site. This protects your bank and credit card info, which scammers love to get their hands on, Weston says.

Don’t donate your car
The billboards make it seem so easy, promising quick pickup of your junker and a fat write-off. But your tax break is limited to your tax bracket, and the IRS has cracked down on writing off more than your car’s fair-market value, Weston says. So if you fall in the 25 percent bracket and donate a $1,000 car, your net benefit is $250. Why not sell the car on your own for $1,000 and donate that?

Don't let guilt guide your giving
You’re emerging from Macy’s, arms bulging with gifts. How could you not give a few dollars to the person soliciting for a good cause outside the door? Here’s why not: “You have no idea if it’s a legitimate charity or representative,” says Laurie Styron, an analyst with AIP. “And if you give cash, you have no way to make sure it got to the group.”

Don't give to police and firefighters
They serve and protect us, but the fund-raisers they hire may not care about protecting your resources. They often prey on the reverence we hold for cops and firefighters and keep most of the money for themselves. Got a soft spot for those battling danger? “Call the department yourself and say, ‘I’d like to donate money or time—what’s the best way?’” Weston suggests. They may have an official foundation or benevolent fund.

Don't only give during the holidays
Giving at the end of the year limits the resources a charity has to work with and pinches your year-end budget. Instead, sign up for automatic payroll deductions so you can donate each month.]]> <![CDATA[How to Save Money And Go Natural]]>

Lean and Green
10 Easy Ways to Eat Natural
Want to eat green on a lean budget? These 10 trends, tips, and tools can help you save.

Organic On the Cheap
This Recipe Feeds 5 for Less Than the Cost of a Fast Food Meal
Think eating all-natural will break the bank? Tuscan Chicken Stew is easy, organic, and less expensive than fast food fare.

Bottoms Up
Inexpensive Natural Wines That We Love
It’s more affordable than you might think to drink natural, eco-friendly wines: Organic, biodynamic and other forms of chemical-free farming are already common among quality wine producers.

Saving at the Grocery Store
Money Q&A: Saving on Organic Foods and More
Expert advice on where to scrimp on expensive organic groceries.

DIY Cleaners
Save Green While You Clean
Using toxin-free, all- or mostly natural cleaning products isn’t just a good idea for protecting the environment inside (and outside) your home—it can actually save you some dough.

All-Natural Hair Treatments
A Pantry Staple that Salvages Split Ends
Olive oil helps quench seriously dry strands. Leave it in your hair overnight as an all-natural and budget-friendly alternative to deep conditioners.

DIY Facial Masks
At-Home Spa: Create a Cranberry Face Mask
Cranberries can help naturally exfoliate lackluster, dead skin. Try this easy, at-home treatment twice a month.

Luxe for Less
Spa Luxury for Less
Who says you have to spend a ton to pamper yourself? We found luxe stuff that won’t blow your bank account.

How to Buy Eco Chic
Green Products That Really Work
Organic products aren't always cheap, so you want to make sure your dollar is well spent. We put these eco-friendly picks to the test.

Ask Our Experts
Free Expert Advice on All of Your Natural Living Questions
Confused about organic versus conventional foods, the value of herbal supplements, and which cosmetics contain dangerous chemicals? Get answers to these questions and more from our panel of experts.

]]> Istockphoto <![CDATA[20 Ways to Get Healthier for Free]]>

<![CDATA[Money Q&A: Saving on Organic Foods and More]]>

Q: Organic groceries are so expensive. Where can I scrimp?

A: According to the Environmental Working Group, a nonprofit environmental-research firm, peaches, apples, sweet peppers, celery, nectarines, strawberries, cherries, lettuce, imported grapes, pears, spinach, and potatoes contain the most pesticides, so it’s best to go organic with these.

Do buy organic milk, which is free of growth hormones, antibiotics, and pesticides. Ditto for meat and poultry; if these cost too much, look for meats and poultry with the “natural” label, meaning there’s no growth hormones, antibiotics, or artificial ingredients.

Save on organics by checking for coupons on the websites of major organic companies. Or join a food co-op or a community-supported agriculture program, many of which offer organic foods. Log on to Localharvest.org for more info.

Q: During the holidays, my office turns into fund-raising central. How can I politely decline these requests?

A: You can sidestep solicitations by asking your boss to request that anyone selling goods for charity or fund-raising post a sales or donation sheet in a public place. If you’re left to fend for yourself, don’t be shy about saying no, but do offer a reason. Maybe you just bought Christmas cookies from the guy down the hall—most people will understand, especially since they’re probably being hit up for donations too.]]> <![CDATA[7 Health Insurance Horror Stories]]>

<![CDATA[Live Healthy for Way Less]]>

From Health magazineYou work out, you try to eat right, and you want to buy the healthiest stuff, but, boy, this healthy-living thing can really hit you in the pocketbook. The money flies like it's got actual wings—to your gym membership, running shoes, that fancy juicer, the organic meat at dinner—and that's just on Monday.

The question is: What "healthy" stuff do you really need? "We're willing to spend a lot of money on being healthy, but we've got to keep our wits about us," says Mary Hunt, author of Live Your Life for Half the Price. "People think that if something says it's healthy, it must be. But that's not always so." Truth is, while some good-for-you investments are worth their weight in carrot sticks, others are more hype than wholesome. Here's how to splurge on things that really make a difference, from the grocery to the gym.

Next Page: Eat healthy for way less

Eat healthy for way less

Organic food
If you're tossing organic produce into your grocery cart with wild abandon, the final bill might be wince-worthy—you'll typically spend 30% to 50% more than you would on the conventional type. But there's a real difference: About three-quarters of traditionally grown produce show traces of pesticides, while only one in four organic fruits and veggies do, according to the Center for Science in the Public Interest. Splurge on organic produce with soft skin or that you eat skin and all (like apples, peaches, bell peppers, strawberries, pears, and lettuce), but save on foods that are fairly pesticide-free thanks to their tougher outer layers (like bananas, kiwifruit, onions, mangoes, pineapples, and broccoli). Wash all items well with soap, water, and a brush, but skip the fancy veggie and fruit washes; the U.S. Department of Agriculture (USDA) and Food and Drug Administration (FDA) don't recommend them.

Your best bet for the environment and your health? Shop at your local farmers market for close-to-home foods that require less shipping, which means fewer greenhouse gases and lower costs—even for organics.

Organic choices in the meat and diary aisles are less straightforward. Beef, poultry, eggs, and milk rarely cop to pesticides, but conventional producers sometimes use antibiotics and hormones on their animals. Although less than 1% of meat shows traces of antibiotics later, there's some evidence that antibiotic-resistant bacteria are more common in conventionally produced cuts than in organic products. You'll pay as much as 100% more for organic meat and dairy, but if you're a big meat eater or milk drinker it may be worth the investment.

Here's how to decode the stickers on your food: A five-digit number starting with nine means it's organic; a four-digit number means it's conventionally grown.

Next Page: Fancy water

Fancy water
Fortified waters, although tasty, can come with big doses of calories. And if you're really running low on your recommended intake of vitamins, a multi might work better. If you're tempted by fancy waters because you hate plain H₂O, try this trick from Jessica Ganzer, a registered dietitian in Arlington, Va. Fill a pitcher with water, throw in some lemon, lime, and orange slices, and refrigerate for a tasty, cheap drink. Just can't resist flavored or vitamin water? Choose calorie-free.

Diet frozen meals
In a perfect world you'd cook a big batch of healthy food and freeze the leftovers. "Cook once and eat three times," dietitian Jessica Ganzer suggests. "You'll enjoy all the benefits of a prepackaged dinner without the added sodium and preservatives." Smart advice, but when you're running late it's good to know that affordable frozen meals have come a long way since their tasteless, sodium-laden predecessors. "They can be an effortless way to control calories," Ganzer says. "I tell my clients to keep some in the freezer for emergencies." A few good brands: Kashi, Amy's, and Lean Cuisine offer whole grains and lean protein and work to keep sodium low. You can find most frozen entrees for $3 to $5 per meal, and they cook in less than 10 minutes (some in less than five) in the microwave. Add a cup of veggies for good measure because some packaged meals don't include a ton of the green stuff.

Next Page: Fancy kitchen gadgets

Fancy kitchen gadgets
If you're a techno-chef who loves to play with the latest machines—and you'll actually use that juicer that will take over your counter space—it might be worth the investment. But if you're part of the use-it-once-and-forget-it crowd, these four low-cost items are all you'll need to whip up plenty of healthy fare.

Nonstick skillet ($50 to $150)
A skillet with a great nonstick coating allows you to cook with minimal oil; the surface is perfect for stir-frying veggies, scrambling egg whites, and prepping healthy sauces. Try one in a larger size (12 inches) and look for deep sides, a fitted lid, and an oven-safe handle. Price isn't a great indicator—in recent tests of nonstick cookware, Consumer Reports found that cost had nothing to do with performance. Their top pick: Kirkland Signature cookware from Costco. (A whole set costs less than $200.) Calphalon nonstick pans perform well, too. And budgetistas can get a good $50 nonstick pan by Bialetti.

Bamboo steamer ($20 or less)
This age-old cooking method requires no oil (just add water), and it will allow your food to retain most of its nutrients and flavor. Bed Bath & Beyond, Target, and www.amazon.com offer bamboo-steamer sets for $20 or less.

Steam bags ($5)
If you don't want to commit to an actual steamer, try the new microwave steam bags from Glad and Ziploc: Just throw in your veggies and follow the instructions on the back. Foods are crisp and delicious—and virtually fat-free!

Grill pan ($25)
If you're dying to throw some shrimp on the barbie, invest in a heavy grill pan, which can withstand much higher temperatures than a nonstick skillet. You'll achieve the same results—grill marks, low-fat cooking—that you would with a more expensive countertop grill but for less money. Tuesday Morning and other outlets carry a variety of low-price options.

Next Page: Work out for way less

Work out for way less

Expensive sports bra
Not all women need a crazy-supportive sports bra. "If you're small-breasted and doing low-impact activities, you can go to almost any retailer and buy a comfortable seamless bra that'll be absolutely appropriate," says LaJean Lawson, PhD, an adjunct professor of exercise and sports science at Oregon State University. "But women with a full C cup and up can't get by with a less-structured bra." That's when it's wise to spend $30 to $50 for support; test it by jumping up and down in the dressing room. For the best fit, get measured by a pro at a bra shop; then head to a sports or specialty-running store for a large sports-bra selection. If you don't have a good retailer for sports bras nearby, try TitleNine.com, which has a great return policy.

If you do yoga or Pilates (or even a lot of crunches), be sure the hooks and seams of your bra don't dig into your spine; lie down on the dressing-room floor to test it out.

Good athletic shoes
Women sometimes splurge on a great pair of running shoes and then wear them for three other sports. That's a recipe for injury. "You can't multitask with your shoes," the ACE's Cedric Bryant says. "Running shoes are flexible and have more cushioning, while shoes for racquet sports are designed for lateral movement." Expect to spend at least $50 on a good shoe, and get one for every sport you play—or buy a good pair of cross-trainers for multiple sports.

Bargain ideas: Buy last year's discontinued model (new shoes may boast slightly different technology or colors, but the good core ingredients are still the same) and ask your running store about deals on returned shoes. (Some chains like Road Runner Sports sell lightly worn returns at a discount.)

Next Page: Fitness equipment

Fitness equipment

Treadmill (about $2,000)
Must have good shock absorbency (something other than foam; ask the salesperson). Give the machine a practice run to check stability, sturdiness of rollers, and width and length of the belt (should be at least 18 inches wide and long enough to keep you from flying off the back). You might feel silly jogging in a department store, but would you buy a car without a test-drive? Aim for a 3-horsepower motor; it's lower than commercial grade but enough to keep you moving. Skip the fancy computer console and 500 different programs to choose from.

Stationary bike (about $1,000 for upright)
Must have high enough resistance to give you a thorough workout. Crank it up and try it out at the store.

Skip the bells and whistles
"If it's stable, comfortable to sit on, and you don't hear any parts rattling, you'll get a good workout" says Richard Cotton, national director of certification for the American College of Sports Medicine.

Elliptical trainer (about $2,000)
Must have stability; also, it should operate smoothly and be easy to use. "These machines are even more mechanically complex than treadmills, especially if they have moving handles for your arms," says Bill Sonnemaker, a personal trainer in Atlanta. Do a test-drive before you buy, and make sure the warranty covers repairs. Skip gym-quality models (they usually cost $5,000-plus) or machines with multiple programs.

Next Page: Special workout wear

Special workout wear
A grueling workout is hard enough. A grueling workout in a sweat-drenched shirt or chafing shorts is just miserable. For comfort's sake, invest in apparel with flat seams to avoid rubbing and moisture-wicking material to funnel perspiration away from skin. These clothes are pricier but bargains exist: There's a large selection of Champion and Duo Dry items for less than $17 each at Target.com, and you can get deals on Dri-Fit and Under Armour garb at Dick's Sporting Goods, Sports Authority, Joe's Sports, and other outlets.

Gym membership
If you see your hairstylist more often than you visit your gym, you're probably squandering your money on a membership. (The average annual cost in 2006 was $660.) About 80% of gym-goers would be better off on a pay-per-use basis, according to a Stanford University study. However, if seeing that recurring charge on your credit card gets you off the couch, it's worth every penny—but it doesn't have to be so many pennies. There are ways to negotiate like a pro, says personal trainer Bill Sonnemaker, who is also the IDEA Health and Fitness Association's 2007 trainer of the year.

Buy a membership just for your gym (not the universal deal that includes far-flung destinations).

Wait until the end of the month to buy, because a salesperson will be more willing to offer you a break to make his or her monthly quota.

Ask for a 13th month free or that the initiation fee be knocked off; that's usually where salespeople are allowed to negotiate.

Next Page: Stay healthy for way less

Stay healthy for way less

Vitamins
Worth it? Yes, if your food choices aren't cutting it.

Most experts say you don't need to take vitamins if you eat a diverse mix of fruits and veggies, lean meats, legumes, and whole grains. Problem is, if you don't eat well, are a vegetarian, have a food allergy, or are pregnant (or hope to be)—categories that include most of us—you might not be getting the nutrients you need. In that case, an inexpensive multivitamin may give you peace of mind. Look for a brand that has 100% of the daily recommended values of vitamins and minerals and has the USP seal, which means that U.S. Pharmacopeia, the organization that verifies the ingredients and quality of dietary supplements, has given it a thumbs-up. Store-brand multivitamins go for about $3 to $6 for 100 tablets, compared with about $8 to $10 for brand names. Don't spend money on additional supplements (fish oil, vitamins D and C) unless your doc has ID'd nutritional gaps. For instance, if you aren't getting enough calcium from dairy (1,000 milligrams for 19- to 50-year-olds), pop a daily Tums with calcium (150 tablets cost $5 to $6).

Next Page: Pumped-up toothbrush

Pumped-up toothbrush
Lazy brusher? Enter bells and whistles.

If you regularly brush and floss, you can stop reading. For the rest of us, the novelty of a fancy brush might help with the twice-daily two minutes required for healthy pearly whites. "Power toothbrushes can be worth the cost because they can help you brush for the appropriate amount of time," says Charles Perle, DMD, of the Academy of General Dentistry. Also, electric toothbrushes with rotation-oscillation action actually work better than manual, research says. We say whatever gets you brushing is healthy.

Prescription drugs
When available, generics can save you money.

"If a generic drug is available, it's almost always smart to buy it," says Don Kemper, CEO of Healthwise, a consumer-health-information company. Generic prescription drugs are legally required to have the same active ingredients as brand-name varieties, although they must look slightly different, so they may be a different color or shape. But they definitely cost less: Pharmacies receive $32 for generic meds, compared with $111 for name-brand versions, according to the Kaiser Family Foundation; and co-pays for generics are about $11, on average, compared with $24 to $38 for name brands.

Ask your doctor about the generic type of any prescription drug you take. If she thinks it's right for you (in rare instances, there may be a reason you should stick with a brand name), have her check the "Generic OK" box on the prescription.

Next Page: Fancy bathroom scale

Fancy bathroom scale
Weighing in can help with weight control—no matter how basic the scale.

If you've ever shopped for a scale, you know there are models that seem to do everything but cook your dinner. They measure body-fat percentage, hydration numbers, body mass index, even bone mass—and, of course, your actual weight. You also know that having a scale is important: Dieters who weighed themselves regularly melted more pounds over two years than those who didn't, according to a University of Minnesota study, and people who stepped on a scale every day lost the most. But do you need the $100-plus model with all the extras? "Unless you're a competitive athlete, probably not," says Cedric Bryant, chief science officer of the American Council on Exercise (ACE).

That said, digital scales, which are a bit pricier, are easier to read than analog and are generally more accurate. Look for load-cell technology, an advanced version of the levers and springs found in older (and cheaper) models; your scale will need less calibration and be less likely to break down over time. Make sure it has the ability to zero out before you step on it, and weigh yourself a few times on a hard surface to see if it's consistent. Cheaper digital scales start around $20 and will likely be made of plastic, which is fine if the underside that contains the weight mechanism is made of metal. Beyond that, it's all about aesthetics. If the fancy glass model will get you to weigh yourself, you'll pay a little more—but it'll be worth it.]]> <![CDATA[Paying for Alternative Medicine Treatments]]>

chronic back pain, insurance companies often consider such therapies—from massage to herbal supplements—outside the medical mainstream. They are, after all, still referred to as complementary and alternative medicine (CAM). However, many insurers do cover selected therapies on a case-by-case basis, depending on the way you request reimbursement. “If you talk to insurance people, they quote you by the book and say massage is not covered,” says Paul Rubin, a chiropractic physician at WholeHealth Chicago, a medical center that integrates traditional and alternative medicine. Yet Rubin says that some of his Blue Cross Blue Shield patients are getting reimbursement. And even if your insurance company refuses to cover alternative treatments, there are ways you can reduce your out-of-pocket expenses.

Insurance coverage
The best way to get reluctant insurers to cover alternative therapies is by making a good case that your treatment is medically necessary. The simplest way to do this is to get a prescription. Ask your primary care doctor to write one that includes the diagnosis and the frequency and length of treatment. Although they may not advertise the fact, some insurers will rubber-stamp CAM treatments if they are prescribed by a physician. Some of the most frequently covered therapies include chiropractic care, massage therapy, acupuncture, herbal remedies, homeopathy, and mind-body stress management.

One of Rubin’s patients, a woman in her mid-50s, came to his office with fibromyalgia; she had chronic pain and fatigue. She was treated by an internist, who prescribed the pain medication Lyrica, and she also saw an energy healer, an acupuncturist, and a massage therapist on staff. WholeHealth Chicago submitted a detailed claim to the insurer that included a prescription for the CAM treatments and receipts that used standard diagnostic and treatment codes. Her insurance paid for the internist and therapeutic massage, says Rubin, although the acupuncture and energy work were denied.

Another strategy is to convince the insurance company that covering alternative treatments may save them money in the long run. Some conventional treatments for chronic back pain, for instance, cost far more (and in some cases may be less effective) than alternative options such as acupuncture and biofeedback. "To a certain extent, it’s playing the insurance game," says Rubin. "I would never ask anyone to not tell the truth, but if you can make the case clearly that what is being done is clinically necessary as an alternative to pharmaceuticals or surgical procedures, the insurance company can see, 'Gee, this treatment is $200, while medication would be $600 and surgery would be $10,000.'"

Next Page: Get a receipt

Next Page: Limiting out-of-pocket expenses

Limiting out-of-pocket expenses
If you have to pay your own way for all or part of your treatment, you should explain your circumstances to the CAM practitioner. “It is always beneficial if the patient discusses the financial issues with the practitioner prior to the first appointment,” says Janet Borges, a licensed acupuncturist and spokesperson for the American Association of Acupuncture Oriental Medicine. “Often they will negotiate a fee for service that may be even more beneficial for both parties than insurance coverage, such as a sliding-scale fee structure.”

You may also be able to save on CAM treatments by using pretax money from a health savings account (HSA) or flexible spending arrangement (FSA). If you have a high deductible health plan ($1,200 or more), sometimes known as a “catastrophic” insurance plan, you are probably eligible to open a tax-free health savings account (HSA). As with an IRA, contributions to HSAs are tax-deductible and the money is tax-exempt upon withdrawal if used for a qualified health expense. Offered by many employers, FSAs allow you to set aside an annual amount of pretax dollars for health care that must be used by year's end. Depending on your tax bracket, the tax savings from these vehicles can add up to a substantial discount on treatments. Eligible expenses may include therapeutic massage, acupuncture, and more (check your plan’s language for details). Even travel expenses—such as bus, taxi, and train fare—that are used primarily to get to essential medical care are eligible.

Discount treatments
If all else fails, you may be able to find affordable treatment in your area. Alternative medicine colleges often offer treatment from students or interns at reduced rates. The Pacific College of Oriental Medicine, for example, has clinics in Chicago, New York, and San Diego, where you can receive acupuncture treatment or herbal medicine consultations for a fee ranging from $10 to $60. Similarly, the National College for Natural Medicine in Portland, Ore., which offers graduate professional degrees in naturopathic medicine, oriental medicine, and acupuncture, has 14 community clinics offering free or low-cost medical care by naturopathic physicians in and around the Portland area.

For affordable acupuncture, try what is known as a community acupuncture center, where treatments are usually offered on a sliding scale ranging from $15 to $40. Patients often receive treatment while sitting in recliners in a shared room. “The community acupuncture model is an option offered primarily to low-income or underserved populations,” says Borges.]]> More insurers are covering alternative therapies like acupuncture. (ISTOCKPHOTO) <![CDATA[Tips for Affording Mental Health Care]]>

depressed, sleepless, or anxious you feel, the high price of professional mental health help can seem prohibitive—who can afford $100 or $200 an hour for therapy? Even if you have insurance, mental health costs can quickly add up with long-term treatment. Plus, mental health benefits often come with separate deductibles to meet, co-payments, and annual caps. For some tips on lowering the cost of therapy—with or without insurance—we consulted Ruth Montag, director of the Resource Center at Mental Health America, a national nonprofit group that helped nearly 10,000 people find resources for mental health care in 2008.

Q: What do you recommend for people with mental health problems who have maxed out their insurance coverage, or are losing their insurance?

A: When someone is already in treatment, we suggest they start by asking their therapist about the possibility of reducing the fee or working out a payment plan. Another strategy that we use is to tell people to try to get at least an initial consultation or a couple of visits with a private therapist, someone recommended in the Depression and Bipolar Support Alliance’s directory, even if you know you can’t afford treatment on an ongoing basis. Especially if you’ve had trouble getting treatment that works, that provider might be able to get to the heart of the matter in just a couple of visits—such as finding the right mix of medication. Then you stand a better chance when you go into maintenance treatment with someone who is more affordable.

Next Page: Affordable options for maintenance therapy

Q: Where can I find the more affordable options for maintenance therapy?

A: Community mental health centers operated by the county or local nonprofit organizations generally operate on a sliding scale where the fee charged is based on income. The Substance Abuse and Mental Health Services Administration maintains an online mental health services locator where you can search for these centers in your area. In addition, you can contact the psychiatry or psychology department of a local medical school or university. Ask whether there are clinics where social work interns or graduate students provide services for a reduced fee. Primary care physicians can also be a resource for those who don’t have mental health benefits as part of their insurance. Another valuable resource that we link to on our website is a database assembled by Psychology Today. It’s a therapist directory that you search geographically, with a profile of each therapist, including his or her specific area of practice interest. The listings detail what insurance therapists take, what their fees are, and whether they have a sliding scale.

Q: What do I do if I’m having trouble getting my insurance company to pay for care?

A: First, it’s extremely important to be familiar with the extent of your coverage; second, we encourage people not to take "no" for an answer. If you are being denied for a treatment that you feel should be covered, enlist the help of your treating professional in the appeals process. We had one situation last year where a mom called us, saying that even though the psychiatrists were recommending residential treatment for her child, the insurance company was refusing to pay. We were able to get the number of the ombudsman for her insurance program, who made the argument very strongly, and the company reversed its decision and approved the treatment.

Next Page: What if my insurer refuses to pay?

Q: What if my insurer refuses to pay?

A: Find out if your state has an external appeal process where the treatment denial can be reviewed. Part of convincing insurance companies to pay is giving demonstrable arguments of how bad the consequences could be if they refuse treatment. So that, for them, it becomes a risk management situation. The Mental Health America fact sheet "How To Overturn Managed Care Treatment Denials" and the Kaiser Family Foundation’s "Consumer Guide to Handling Disputes with Your Employer or Private Health Plan" can be helpful tools for facing treatment denials.

Q: What’s the first place you’d direct people to go if they don’t have any insurance coverage?

A: For the most affordable care, you can rely on community mental health centers. Many employers also offer excellent Employee Assistance Programs (EAPs), which can help you (or your family members) locate affordable mental health providers in the community. Many EAPs also provide short-term counseling and support groups. Most states also have programs and benefits for individuals with no health insurance that can help cover the cost of therapy, medications, and other treatment. We encourage callers who don’t have insurance to see if they are eligible for health coverage through Medicaid or other state programs for people who are uninsured.

]]> Many mental health providers are willing to work on a sliding fee scale. Don't be shy about asking. (FOTOLIA/HEALTH) <![CDATA[Hidden Benefits of Your Health Insurance]]>

Disease management
A buzzword in the insurance world these days is "disease management," which refers to programs that help health-plan members with chronic conditions, such as diabetes or asthma. For diabetics, this benefit could range from a counseling session on nutrition to a full-fledged program including blood monitoring and nurse consultations. Unfortunately, the buzz is often used in selling the plans to employers rather than to employees, many of whom are unaware that these programs exist. "There is a lot of sizzle on the marketing side, but customer service is often not really geared for it at this point. It’s incumbent upon the member to inquire whether there is a disease management program," says Nancy Fase Guernon, director of operations at CareCounsel, a health-care advocacy outsourcing company.

Better mental health benefits
In the past, many benefit plans limited or excluded coverage for mental health conditions. Thanks to the Mental Health Parity and Addiction Equity Act, as of 2010 some insurance plans will be required to offer mental health benefits equivalent to those they provide for conditions such as cancer and heart disease. The new law is expected to expand access to treatment for conditions such as schizophrenia, bipolar disorder, eating disorders, and autism. "The parity act says that if insurers cover medical or surgical benefits, they have to cover mental diagnoses at an equal level," adds Fase Guernon. Some states supplement federal law by passing their own parity laws, she notes, so check with your state department of insurance to determine the level of coverage to which you’re entitled.

Next Page: Coverage for trying to conceive

Coverage for trying to conceive
 For couples relying on assisted reproductive technology such as in vitro fertilization (IVF), the cost of treatment can be prohibitive. One cycle of IVF, for example, costs $12,400 on average, according to the American Society for Reproductive Medicine. Fourteen states, including New York and New Jersey, have passed legislation requiring insurers to offer some level of coverage for infertility diagnosis and treatment. In most states, these laws include paying for IVF (although California and New York specifically exclude IVF). For a state-by-state summary of laws related to infertility therapy, visit Resolve (a national infertility association), or the National Council of State Legislatures.

Complementary and alternative medicine (CAM)
A growing number of insurers now cover alternative and complementary treatments such as chiropractic, massage therapy, herbal medicine, and acupuncture, which has been proven to alleviate pain and can ease chemotherapy-induced symptoms such as dry mouth.

You should be aware that coverage of CAM often has higher deductibles than conventional treatments. You may also need to purchase a separate rider to your current insurance in order to get the coverage. Also, even if your insurance does not reimburse for such treatments, it may have a list of CAM providers with whom it has negotiated discounts for members.

"It’s easier to get reimbursed for alternative treatments that are used to provide comfort for the patient, such as black cohosh, which some women take to relieve the hot flashes that are caused by the antiestrogen drugs they are taking to treat their breast cancer," says Otis Brawley, MD, chief medical officer at the American Cancer Society. "But when you’re talking about herbal treatments directed at the cancer itself, it’s very unlikely to get paid for."

Stress, weight loss, and smoking cessation
 Insurance companies are increasingly promoting healthy living. If you are diabetic and need to lose weight, your insurer may reimburse part of the cost of a health-club membership, weight-loss regimen, or other program that can help manage your diabetes. If you are suffering from heart disease and are a smoker, your health plan may offer counseling or support programs to help you quit.

"Carriers want people to take better care of themselves because it costs them money when they don’t," says Jamie Charlton, a partner and health-benefits specialist at Saxon Financial Consulting in Cincinnati. "So they are promoting benefits such as health coaches, who help you quit smoking or manage stress."]]> Read the fine print: Your plan might surprise you. (ISTOCKPHOTO) <![CDATA[Health Insurance Jargon Defined]]>

COBRA
Stands for the Consolidated Omnibus Budget Reconciliation Act of 1985. It’s a federal law that gives you the right to temporarily (for 18 months or more, in most cases) continue with the group insurance plan of your employer even after you leave a job—voluntarily or involuntarily—or when you reduce your hours, such as from full-time to part-time.

Creditable coverage
Almost any health-insurance policy (see "excepted benefits")—such as an employer-provided health plan, an HMO, an individual health-insurance policy, Medicare, or Medicaid—that you were covered by before signing up for a new policy. A certificate of creditable coverage, which is a written document issued by the health insurer, will state how long you were covered under your former policy; that amount of time offsets any preexisting-condition exclusion period imposed by your new health-insurance plan. If you were insured continuously (with no significant break in coverage) for 12 months prior to joining a new plan, for instance, there will be no preexisting-condition exclusion imposed.

Excepted benefits
Certain types of insurance that do not qualify as "creditable," and therefore will not help establish continuous coverage for the purpose of avoiding a preexisting-condition exclusion under a new health plan. Some examples: accident-only insurance, disability income insurance, and workers’ compensation. These are not considered health coverage. Certain other benefits, such as dental or vision coverage, or long-term care coverage, are excepted if they are offered separately or are not an integral part of a health plan.

HIPAA
Health Insurance Portability and Accountability Act. It is a federal law that determines your rights regarding preexisting-condition exclusions, special enrollment in health plans when certain life or work events occur, and availability and renewability of health coverage, among other things.

Next Page: Late enrollee

Late enrollee
An individual who joins a group health plan on a date other than either a) the earliest date on which coverage can begin under the plan terms or b) on a special enrollment date. Under HIPAA, a late enrollee may be subject to a maximum preexisting-condition exclusion of up to 18 months.

MHPA
The Mental Health Parity Act is a federal law that requires health plans to provide mental health benefits that are equivalent to the plan’s medical benefits. MHPA applies only to employers with more than 50 employees.

Preexisting condition
An illness or condition that existed before the start of a person’s coverage under a group health plan.

Preexisting-condition exclusion
A limitation or exclusion of benefits for a condition that you had before your enrollment date in the group health plan. Under HIPAA, a preexisting-condition exclusion may only be applied if a) you had a significant break in coverage during the 12 months prior to your enrollment in the plan and b) received medical advice or treatment for the condition in the six months before your enrollment. The exclusion may not be longer than 12 months (18 months for a late enrollee).

Significant break in coverage
Generally, a significant break in coverage is a period of 63 consecutive days during which you have no creditable coverage. In some states, the period is longer if your plan coverage is provided through an insurance policy or HMO.

Special enrollment
Joining a group health plan when certain work or life events occur, regardless of the plan’s regular enrollment dates. Generally, special enrollment is available when you, your spouse, or your dependents lose other coverage; when you marry; or when you have a child. The plan must give you at least 30 days to request special enrollment.

Source: Adapted from the U.S. Department of Labor’s Health Benefits Advisor Glossary]]> Understanding the key terms will help you get the coverage you need. (HEALTH) <![CDATA[How to Keep Your Insurance Benefits When You Quit or Get Fired From Your Job]]>

Here’s what to consider—before you leave your job—to make the best choices for you and your family.

Should you stay or go?
In some cases, the need to keep health-care coverage could outweigh career considerations. “I’ve had some patients remain in jobs even though they’ve had better offers because they don’t want to lose their health insurance,” says Otis Brawley, MD, chief medical officer for the American Cancer Society. "One [cancer] patient I know got a job working for the federal government, because federal health insurance doesn’t allow exclusions for preexisting conditions.” Be sure to look carefully at a new employer’s health plan for comparison, and weigh the importance of continuing treatment with the doctors and specialists you are seeing now.

Next Page: Know your COBRA rights

Know your COBRA rights
Under the Consolidated Omnibus Budget Reconciliation Act of 1985, commonly referred to as COBRA, you and your family have the right to retain access to your employer-provided group health insurance for up to 18 months after you leave the job. That means you will get the same coverage and the same doctors you have now. You will have to pay for 100% of the coverage (rather than sharing the cost with your employer), but it is still usually cheaper than buying an equivalent policy on your own (though not necessarily as cheap as policies with inferior benefits). If you qualify for Social Security disability benefits, you and your family can get an additional 11 months of COBRA coverage, and if you have COBRA coverage through your spouse and you get a divorce, you and your children can get an additional 18 months. For more about your COBRA rights, visit this list of frequently asked questions assembled by the U.S. Department of Labor. Individual states also offer their own assortment of protections, so be sure to look into them.

Look into your spouse’s employer-sponsored group plan. If you’re married, joining your spouse’s health plan may be a cheaper option than COBRA. Under the Health Insurance Portability and Accountability Act of 1996, you have the right to enroll in your spouse’s health plan without having to wait until the next enrollment period, and without triggering a preexisting-condition exclusion. This is called “special enrollment.” If you elect to use COBRA instead, you have another opportunity to special enroll once you have exhausted the maximum period of COBRA coverage, or you can switch to your spouse’s policy during any regular open-enrollment period.

Next Page: Consider alternate coverage for your children

Consider alternate coverage for your children
One option that may save you money is to enroll yourself and your spouse in COBRA but get low-cost insurance for your children through government programs. Families that can’t afford to buy private health insurance for their children may be able to obtain coverage for them through the federal State Children’s Health Insurance Program (SCHIP), which covers about six million American children. Every state now offers coverage for uninsured children at little or no cost, even if the parents are working. Many states impose waiting periods of three months or more dating to when the child was last covered by private health insurance, however. To find out about income limits and eligibility for your state, visit the website for Insure Kids Now!, a national campaign from the U.S. Department of Health and Human Services.

Avoid a gap in insurance coverage of more than 62 days
If you have a preexisting condition for which you are currently receiving treatment, you’ll want to try to avoid a gap in coverage of more than 62 days, which will make your preexisting condition subject to an exclusion period when you get new insurance coverage. “If you have a long waiting period before beginning your next job, you can take the COBRA benefit until the other company picks you up, and there would be no issue of preexisting conditions because you would be a timely entrant into the new plan,” says Richard Imbrey, a certified financial planner and insurance agent in Knoxville, Tenn. ]]> Losing or leaving your job doesn't mean you have to lose your insurance coverage right away. (ISTOCKPHOTO) <![CDATA[Saving on Care: Emergency Rooms vs. Urgent Care Facilities]]>

urgent care facility. Sometimes called a “doc in a box,” these freestanding walk-in centers usually offer extended hours, and their doctors can treat non-life-threatening medical situations, perform basic X-rays and lab work, and dispense prescriptions.

Emergency room vs. urgent care facility
Franz Ritucci, MD, president of the American Academy of Urgent Care Medicine, recalls a Florida woman in her 40s who came to him with chest pain and heart palpitations. He took her medical history and did a physical exam, including a 3-D electrocardiogram and a check of her blood-oxygen levels. In less than an hour, she was diagnosed with a panic attack, given a prescription for anxiety medication, and discharged. Her cost: less than $400.

Had she gone to the emergency room with the same symptoms, the routine treatment would be far more intensive. “She would get a full panel blood work, probably cardiac enzymes, serial EKGs,” says Dr. Ritucci. “She would be on a heart monitor, probably have a cardiology consult, and maybe an admission to the hospital of less than 24 hours. The standard of care might be excellent, but the costs can quickly get out of hand.” Estimated bill: $2,000 or more.

Next Page: Emergency room

Emergency room
When to go: If you have symptoms of heart attack or stroke, or feel that your "life or limb" is in danger, go immediately to the emergency room. Also, if you think you might be having a medical emergency, but aren’t sure, go to the ER. According to the American College of Emergency Physicians, you should visit the ER if you have any of the following warning signs:

Chest pain or pressure
Uncontrolled bleeding
Sudden or severe pain
Coughing or vomiting blood
Difficulty breathing or shortness of breath
Sudden dizziness, weakness, or changes in vision
Severe or persistent vomiting or diarrhea
Changes in mental status, such as confusion

If you have a chronic condition, discuss in advance with your primary care doctor under what circumstances you should go to the ER.

How to find one: If you have a choice of emergency rooms nearby, ask your primary care physician which he or she recommends before you need to go. Also, check with your insurer to see which facilities belong to your insurer’s network, and whether the amount of ER coverage differs at in-network and out-of-network hospitals.

See how the hospital rates on important quality measures including care for heart attacks, heart failure, pneumonia, or surgery, by checking the U.S. Department of Health & Human Services’ consumer-oriented Hospital Compare online tool.

Cost: According to the federal Agency for Healthcare Research and Quality, the average cost of an emergency room visit in 2003 (the most recent year for which statistics are available) was $560.

Next Page: Urgent care center

Urgent care center
When to go: Urgent care facilities are for non-life-threatening conditions that need attention right away. These include minor traumas such as cuts, sprains, eye injuries, flu, fever, insect bites, and simple fractures. Patients are usually seen on a walk-in basis, and many centers have extended hours. (By administering an EKG or adjusting your diabetes medication, urgent care centers can even help manage your chronic health conditions after normal business hours, when your family doctor may not be available.)

Most urgent care centers have computerized radiology equipment and the ability to do lab work such as a complete blood count (CBC) test or electrolyte test. They can also run diagnostic tests for conditions such as mono, strep, pregnancy, flu, and viruses, according to Dr. Ritucci. In some states, urgent care centers can dispense the same medications as a pharmacy.

Many urgent care centers are staffed with at least one board certified physician. But they often use “physician extenders,” such as nurse practitioners, who are certified to treat certain ailments, and physician assistants, who generally work in tandem with an MD. “In our center, anytime a patient requests it, they can see the doctor rather than the physician assistant or nurse practitioner,” says Phillip Disraeli, MD, a physician and part owner of Metro Urgent Care in Frisco, Texas, and the director of clinical programs for the Urgent Care Association of America.

How to find one: It’s a good idea to locate an urgent care facility close by so you know where to get quick help when you need it, and to research what its medical capabilities are. Pay a visit and ask about their facilities for treating your condition, such as the ability to do lab work, CT scans, or life support if the situation demands it.

To locate urgent care facilities in your state, visit the website of the Urgent Care Association of America (UCAOA). Look for one that is accredited, which indicates that it meets industry standards for ambulatory care.

Cost: As a rule of thumb, one-third to one-half that of an emergency room visit, according to Dr. Ritucci. Urgent care centers usually accept many types of insurance, and many offer discounts to those paying cash. ]]> When trying to settle medical bills, don't be afraid to negotiate. (ISTOCKPHOTO/HEALTH) <![CDATA[Do You Really Need That Medical Test?]]>

American Journal of Preventive Medicine found that in 43% of routine checkups of outwardly healthy people, doctors ordered an X-ray, electrocardiogram, or urinalysis—tests that are not recommended for routine prevention under national guidelines.

"There is harm in extra tests, such as exposure to radiation," says Daniel Merenstein, MD, the director of family medicine at Georgetown University and the lead author of the study.

Besides causing stress, excessive testing can eat up funds or insurance coverage. Dr. Merenstein says that in one recent case, a couple had an extensive infertility workup costing thousands of dollars, even though they had been trying to conceive for only six months. (Medically, infertility is defined as trouble conceiving for at least one year.)

"In another study, we found doctors in the Washington, D.C., area were overusing colonoscopies—doing them every 5 years instead of every 10 as guidelines recommend," Dr. Merenstein says, referring to the recommended interval for people whose colonoscopies show no abnormalities. Colonoscopies, which range in cost from $650 for a simple procedure to $2,000 or more if they include biopsies, are important for detecting colon cancer, but they do carry risks of complications, such as bleeding and bowel perforation.

Superfluous tests aren’t always the doctor’s idea. Bob Phillips, MD, director of the Robert Graham Center, a Washington, D.C.–based research center that studies policy in family practice and primary care, had one 70-year-old patient who asked him to do a prostate specific antigen (PSA) test for prostate cancer. The results were normal, but the man was consumed with worry because his father had suffered from the condition. He sought a second opinion from a urologist, who repeated the PSA on account of this family history. Although the second PSA showed no increased risk for cancer, the urologist recommended a blind biopsy. Sure enough, cancer was found, and the man had his prostate removed, a procedure which left him impotent and incontinent.

"At that point, he came back to me very upset about the side effects, and asked me, 'Did I do the right thing?'" says Dr. Phillips. "By age 70, half of men will have prostate cancer, but most don’t end up dying of it. I felt just terrible for him. There’s a good chance he would have lived his life without any ill effects from the cancer."

Question why a test is being done
If your doctor orders an MRI, CT scan, or other medical test, speak up. "Ask why it’s being ordered, what will be done afterward if the results are positive (or negative), and what your risk factors are," says Dr. Phillips. If the answer is simply, "routine screening," the test may be unnecessary. The doctor should have specific reasons, he says.

Some blood tests, such as the complete blood count (CBC), are sometimes done too often. While not dangerous, the costs can add up, especially if you get them several times. "The main thing is, ask your doctor, 'Do I really need this test?'" says Dr. Merenstein.

Next Page: Organize your medical records

Organize your medical records—and share them with all your providers
One reason for unnecessary tests is scattered record keeping. "It helps if your doctor has electronic medical records," says Dr. Phillips. "Frequently, blood tests are repeated because doctors don’t know a test has already been done or because they can’t put their hands on the results. And if you’re also seeing a cardiologist, an endocrinologist, or other specialists, you’re likely to have the same test repeated two or three times."

You can avoid duplication by keeping track of your own records, including copies of EKGs, X-rays, and blood work. Ask for photocopies of lab results and carry them with you when you see specialists.

"Everyone should have one page that shows, this is my last colonoscopy, my last mammogram, my last blood-sugar test," says Dr. Merenstein.

Whenever you are referred to another doctor, Dr. Phillips suggests that you ask for your test results to be shared with other physicians: "Say, 'Here’s the number for my cardiologist, can you fax my results to him?'"

Online health record services such as Microsoft's HealthVault, Google Health, and iHealthRecord offer free and easy ways to compile medical records and track prescriptions. Pay services such as MyMedicalRecords.com and FollowMe even allow you to upload and organize images of MRIs, CT scans, and X-rays, and to have them handy if you change doctors or see specialists.

Shop around for less expensive tests
When you do need to have a test done, it pays to call a few different testing facilities to compare prices. If you’re paying out-of-pocket, or are worried about exhausting your health-insurance caps, you might find that the savings are considerable.]]> Make sure your insurance covers any test your doctor wants to give you. (123RF) <![CDATA[Where to Find Money to Pay for Your Major Health Bills]]>

study. Even middle-class people with good health insurance can quickly become mired in debt if they fall ill and can’t work.

“What happens is, someone in their 50s has a major heart attack. Even with good insurance, their share is $50,000 and they put it on a credit card,” says Winchell Dillenbeck, executive director of the Consumer Credit Counseling Service of the North Coast, in Arcata, Calif., a nonprofit community service agency. “With a chronic condition, they keep piling more and more on the card. Meanwhile, their health limits the amount they can work, they have less income, and they struggle to stay a step ahead of the creditors. Eventually the minimum payment outgrows the affordability.”

Whether you need to pay for experimental surgery that is not covered by insurance, unreimbursed cancer therapy after you’ve maxed out your policy, or modifications to your home so you can live there longer, here are some resources to consider if you need assistance paying your medical expenses.

Next Page: Health-care financing

Health-care financing
You may have seen brochures in your doctor’s office for health-care financing, which is often used for elective medical procedures—such as laser eye surgery, plastic surgery, and cosmetic dental work—that aren’t covered by insurance. These loans, from lenders such as Bank of America and CareCredit (a division of GE Money), are an option for paying your major medical expenses, but financial advisers warn that they can be expensive. “There are lots of them out there charging 19% to 29% interest,” says Chris Cooper, a certified financial planner and social gerontologist in Toledo, Ohio.

Consumers with good credit may be able to find a deal on these loans by taking advantage of zero-interest offers, which typically give you 12 months to repay without incurring any interest. But beware: These unsecured personal loans are similar to credit cards. If you miss a scheduled payment, or don’t pay off the balance within the specified period, you may face interest rate hikes as high as 12% to 29%.

“It’s a huge rip-off if you’re asked to pay medical bills at 27% interest,” says Dillenbeck. Even in today’s tight credit environment, your goal should be to get a rate of 10% or less, and if you’re not sure whether you can meet the payment terms, look elsewhere for cheaper sources of funding.

Life insurance policies
If you have been paying premiums on a life insurance policy for a long period of time, the policy has some cash value that could be exploited as a source of funds. You could either cash in the policy or borrow against it. The latter can be advantageous because the interest rates tend to be low—5% to 8%, typically. Be sure to speak with your financial planner or accountant before you take this step. If you want to borrow against the policy, you need to ensure that the interest that accrues to the policy balance will outpace the interest on the loan. And if you subsequently cash in the policy or let it lapse, the full value of the policy (including the borrowed amount) will be subject to income tax. “You have to make sure cashing in your insurance is OK with the rest of your financial plan,” Cooper says.

Next Page: Credit unions

Credit unions
Credit unions are nonprofit, member-owned financial institutions that usually offer loans with interest rates lower than those at a commercial bank. Ask your human resources department if your employer has a relationship with a credit union that you can join. Ask family members if they belong to a credit union—often you can join if your relatives are members. Visit the website of the National Credit Union Administration, a federal agency, to find a credit union by city, state, or type.

Home equity loan or line of credit
If you own your home and have a good credit score (around 750 or higher), a home equity loan can be one of the most inexpensive sources of funds available. The rate (usually variable) runs around 8% or 9%, a good deal compared to most other options. Plus, “if you itemize your tax deductions, a home equity loan might be your cheapest source of money because you can deduct the interest,” says Cooper.

But before you use your home equity for medical expenses, think about the broader financial picture for your family. If you are unable to pay off the loan, you risk losing your house. An even more sobering scenario: “If you borrow the guts out of your house to pay for an operation and the person dies, what is the family or spouse going to do?” says Cooper.

In some cases, however, a home equity loan used for medical reasons may actually increase the value of your home. Using a loan to make medically necessary modifications to your house, for instance, can have a long-term benefit, depending on your property type and its location.

“More people are starting to need homes with elevators, or ramps for wheelchairs,” says Cooper. “Putting an elevator in a two-story house might be a very good investment.”

Next Page: Reverse mortgages

Reverse mortgages
People age 62 and older who own a home are eligible to apply for a reverse mortgage, a program which converts home equity into a bank loan or line of credit. You make no payments to the bank until you (or your heirs) sell the house, at which point the bank recoups its money from the proceeds. (If you move out for longer than 12 months, you will need to repay the bank then.) “We counsel people who are trying to avoid bankruptcy, and many of them do not know that a reverse mortgage is an option for them,” says Scott Scredon, spokesperson for the nonprofit Consumer Credit Counseling Service of Greater Atlanta.

The amount of money you can borrow depends on your age, current interest rates, and the appraised value of your home. (An easy-to-use reverse mortgage calculator is available on the AARP’s website.) You may want to consider a reverse mortgage if you have no other means to pay for urgent health care and are likely to live in your home for the foreseeable future. If, on the other hand, you expect to move out within a few years, can afford the monthly payments on a traditional home equity loan, or have access to other funds, you may want to think twice.

“This should be used as a last resort. You don’t want to do it until you’re very advanced in age,” says Cooper. “You want to wait as long as possible. A reverse mortgage is like a pension: The earlier you draw your pension, the less payment you get, but you get it for a longer period of time.” However, Cooper says that people might want to consider taking out a reverse mortgage earlier if there are signs that the value of property in their area is decreasing (for example, if the population or the property tax rate is on the decline).

Before you can take out a reverse mortgage—roughly 90% of which are insured by the federal government—you are required to receive information from a counselor approved by the U.S. Department of Housing and Urban Development, to make sure you understand the terms.

“People need to know that reverse mortgages are expensive loans with high upfront costs,” says Donald Redfoot, strategic policy adviser at the AARP’s Public Policy Institute. “They are not to be entered into lightly. They are for people who want to stay put in their homes, so if the nature of their health or disability requires them to move to get care, this would not be a good option.”

The funds can be used for anything, even daily living expenses, but they are often used for health-care expenditures that are not covered by health insurance or Medicare, such as prescription drugs, home care, modifying a home for wheelchair access, or the purchase of a specially equipped van, Redfoot says. ]]> Before you write a check for your medical bills, consider health-care financing or a home equity loan. (ISTOCKPHOTO) <![CDATA[4 Ways to Get Your Medical Expenses Covered]]>

long-term health condition needs is to become embroiled in a drawn-out fight with an insurance company over treatment payments. The best protection is preemption. If you’re having a scheduled procedure, talk to your health-care provider and your insurance company ahead of time. “You’ve got to make sure up front that the treatment is going to be covered,” says Nora Johnson, vice president and director of education and compliance for Medical Billing Advocates of America. Here, she shares the key questions to ask so you don’t end up paying out-of-pocket for your medical expenses.

Is this treatment considered experimental? Insurance companies will only pay for procedures that, in their view, are well-proven to be effective. “If your doctor says, ‘There is a new treatment that I think could really work on you,’ of course you’re going to say you want it. But the doctor may not know, and you may not know, that the insurance company considers this treatment experimental,” says Johnson. If that’s the case, ask your doctor whether he or she can help you argue that it should be covered anyway. You may have to file an appeal with your insurer and, if you do get permission, be sure to get it in writing. Indeed, it’s a good idea to get written preapproval for all procedures, even if it’s not required.

Next Page: Have we established medical necessity?

Have we established medical necessity? Likewise, your insurer will want to be sure that your condition warrants the treatment. If you have a variety of symptoms, what your doctor highlights could make the difference between coverage and no coverage. “A headache diagnosis is not going to establish medical necessity for an abdominal CAT scan,” says Johnson, even if your doctor orders it. “They would have to list vomiting or stomach pain as a diagnosis to justify the procedure. If your insurance company says it won’t cover the procedure, discuss with your doctor whether there is any leeway in the diagnosis that could provide the needed justification.”

What is the proper diagnostic code to be used for billing? The next step is to make sure the diagnosis and recommended treatment are properly reflected in the billing codes. “Medical coding is the very foundation of all medical reimbursement. If something is coded wrong, the insurance company is likely to deny it,” Johnson says. Ask the billing department of your doctor’s office or hospital how the procedure will appear on the bill, and then try to get your insurance company to confirm that it will be covered.

Are all the practitioners on the team in-network? Even if you are being treated at a hospital that is in your insurer’s provider network, there may be doctors treating you there who are not—say, the anesthesiologist on your surgery team. In that case, call your insurer or go online, see which anesthesiologists are in your network, then call the hospital and say you want an anesthesiologist who participates with your insurance, advises Johnson. "You may be told that there are no participating anesthesiologists in the area that have privileges at this hospital," she says. "Demand to speak with the anesthesiologist who will be assigned to your case, and insist that your insurance company's 'allowed amount' be accepted as payment in full for anesthesia services. And get the agreement signed and in writing!" ]]> Call your insurance company before a procedure is scheduled to make sure you're covered. (ISTOCKPHOTO/HEALTH) <![CDATA[8 Things You Must Do to Prevent Hospital Overcharges]]>

Edward R. Waxman & Associates, an independent hospital bill auditor with 10 years of experience helping consumers sort through their medical bills.

Overcharges hurt the most when they are not covered by insurance, but even when they are, they can impact your pocketbook or your health.

They inflate co-pays and—even more important if you will ever face treatment for an expensive chronic condition—they eat up your insurance benefits, making the day when you max out your policy that much closer.

Often, erroneous charges are obscured by billing codes and "medicalese." In one case, a 60-year-old obese man with chronic obstructive pulmonary diseaseand congestive heart failure was admitted to the hospital for a 57-day stay. The bill was $138,345. Waxman audited it, noting a daily charge of $202.75 for “MAGNUM II BA.” A drug? A lab test? Nope. It was the name of a heavy-duty bed designed for overweight patients. Hospitals are not allowed to charge for reusable equipment like beds, so Waxman disputed it. The hospital took the charge off the bill—resulting in a total reduction of $11,556.75.

Next Page: Steps to take to protect yourself

Here are some steps to take to protect yourself against paying more than you should.

Talk to your hospital about the bill ahead of time. If you’re paying your own way for an expensive medical procedure like a coronary bypass, go in advance and ask to speak to the chief financial officer of the hospital, advises Gerard F. Anderson, a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health. You might not reach that person—more likely, you will be passed to a manager in the financial department—but speak to the highest-level official you can. Hospitals, which usually charge three or four times the cost of their services, routinely accept discounted payments from insurers and Medicare, so they may be persuaded to give you a break too. “Say, ‘I’m willing to pay a little bit more than what Medicare pays.’ Often they will give you a substantial discount—30% or more,” says Anderson.

Keep a log. To the extent that you’re able, write down the dates of your hospital procedures and medicines that you’re given, so you have something to check the bill against later. “If you have an accountant mentality and you’re awake enough to be able to do that, that’s great, but the reality is that many people can’t,” says Louis Saccoccio, executive director of the National Health Care Anti-Fraud Association. If you’re too weak to do it yourself, assign a friend or family member to the task.

Pack your own drugs. Take your over-the-counter and regular prescription medications with you. “In the hospital, the nurse has to put it in a plastic cup and walk it down the hall to you—you may pay $3 or $5 for an aspirin,” says Waxman. Prescription drugs, of course, can be much more, and can add up during a long stay. Bring any that you are taking regularly in their original pharmacy bottles. Be sure to tell your nurse what you are taking, and check your hospital and doctor's bills carefully after treatment to make sure you weren't charged for the medication anyway.

Double-check your personal information on file with the hospital and your insurer. An incorrect social security number, name, address, or date of birth can result in accidentally being charged for someone else’s treatment. Also: “Be very careful of your insurance card. Make sure no one gets hold of it or makes copies of it unnecessarily. Someone could try to use it to get health-care services,” says Saccoccio. Victims of what is now termed medical identity theft have found their health-insurance lifetime limits exhausted after their accounts were billed for services they never received. The Federal Trade Commission measured statistics on medical identity theft for the first time in November 2007, finding approximately 250,000 victims in 2005. Health-care employees, not random thieves, are thought to be responsible for most stolen insurance numbers, but you can help protect yourself by guarding your insurance information closely. Since you will have to present your insurance card when you are admitted to the hospital or go to a doctor's appointment, be vigilant about checking your bill and making sure it doesn't include any fraudulent charges that may have stemmed from an inside job.

Next Page: Order an itemized statement

Order an itemized statement. Many hospitals send a summary of charges, but you have a right to ask for the complete breakdown. Look at the line charges and the diagnostic codes. These can be hard for the average person to understand, but if something looks fishy, ask the billing department to explain it. If you have a bill of $10,000 or more, however, consider hiring a professional bill auditor, Waxman advises.

Read your explanation of benefits (EOB). Your insurer will send you a letter that explains exactly what was paid, and how much you are responsible for. Compare it with the hospital bill. Though the medicalese may be hard to understand, at least check the dates for accuracy. “If you were in the hospital overnight, and a month later you get an EOB that says the hospital stay was four days, then obviously something is wrong,” says Saccoccio. If you kept a log during your stay, compare it against the services and medicines on your EOB. If there are discrepancies, ask your health plan to review your hospital bill.

Enlist help from the state. If you are held responsible for charges that you think are erroneous, contact the consumer protection office of the state attorney general’s office for help. Visit the website of the National Association of Attorneys General to find the phone number for the attorney general's office in your state.

Consider hiring help. Medical billing advocates charge an hourly fee (about $25), or take a percentage of recovered money, to audit your medical bills and negotiate with health-care providers. If you have a very large set of confusing bills and think there may be errors, this can be a time-saving option. You can find a professional through Medical Billing Advocates of America, a network of 61 medical bill auditing companies across the country. ]]> Hospitals accept discounted payments from insurers and Medicare, and they may do the same for you if you know how to ask. (ISTOCKPHOTO) <![CDATA[How to Get Help Paying for Drugs You Can't Afford]]>

Each patient-assistance program sets its own eligibility requirements. The income limits vary widely, from 100% of the federal poverty guidelines (which in 2009 stood at $22,050 for a family of four) to over 300% of the guidelines, according to Rich Sagall, MD, president of NeedyMeds, an online clearinghouse of information for people who cannot afford medicine.

Most patient-assistance programs require the applicant to be an American citizen or legal resident, and most are restricted to the uninsured. "Most programs help people with no insurance, but some will help the underinsured," says Dr. Sagall. For instance, some companies will provide medications to patients who have reached the limit of their prescription insurance; others help people on Medicare Part D, the federal drug-subsidy program. In general, however, if you qualify for government-funded programs (such as Medicaid), you probably will not be eligible for most patient-assistance programs.

For a comprehensive directory of available patient-assistance programs (including which programs offer which drugs), visit NeedyMeds. Some programs run by pharmaceutical companies require your physician or another advocate to register you. If your doctor isn’t available to help and you need someone to act on your behalf, or if you just need some help with the paperwork, NeedyMeds can direct you to an advocate in your area.

Next Page: Free or reduced-cost prescriptions

Additional sources of information on free or reduced-cost prescriptions:

American Society of Health-System Pharmacists (ASHP). This organization offers a list of frequently asked questions and links to directories of patient-assistance programs.
Partnership for Prescription Assistance (PPA). The website of the PPA, a national program sponsored by America’s pharmaceutical research companies to help patients in need of access to prescription medicines, features an online application wizard that can help patients determine which patient assistance programs they may be eligible for.
RxAssist. A pharmaceutical information center created by Volunteers in Health Care, RxAssist offers a comprehensive database of patient-assistance programs.
The Patient Advocate Foundation’s Co-Pay Relief Program. If you have insurance but are still struggling with high costs for medication, this program gives financial aid to patients who meet certain income qualifications and who are being treated for chronic conditions such as cancer, certain autoimmune disorders, and secondary issues resulting from chemotherapy.
Medicare Rights Center. An independent source of health-care information and assistance for people with Medicare.

]]> If you don't have health insurance, patient-assistance programs can help you pay for prescriptions. (ISTOCKPHOTO) <![CDATA[Expert Advice on How to Convince Your Insurer to Cover Your Drugs]]>

back pain found that her insurance company wouldn’t cover the painkiller her doctor prescribed because it was only specified for breast cancer patients. She ended up on an alternative medicine, but she and her doctor felt it was not nearly as effective. It can be a lot of work, but in some cases it may be worth trying to change your insurer's mind. Here, Nancy Davenport-Ennis, CEO and president of the Patient Advocate Foundation, and Joseph Augustine, a litigator in private practice in New York, explain how to turn a denied claim into a covered benefit.

Q: What documentation do I need?

A: "You should take copious notes of all phone calls and demand a detailed written explanation for the denial—not just a one-sentence letter, but one that sets forth the exact policy language the insurer based its decision on," advises Augustine. "In your appeal, you’ll want to address the insurer’s stated reason for the denial and why you think it was wrong."

Next Page: Is there anyone who can help me?

Q: Is there anyone who can help me?

A: Your doctor will be able to help you—and may be able to handle the appeal for you, says Davenport-Ennis. Also, if you're insured through your employer, call the benefits manager and explain the problem. She can answer questions about the policy and, in some situations, put enough pressure on the insurance company to get the denial overturned. (For more tips, check out PatientAdvocate.org or contact the Patient Advocate Foundation at 800-532-5274.)

Q: Do I have to make my appeal within a certain time frame?

A: Most likely; you can find out what that time frame is by calling your insurer or reading your policy. Do not delay in filing the appeal, says Augustine. "Failing to make a deadline can sometimes limit or cut off your rights," he notes.

Q: What information should I include in my appeal letter?

A: An appeal letter should include your policy number, group number, claim number, the reason for the denial (which should have been specified in the denial letter), as well as a brief history of the illness and why this drug is the best treatment, says Davenport-Ennis. Also state why the denial decision was wrong. For instance, maybe you have side effects with the preferred drug or your condition is so serious that, in the opinion of your doctor, it requires the most potent drug.

"The key is to be concise and to the point, and to advise the insurer that you are prepared to appeal any denial to the last step," says Augustine.

Q: What else should I include along with the appeal letter?

A: Davenport-Ennis advises that you include:

A letter from your doctor that explains your specific case and why the drug is medically necessary.
Studies from professional medical journals proving that the drug is helpful for your condition. Your physician can assist you in obtaining these articles.
Statistics on whether your insurer has reimbursed patients in the past for the same medication. "Ask your doctor if she knows of any cases," says Augustine. "You can also ask your insurer if it has approved such medications in the past, and demand a numerical summary of all claims made for the same prescription and the number of times the insurer granted or refused reimbursement for it. If they have granted it for others, they will have to explain their criteria and why they denied it to you."
Finally, make a copy of all the information and send it via registered mail.

Q: If my appeal is turned down, do I have any recourse?

A: You can reappeal (one or two times, depending on your plan's rules), notes Davenport-Ennis. You'll need to prepare a new appeal, in which you'll want to include new information that specifically addresses the reasons cited in the denial. Again, keep copies of all information and send the packet via registered mail.

If you get a final denial, the next step may be a free external review by a third-party company, which will reconsider your insurer’s decision. For details about your state's external review program, check out the Consumers Union’s Consumer Guide to Handling Disputes With Your Employer or Private Health Plan.

]]> Enlist your doctor to help you get coverage for drugs your insurer doesn't want to pay for. (ISTOCKPHOTO) <![CDATA[Is Buying Discount Drugs in Foreign Countries a Good Idea?]]>

As tempting as it is to view the world as one big discount pharmacy, buying prescription drugs abroad isn’t a foolproof way to save money. For one thing, it may be illegal.

Restrictions Have Eased in Some Cases
The laws governing the importation of prescription drugs are complex and filled with lots of gray area. Although purchasing prescription medicines from foreign pharmacies is technically illegal, in most cases, the high cost of drugs in the U.S. has pressured the government into easing some restrictions.

Ordering drugs from other countries is now effectively allowed under the law if the drugs are clearly for personal use and do not present an unreasonable risk to the individual. With some restrictions, the law also specifically provides an exception for purchasing drugs from Canada. As of October 2006, U.S. Customs officers also suspended their policy of seizing packages of prescription drugs from Canada in the mail and at border crossings. And at least half a dozen state governments, including those in Wisconsin and Illinois, have set up programs to help residents order drugs from abroad.

The FDA continues to discourage this practice, however, because the agency cannot guarantee the integrity of imported medications or the legitimacy of the pharmacies that sell them.

The Internet has made ordering drugs easier than ever before, but it can also disguise the source of the drugs you are buying. Even ordering online (or by mail) from a Canadian pharmacy is not necessarily a way to play it safe. A 2005 FDA operation—in which the agency examined nearly 4,000 packages at airports in New York, Miami, and Los Angeles—found that 85% of the drugs ordered from what customers believed were Canadian pharmacies actually came from 27 other countries. Upon examination, a number of the products were also found to be counterfeit.

Next Page: Sleep med turns out to be antipsychotic

Sleep med turns out to be antipsychotic
Counterfeit drugs can cause adverse side effects, which can be life-threatening. In February 2007, some Internet customers who thought they were ordering Ambien (for insomnia), Xanax and Ativan (for anxiety), and Lexapro (for depression and anxiety) received drugs containing haloperidol, a powerful antipsychotic; some subsequently sought medical treatment for symptoms such as difficulty breathing and muscle spasms. "Most drugs coming from outside the U.S. are unapproved, illegal, and potentially pose risks," says FDA spokesman Chris Kelly. "Sometimes sellers from outside the U.S. don’t follow our standards in labeling drugs for safe and effective use, so consumers might not be getting proper information about how to take the drug and/or about side effects."

Although a website may appear to be reputable and may look similar to legitimate retail pharmacy websites, it may be providing unapproved drugs from unreliable sources. Before placing an order, check if the site is accredited by the National Association of Boards of Pharmacy (NABP). Online pharmacies vetted by the NABP carry a blue oval seal that reads “VIPPS,” which stands for Verified Internet Pharmacy Practice Site.

Buying drugs abroad has the potential to save you money, but it is important to do so cautiously and within the law. You should also keep in mind that, generally, only brand-name drugs are cheaper outside of the United States. Generic drugs are usually less expensive in the U.S. than in Canada. Some large chain stores (such as Wal-Mart and Target) offer a 30-day supply of many generics for just $4. "That is less than the shipping price of most Internet sellers," Kelly points out. And although brand-name drugs from Canadian pharmacies are cheaper, the savings have declined in recent years due to a weaker American dollar. ]]> The government frowns on overseas buys, but makes exceptions for Canada. (ISTOCKPHOTO/HEALTH) <![CDATA[5 Tips for Safely Buying Drugs on the Internet]]>

Shop around. Websites such as PharmacyChecker and DestinationRx allow you to search for the drug you need and compare prices at numerous online pharmacies. Don’t assume that online prices will be lower than those at your local pharmacy, however. Prices often vary between different pharmacy chains, websites, and even a single chain’s stores and website. You may have to comparison shop by checking with multiple stores and sites.
Make sure the pharmacy is legitimate. Verify that there is a licensed pharmacist available to answer your questions and that the site requires a prescription from your doctor or another authorized medical professional. You’ll need to mail in a prescription—or have your doctor fax or call it in—before a legitimate site will send you any medicine. Check the website in question for specific instructions.
If possible, buy from a licensed online pharmacy. Ideally, the website will be certified by the National Association of Boards of Pharmacy (NABP). Online pharmacies vetted by the NABP carry a blue oval seal that reads “VIPPS,” which stands for Verified Internet Pharmacy Practice Site. Visit the NABP’s website for a complete list of these certified pharmacies.

Next Page: Plan ahead
Plan ahead. You should allow at least two weeks for your prescription to be processed. If you don’t receive your order in time, you may need to get a fill-in, which you may have to pay for out-of-pocket, as most prescription plans don’t pay for more doses than the prescribed amount.
Exercise caution when ordering from pharmacies outside the U.S. Although this is a common practice, and although several state governments have set up programs that help their residents purchase drugs from Canada and other countries, buying drugs from foreign pharmacies can be risky and in some cases illegal. The Food and Drug Administration has reported instances of Americans who unwittingly purchased counterfeit or tainted medications from foreign pharmacies.

]]> Surfing for drugs on the web is a great way to save, but don't assume that online prices will always be lower than those at your local pharmacy. (ISTOCKPHOTO) <![CDATA[Should You Get Disability Insurance?]]>

While government programs such as Social Security provide disability benefits, the eligibility requirements are strict: Your disability must be expected to last for at least a year and the government must conclude that you are incapable of any gainful employment. Also, the benefits may fall well short of your lost income. A 40-year-old making $60,000 a year, for instance, can only expect about $1,700 a month from Social Security in the event of disability.

There is another way to guard against the worst-case scenario. Disability insurance can provide some financial security—and peace of mind—if you’re unable to provide it yourself.

What is disability insurance?
Disability insurance, also known as disability income insurance, replaces a portion of your income—typically between 50% and 70%—if you are no longer able to work due to sickness or injury. (No insurer will agree to replace all of your predisability income, the rationale being that you would have little incentive to return to work.) "Your ability to earn an income is likely to be your largest financial asset," says Marvin Feldman, president and CEO of the Life and Health Insurance Foundation for Education in Arlington, Va. "It's worth protecting."

When do you need disability insurance?
The short answer: right now. "You want to buy it when you don't need it at all," says Larry Saffer, a registered financial planner and insurance agent in Plantation, Fla. If you wait until you are actually ill, you may be uninsurable. And policies are most affordable when you are young and healthy. Saffer recalls the case of a 34-year-old teacher who, at his recommendation, purchased a disability policy through the school where she worked. She nearly forgot that she had the coverage, since it cost just a few dollars out of each paycheck. But then a medical mistake during a routine outpatient procedure led to emergency colostomy surgery, eight days in the hospital, and several more operations to correct the error. She had to use a colostomy bag for more than a year and was unable to return to the classroom for close to two. Her disability insurance kept part of her salary coming in through it all. "She thought it was a waste of money initially," Saffer says. "But when she needed it, it was there."

Next Page: What kind of policy should you look for?

There are two main types of policies: noncancelable, in which both the premium and the benefits remain unchanged over the life of the policy; and guaranteed renewable, a substantially cheaper option with fixed benefits that allows the insurer to increase the premiums in some cases. The average annual premium for noncancelable policies is around $1,700, according to a 2006 Wall Street Journal report. For guaranteed renewable policies, it’s just over $500.

Every policy varies in its definition of what constitutes a disability, and when the benefits will begin. Some policies may limit coverage for mental health problems, for instance, while others might require that you be unable to perform any job, not just the occupation you were in when you became disabled. Depending on the premium, the waiting period before the payments start can range from 30 days to 6 months or more. Make sure your policy is broad enough for your needs.

Where can I get disability insurance?
Most employers offer some form of short-term sick leave or workers’ compensation, but many companies (especially larger ones) also offer long-term disability insurance through group health plans. This approach has its limitations, however. Employer-sponsored insurance typically is not portable (that is, you can’t take it with you if you leave your job). Also, if your company pays the premiums, you will owe income tax on any benefits you receive.

The alternative is to purchase a policy through a private insurer. Coverage you buy on your own tends to be more flexible and usually covers a wider range of illnesses. If you do have access to an employer plan, but it is not comprehensive enough, you can also use a private policy to fill in the gaps. Expect to pay 2% to 3% of your annual income for private disability insurance.

Buyer beware
While disability insurance is almost always a good idea, it’s important to be prudent when shopping for a policy. As with any insurance policy, scrutinize the fine print concerning benefits and waiting periods. In these troubled economic times, it’s also especially important to research the insurer and determine whether the company is financially healthy and has a track record of honoring claims. Experts recommend consulting credit rating services such as Moody’s and Standard & Poor’s for financial information, and state insurance departments to investigate complaints and regulatory actions. In recent years, instances of insurers denying disability claims or discontinuing benefits have led to numerous well-publicized appeals and lawsuits.]]> The best time to get disability insurance? Before you need it. (FOTOLIA) <![CDATA[How Do You Ensure the Care of a Chronically Ill Spouse if He Outlives You?]]>

study in the Journal of the American Medical Association found that people who were caring for a spouse and experiencing strain were at 63% greater risk of death than non-caregivers.

A caregiver’s death is not only heartbreaking for the family that loses a beloved member; it also creates uncertainty about how the surviving spouse will be cared for. Here are some steps to consider in making sure your spouse gets the care he or she needs if you are no longer living.

Plan early
As the old saying goes, "Hope for the best, plan for the worst." Talk to your family about who will step in to care for your spouse in the event that you pass away or become seriously ill. Who will be responsible for medical decisions? Who will keep track of the finances? What resources will be available to pay for care if you are not providing them yourself?

Make it official
To ensure that there is a seamless legal transition, both you and your spouse should, via powers of attorney, designate an agent who can make health-care and financial decisions on your behalf. (At the same time, you should communicate your wishes in these matters to the person you designate.)

If you die without naming an agent, your children or other family members could face a legal morass. They won't necessarily have the authority to make important financial and medical decisions for your ill spouse. Experts suggest that you review your powers of attorney and any other relevant documents every three to five years. This allows you to reiterate your wishes and, if necessary, take into account any changes that may have occurred in your life, such as a child or other designee who has moved away.

Next Page: Consider establishing a trust

Consider establishing a trust
One of the most important considerations when leaving a spouse behind is how his or her care will be paid for. When one spouse dies, the couple’s assets ordinarily pass automatically to the surviving spouse, even in the absence of a will. This isn’t always a good thing, however. Establishing a living trust—so called because you fund it while you’re alive—is one way to avoid the problems that can occur if you let your spouse inherit everything directly.

If your assets pass to your spouse, and he or she has not designated an agent using a power of attorney, a court-appointed guardian will have to be named. If assets—including real estate and bank accounts—are transferred to a trust, on the other hand, a trustee will already be in place and the money will be designated for your spouse’s care. Using a living trust instead of a will also obviates the need for probate, the often lengthy and costly process by which a court settles an estate (including any disputes over the will).

When you establish a trust, you should name yourself as the trustee and also name a successor to administer the trust if you die or become incapacitated. "If you have the trust set up, and you fund the trust, then the successor trustee can step in much more easily to help the chronically ill person take care of their affairs," says Constance Stone, a certified financial planner with Stepping Stone Financial in Chagrin Falls, Ohio.

Bequeathing your assets directly to your spouse, moreover, can disqualify him or her from government assistance programs. Medicaid, for instance, sets very low asset ceilings for eligibility ($2,000, typically, though it is higher in some states). As long as you fund the trust more than five years before your spouse applies for Medicaid, the trust can hold the assets you leave your spouse without being considered his or her personal property, thereby allowing your spouse to be eligible for Medicaid. "Then the assets in the trust can be used to pay for things other than what Medicaid pays for," says Peter J. Strauss, a partner in the firm of Epstein, Becker & Green P.C. of New York.

Living trusts aren’t appropriate for everyone, however, and the relevant laws are complex. To learn more about trusts, contact an estate-planning attorney or a certified elder-law attorney. The National Academy of Elder Law Attorneys features a searchable directory on its website.]]> Don't assume you'll be there to pay the bills for your sick spouse. (GETTY IMAGES) <![CDATA[Why Your Parents Need a Living Will]]>

Q: What is a living will?

A: A living will, sometimes called an advanced health directive or a medical power of attorney, is a legally enforceable document that identifies a patient's end-of-life wishes. It can specify that you want the cessation of treatment under a specific set of conditions—when you want to "pull the plug," in other words. Most people draw the line in one of three ways.

If they're in a coma or a persistent vegetative state and there's no hope for recovery.
If they're not in a coma, but have lost so much cognitive function that the doctor feels there's no hope for recovery.
If there's a terminal illness with no hope for recovery.

A living will does not authorize someone else to act on your behalf for medical decisions. You need a health-care proxy for that.

Q: Who should have a living will?

A: Anybody who is older than 18 and competent. If you are sure you don’t want to be put on artificial support, and don’t want to have extraordinary measures used to sustain your life, then you should sign a living will. Remember the case of Terri Schiavo: Her husband and her parents fought a seven-year legal battle over removing her feeding tube, with some 20 judges ruling on whether there was sufficient evidence that she would want to stop treatment. If it had been in writing, would you need 20 judges, or all the heartache and family strife? No.

Next Page: What to include in your living will

Q: How do you get a living will?

A: In many cases, state bar associations have forms available online. They may not be exactly what you want, but at least they're a starting point. If you work with a lawyer, you won't have to worry about whether the form is good or bad. Plus, you may want something very specific in your document that the form doesn't cover; a lawyer can help you with that. Each state has its own requirements for what you need to do to make the document legally enforceable, such as the number of witnesses and who can sign as a witness. These guidelines, which can affect whether the document is legal or not, should be spelled out on your state's bar association site. You may also be able to find living will resources at local hospice groups. Some hospitals offer the forms for patients or visitors.

Q: What should a living will say?

A: I recommend that a living will respond broadly to what a person wants—it’s hard to anticipate every possible specific scenario. However, there might be individualized specifics. Take my grandmother, for instance. On the one hand, she believed that "where there's life, there's hope," but on the other, she never wanted to be intubated because she had it done once and found it to be the most excruciating experience. Also, she didn't want a doctor to perform any chest compressions on her, even if she could die without them, because she was weak and her ribs could be easily cracked. So the document we drew up for her had to take all that into account.

Q: How do you talk to your parents about getting a living will?

A: The best way to have that conversation is proactively. Have it in advance of anyone needing a living will. Even if your parents put off your initial approach, at least you've planted the seed. And even in states where next of kin can legally make an end-of-life decision for someone, a living will can at least let you know what your parents want. I recently had a situation where a man who had a terminal illness came to see me to do his end-of-life planning, including a living will. At his funeral, his daughter came up to me said, "When we got the call from the hospital that a decision needed to be made about Dad, we pulled out all the documents and read what he wanted. It was such a comfort knowing that he thought about these things and was specific about what he wanted."

]]> Want the peace of mind that comes with having a living will? A lawyer can help you navigate your state’s laws. Fotolia <![CDATA[How to Choose Between Home Health Care, Assisted Living, and a Nursing Home]]>

and your bank account. Family and friends can step in to assist, of course, but there may come a point when your loved one needs professional care. Here are some basic options to consider.

Home sweet home
In-home health aides average $19 an hour, and hired companions who don't provide health care are slightly less expensive. Do the math and you'll see that for round-the-clock assistance, the tab can run as high as $170,000 a year, making home care a very costly option.

"It's so expensive because people are basically trying to recreate the nursing facility at home," says Chris Cooper, a certified financial planner and social gerontologist in Toledo. Medicare and private insurance generally do not cover long-term in-home care. So unless you have a long-term-care insurance policy, the cost must be paid out-of-pocket, which may mean liquidating assets or applying for a reverse mortgage.

Despite the expense, "most people try to do what they can to stay at home before placement in a facility," says Nancy Wexler, a Los Angeles–based geriatric care manager and author of Mama Can't Remember Anymore: Care Management of Aging Parents and Loved Ones. The good news is that many people don't need 24-hour care, at least not right away. Someone with a chronic condition like heart disease, for instance, might only need help with specific tasks, like meal preparation or bathing.

To find an in-home aide, ask others who have used one or consult a geriatric care manager. It might cost more to employ an aide through an agency, but if any sort of problem arises, the agency will furnish a replacement quickly. That beats spending stressful days trying to find aides and conducting background checks.

Next Page: Assisted living options

Assisted living
"Assisted living is not as institutional and depressing as many nursing homes," says Joseph L. Matthews, the author of Long-Term Care: How to Plan & Pay for It. "It allows you to have your own living space, but it provides a level of monitoring that most can't afford at home."

A key benefit of an assisted-living community is that, should your loved one's health deteriorate, services are already in place to provide extra care in the same facility. He or she can start with a basic apartment and live independently, with services such as cleaning, meals, and transportation taken care of. If additional assistance is needed—with dressing, bathing, or walking, for example—that help is available. The level of medical care depends on the facility, but most can’t offer the kind of round-the-clock professional medical attention that's common in a nursing home. The average cost for assisted-living facilities in the United States is just under $3,000 per month (more than $35,000 per year), according to a 2007 market survey conducted by MetLife. In a growing number of states, at least some assisted-living services are covered under Medicaid, the government health-care program for low-income people, but most people pay for it themselves or through a long-term-care insurance policy.

When researching assisted-living facilities, be sure to read the fine print. "As soon as you need something more than the basics, they raise the rate considerably," cautions Wexler. Also, you can't assume the facility will automatically up the level of care when your loved one’s health situation changes, warns Matthews. You'll need to monitor the situation to make sure he or she is getting the proper treatment.

Next Page: What you need to know about nursing homes

Nursing home
A nursing home is a last resort for most people, who often end up there after a hospital stay or severe illness. For example, a heart attack might put someone into a rehab facility and leave him too ill to return home. Or a person's health might deteriorate to the point where so much care is needed at home that it's no longer financially feasible.

"If you need a lot of care, and you don't have family who can help, a nursing home is the most practical choice," says Matthews. Annual costs range from less than $50,000 to nearly $200,000 a year—a fortune, but potentially less expensive than hiring home health aides. If your loved one spends down all his or her assets, Medicaid will pay for most nursing-home care at a facility that accepts the plan. Don’t bother giving away all your parents' assets a month before moving them into a facility, however. Federal law now requires a five-year look-back period to prevent just this type of activity.

When you choose a nursing home, look for the signs of a good facility.

Don't take the staff's word for how great things are. Talk to residents and their families. The staff should willingly put you in touch with some contacts. This is one of the best ways to evaluate any facility.
Evaluate with your nose. If it doesn't smell good, follow your nose elsewhere. After visiting a few, you will be able to tell the difference.
Sample some meals. "When you become old and sick, a lot of your life revolves around meals," says Matthews, "so make sure the food is good." Meals also are an excellent opportunity to observe the nature of the interactions between the staff and residents, he says.
Find out the staff-to-resident ratio. This can be tricky to uncover, cautions Wexler. You might be told one thing by the facility's honchos, but nursing homes are chronically understaffed and there's a tendency to stretch staff-to-resident ratios beyond what's reasonable. Casually ask a low-level staffer how many nurses there are. A ratio of 1 registered nurse for every 15 residents is the national average, according to the Centers for Disease Control and Prevention’s National Nursing Home Survey, but many facilities routinely go above that.
Pay attention to detail. According to Cooper, you can tell a lot about a facility and the attentiveness of its staff by looking for small signs. Is the piano tuned? Is the air conditioner humming well? If the staff is taking care of small details, they're also taking care of big ones.
Get a recommendation from the pros. Your local Area Agency on Aging is a good resource and will know about nursing homes that accept Medicaid. Geriatric care managers are often very familiar with private nursing homes. They do a lot of due diligence on them and over the years develop a sense of what makes a good nursing home and what doesn't.
Check that the nursing home is accredited by the Joint Commission, a nonprofit organization that certifies health-care organizations and programs. Once you've narrowed your choices down, contact your local Better Business Bureau to see if the facility has drawn any complaints or government actions.
Ask to see the results of the home's latest inspection.
For a fee, companies such as CareScout can provide ratings of facilities.

Remember, even after choosing a facility, your loved one will only get the best care if you make yourself visible and stay involved.]]> Caregiving options can be costly, but it’s possible to find a solution that makes your budget—and your loved one—happy. Getty Images <![CDATA[Special-Needs Trust: How to Ensure the Care of Your Disabled Child]]>

"People with disabilities are now living long lives," says Chris Cooper, a certified financial planner in Toledo. "They're living into old age and getting old-age problems like Alzheimer’s and arthritis, so they're dependent much longer." In conjunction with government assistance, a special-needs trust can ensure that your child is set for life.

What is a special-needs trust?
A special-needs trust, also known as a supplemental trust, is a safe place to park assets for your disabled child. First of all, the trust is protected; if you are sued, go through a divorce, or have your will contested, the funds cannot be touched and there will never be an interruption in available money for your child. Second, by giving money to the trust rather than directly to your child, he or she will continue to qualify for government assistance programs. "You can give money in such a way that the state doesn't view it as an asset or a resource," Cooper says.

How does a special-needs trust interact with government programs?
Many children with special needs—a category that comprises a wide array of medical, behavioral, developmental, learning, and mental-health conditions—qualify for government assistance programs such as Medicaid, which covers most medical services and housing, and Supplemental Security Income, which provides a monthly stipend for basic living needs. These programs are administered on the state level; though eligibility requirements vary, in most states your child cannot have more than $2,000 in assets. If you or a relative bequeaths more than that to your child, it should be placed in a special-needs trust; otherwise he or she can be disqualified from government programs.

Next Page: How do I set up a special-needs trust?

How do I set up a special-needs trust?
Initiate the trust as soon as you determine that your child may not be capable of supporting himself. If your child's development improves and he is able to earn a living, great—the trust can always be dissolved and the funds returned to you or given to the child. Special-needs trusts are complicated animals, however, and rules vary from state to state. You should find a financial planner who deals specifically in this area of the law.

How do I fund the trust?
Although you can fund the trust with your estate or the proceeds of a life insurance policy, Ron Pearson, a certified financial planner in Virginia Beach, Va., who specializes in families with special-needs children, recommends that you do it throughout your lifetime. Should you die unexpectedly, the trust will already be operational and able to provide your child with money. You should also inform your extended family about the trust so that relatives don't inadvertently disqualify your child. Aunt Edna's thoughtful $10,000 inheritance should be left to the trust, not the individual.

How will my child use the trust?
The money is doled out by a trustee, either yourself or someone you designate. The funds can be used anytime, not just after your death. For instance, you might make use of government programs to provide basic expenses like medical care and housing, while using a special-needs trust for "enhanced care that improves the quality of life," says Pearson. Pearson, the father of two developmentally disabled sons who live in a group home, says he gives his sons money from their trusts that they mostly spend on country music CDs. You could also use the money for medical equipment or care that Medicaid doesn’t cover.]]> A special-needs trust can take some worry out of raising your disabled child, as it helps ensure that he or she will continue to qualify for government assistance programs. (ISTOCKPHOTO/HEALTH) <![CDATA[How to Talk About Money and Health With Your Aging Parents]]>

Talking With Your Aging Parents and a psychologist in private practice who specializes in intergenerational communication. Worse, not talking about the issues now can result in misunderstandings and heartache later. Here are some strategies for talking with your aging parents.

Talk early and often. Don’t wait until a moment of crisis to start having these conversations. Otherwise, "you're having them under the worst set of circumstances possible," says Elinor Ginzler, the coauthor of Caring for Your Aging Parents and the senior vice president of livable communities at AARP, the Washington, D.C.–based membership organization for older Americans. In fact, an AARP survey found that a majority of parents are more comfortable talking about such issues when things are going well. Aim to have multiple conversations on these topics over many years.

Tip: Be indirect. "A good way to defuse the personal element is to say, 'I have a friend who...,' 'I read an article about...,' 'I'm concerned that...,'" suggests Sanford J. Mall, a certified elder law attorney with Mall Malisow & Cooney in Farmington Hills, Mich. "Even if that initial approach is put off, at least the seed is planted."

Next Page: Don't go it alone

Don't go it alone. Involve your siblings and other relatives, Ginzler suggests. You'll need to draw on your family dynamics in order to manage the situation. For instance, designate the right person to initiate these difficult conversations. Is one of your siblings a real comedian who puts everyone at ease? Does an aunt have just the right touch to handle volatile situations? And don’t forget to talk to each other—you can avoid a lot of strife if you have outlined your own expectations and capacity, financially and emotionally, to help your parents.

Tip: One way to get the conversation going is to get all family members, including the young and healthy, to draft and sign advanced care directives, which allow another person to make health decisions in the event of incapacity. This way, you can begin a family discussion about what everyone's wishes are for their end-of-life care without singling out your aging parents. You may be able to obtain sample documents from your state bar association, or you can have an estate attorney draft one for you.

Don’t force the issue. If your parents adamantly refuse to talk about a subject, let it go and try another time. Or compromise: For instance, if they are uncomfortable laying their entire financial life in front of you, ask them only to give you a rough outline. Where are accounts held? Is there a will? Who is the executor? Is there a life insurance policy? Who is the beneficiary?

Tip: Edinberg suggests that at the very least, you should convince your parents to make a list of all their financial assets—the institutions where they're held and the account numbers—and keep it in designated spot. That way, children will know where to locate these documents if the need arises.

Be respectful. There might, of course, come a time when parents' decision-making skills become impaired. Even then, don't deprive them of self-determination, experts say. "We do not like the term 'parenting your parent,'" Ginzler says. "You will always be the adult child to your father or mother, even if that relationship changes." Find ways to address your concerns, such as your parents' safety and comfort in their present living situation, without being disrespectful. For example, don't simply declare that your parents must move out of their home. Work together to try to come up with a solution. Perhaps the answer is hiring a home health aide or making modifications to the home. "It is important to be realistically reassuring to your parent that they can have as much good functioning independence as possible," Edinberg says. ]]> Talk to your parents now: An AARP study found that most people are comfortable discussing their health and finances when they feel well. (ISTOCKPHOTO) <![CDATA[How to Give Your Doctor and Hospital a Fiscal Checkup]]>

How to check up on your doctor
Consult your state medical board. Find the website of the medical board in your state through the Federation of State Medical Boards (FSMB) directory. Go to your state’s site and look for a function called “Licensee Search,” “License Verification,” or “Physician Profiles,” etc. (the exact terminology varies by state). Enter your doctor’s name, which, depending on the state, will pull up information on his or her medical training, licensing, board certification, professional memberships, and hospital affiliations, as well as any history of state disciplinary actions. (For a $9.95 fee, you can also access a doctor’s report directly through the FSMB.) In some states, such as New York and Virginia, you’ll also be able to see whether a doctor has had any malpractice judgments or settlements against him. With a malpractice record, you should look for a pattern. "If there is one settlement, it’s something to ask your doctor about. If there are three or four judgments, stay away,” says Patty Skolnik, a Colorado resident who successfully lobbied for legislation requiring that malpractice information be made available to the public in her state. (Skolnik’s son, Michael, died in 2004 after experiencing complications from a 2001 brain surgery.)

Next Page: Quiz your surgeon

Quiz your surgeon. If you are choosing between doctors, ask how many times each has performed the particular procedure in the past year and what his infection rate is. “Doctors know their infection rates for different procedures, and they should be willing to share that with you,” says Betsy McCaughey, PhD, a health policy expert, former New York State Lieutenant Governor, and sole founder of the Committee to Reduce Infection Deaths.

Consider a ratings service. Among the most established and most comprehensive health-care ratings websites is HealthGrades, which provides profiles of all of the approximately 700,000 practicing physicians in the country, as well as approximately 5,000 hospitals. In addition to basic information such as board certifications and disciplinary actions, HealthGrades has other features that can help round out your sense of the doctor before you meet him, such as patient satisfaction ratings based on survey data and the quality ratings of the hospitals where the doctor practices. Some doctors have paid the site to include video of themselves discussing their philosophy of practice, an easy way to get a feel for a doctor before meeting him. The reports also note whether a doctor has received a quality designation from a nonprofit organization called Bridges to Excellence, which assesses how well doctors handle specific conditions, such as diabetes. “Ninety percent of the doctor information on the site is free,” says spokesperson Scott Shapiro.

The paid-doctor reports at HealthGrades, which start at $18, may offer some convenience. But you should know that much of the information, such as malpractice history and state sanctions, is also available for free elsewhere.

How to check up on your hospital
Visit your state department of health website. Some states, such as Florida and California, offer hospital “report cards.” (A partial list of states is available on the Consumer Reports website.) In most states, you’ll find data on a variety of quality measures, such as mortality rates for coronary artery bypass surgery or angioplasty. Some states, including Florida and Pennsylvania, also track hospital infection rates; hospital-acquired infections cause an estimated 103,000 deaths per year—as many as from AIDS, breast cancer, and car accidents combined, according to McCaughey.

Check out the Joint Commission. Hospital report cards can be found at the Quality Check website of The Joint Commission, a national nonprofit that accredits health-care organizations. You can review the performance of hospitals on the measures that the commission calls National Quality Improvement Goals: guidelines for surgical care and the treatment of heart attack, pneumonia, and other conditions. You can also find out whether the hospital meets accreditation standards or has received awards for quality.

Next Page: Check Medicare’s website

Check Medicare’s website. As the largest payer for health-care services in the United States, Medicare has a wealth of information online through its Hospital Compare tool. The site provides information on 26 quality measures, including how well hospitals provided care for patients with heart failure or pneumonia, for example. Recently, the site added 10 new measures of patient feedback, including how clean patients said their rooms were.

Look into a professional hospital-ratings service. Among the best of the websites for hospital ratings is the nonprofit Leapfrog Group. The site surveys hospitals to see whether they implement important safety measures such as computerized drug systems, which one study has shown to reduce errors by 86%. “Leapfrog is excellent, but it’s hard to find a Leapfrog—recommended hospital. There are not that many of them around,” says McCaughey. HealthGrades, which partners with Leapfrog for some hospital measures, provides a different perspective on hospital quality by measuring how well patients did after approximately 30 different diagnoses and procedures, ranging from coronary bypass to knee replacement surgery. According to HealthGrades research, patients treated at hospitals rated in the top 5% on its website are 27% less likely to die than those admitted to other hospitals. And patients who undergo surgery at these top-rated hospitals also have, on average, a 14% lower risk of complications during their stay. ]]> Information about your doctor's medical training, board certification, and state disciplinary actions is just a click away. Healthgrades.com <![CDATA[5 Money-Saving Questions to Ask Before Your Doctor Writes a Prescription]]>

save money on medicine even if you have good insurance. Here are five questions to ask your doctor—and yourself—to save money on prescriptions.

1. Are there any lifestyle changes I can try before starting a drug regimen?
"For many chronic medical problems, treatment should start with lifestyle changes," says Edward Jardini, MD, the author of How to Save on Prescription Drugs: 20 Cost-Saving Methods and a family physician at a private practice in Templeton, Calif., where he was formerly the chair of the Pharmacy and Therapeutics Committee and chief of family practice. One of Dr. Jardini's patients, Ernesto (not his real name) was 49 when he developed diabetes in 1999. Instead of going on drugs, Ernesto decided to try losing weight first. He dropped 10 pounds in three months, and was down to 232 pounds. Even that small weight loss stabilized his blood-sugar levels, and his diabetes has been undetectable—and he has been drug-free—ever since.

"If the patient asks [about diet and exercise], the doctor knows, 'Here's someone who's willing to do something besides swallow a pill,'” says Dr. Jardini.

Of course, though healthy eating and exercise can help many conditions, they can’t always cure every medical problem or replace a drug regimen. Plus, they can be tough to stick to or integrate with your job or other responsibilities. If you decide you want to start with lifestyle changes, set a time frame (say, three months) with your doctor to see if it’s working; if it’s not, then you may want to reconsider medication. Some conditions may require medication from the outset, which can then be reduced if lifestyle changes have enough of an effect.

Next Page: Can I try the least expensive option first?

2. Can I try the least expensive option first?
“If you're starting a new treatment, why not start with the most economic medication rather than a brand-new drug?" says Dr. Jardini. Ask your doctor, "Are there any generics or similar medicines or ones in the same class that are less expensive that I can try first?"

Generics are copies of brand-name drugs that contain identical active ingredients and work the same way in the body. They’re less expensive because the manufacturers of generic drugs, unlike brand-name makers, do not have to invest money in research, development, and marketing. And because generics are available only for drugs whose patent has run out, the competition in the marketplace among manufacturers drives the price down. For example, ninety 10-mg tablets of generic simvastatin, a drug used to lower cholesterol, sell for around $50, while the same amount of Zocor, the brand-name version, costs about $240. (These are approximate market prices, not insurance co-pays, and prices might vary on a prescription drug plan.)

Older drugs, which will usually be generic versions, are often as effective as newer ones for certain conditions but are usually a lot less expensive. For instance, one of the newest drugs to treat diabetes is Actos, which costs about $440 for a 90-day treatment of the lowest starting dose (15 mg). While it helps to stabilize blood sugar, so do all diabetes drugs, according to Dr. Jardini. Metformin, an older treatment, is only about $20 for 90 days of the lowest starting dose (500 mg), and a study in the Journal of Clinical Endocrinology showed it had almost identical blood-sugar control as Actos. Plus, Actos has actually been associated with a higher risk of heart failure, Dr. Jardini adds.

A third option is to ask your doctor if there’s a less expensive drug in the same class. Beta-blockers, for example, are used to treat hypertension. On some online drug stores, the price for a three-month supply of the lowest starting dose (5 mg) of bisoprolol fumarate is about $93, while another beta-blocker, atenolol, costs only around $12 for the lowest starting dose (25 mg).

Next Page: Will I be able to afford this long-term?

3. Will I be able to afford this long-term?
Think long-term, especially if you will be taking multiple medications. "It's really important for patients to be proactive and ask their doctor if there are cheaper alternatives," says Derjung Mimi Tarn, MD, assistant professor of family medicine at the School of Medicine at the University of California, Los Angeles. It might not occur to your doctor to bring up your pocketbook. In a 2006 study, Dr. Tarn found that physicians prescribing new medications brought up cost and acquisition issues with patients in only 33% of cases.

4. Should I take the free samples?
A recent study at the University of Chicago Medical Center found that patients who had received samples had significantly higher prescription costs than patients who didn't. That's because samples will always be the newest and most expensive brand-name drugs, and after the free samples run out, you are more likely to continue buying that brand. You may be better off getting a prescription for a cheaper generic, if possible.

5. Can I talk to my pharmacist to figure out the least expensive option?
If you already have a prescription, it’s not too late to consult your pharmacist. "When patients are prescribed an expensive medicine or one with a high co-pay, a pharmacist can tell them what they can substitute," says Vibhuti Arya, spokesperson for the American Pharmacists Association. Arya recommends asking your pharmacist about generic options every couple of months, to check if the patent of an expensive brand-name drug has expired, opening the way for a generic version. Of course, you'll need to discuss any alternative medications with your doctor.]]> Opting for generic drugs instead of brand name prescriptions can save you hundreds of dollars each year. (ISTOCKPHOTO/HEALTH) <![CDATA[Health-Care Cost Expert Kathryn Votava on Buying Long-Term-Care Insurance]]>

family and friends to provide care for them when they can no longer do it themselves. But at some point, the care required can be too much for these informal networks to handle. That's where long-term-care insurance comes in. Caregiving expenses are usually not covered by health insurance, and they can be staggering—a semi-private room in a nursing home, for instance, can run about $70,000 a year, and in-home care can reach as high as $350,000 for round-the-clock help. We asked Kathryn Votava, PhD, assistant professor of clinical nursing at the University of Rochester in New York and president of Goodcare.com, a company that analyzes health-care costs, for advice on how to shop for the best long-term insurance policy.

Q: What does long-term-care insurance cover?

A: Depending on what kind of policy you choose, it will pay for a nursing home, assisted-living facility, community programs, or for someone to come to your home to care for you. It can offset some of the costs—notice I said some. Most people think that if they have a long-term-care insurance policy, they're covered completely. Not only is the average policy not enough to cover the cost of this type of care, but people don't take health-care inflation into account. And you will still need to pay for your Medicare Part B, Medigap plan, prescription drugs, and doctor visits just as before. Those expenses don't go away and long-term-care insurance doesn't cover them.

Q: How much coverage should I get?

A: The average policy covers $149 a day. Now, if you live in some parts of Texas or Louisiana, that might cover your long-term-care needs. But in a place like New York City, the average is more than twice that. Get an understanding of what the costs are in your area. The two big surveys of nursing-home prices are from Genworth Financial and MetLife Financial. That will give you a ballpark figure, but even those underestimate how much it actually costs. I'd call a good nursing home or home health-care agency that you might like to use eventually. Find out what the daily cost might be, for example $300 a day, and buy the coverage that's closest to that daily cost. When it comes to 24-hour care at home, you will find that a long-term-care insurance benefit will not come close to covering that level of cost, because extensive in-home care is costly. Remember that once you have exceeded two to four hours a day, seven days per week of in-home care, you will probably be paying more for long-term-care than if you were in a nursing home. Therefore, if you need more than two to four hours per day of in-home care, your long-term insurance benefit may provide more long-term-care if you are in a nursing home.

Next Page: How long should my coverage last?

Q: How long should my coverage last?

A: You can purchase a policy that pays a set dollar amount per day for either some period of time or as a continuous lifetime benefit. I advise people that the most economical choice is to purchase a plan that provides benefits for five years. Only about 20% of people stay in a nursing home for five years or more. That's the minimum coverage you should have. If you have more money to spend, then certainly buy coverage for a longer time period or a bigger benefit so that if you're certain that you want in-home care, you will have more money to pay for it. Take the money you'll save on the shorter coverage period and buy a shorter waiting period, benefit for home care (as many policies pay out only 50 cents on the dollar for long-term-care at home), and compound-inflation protection riders. Don't give up coverage on the front end for something you are much less likely to collect on the back end. Once you have the minimum coverage, if you have more money to spend, then you can buy coverage for a longer time period.

Q: What additional features are worth paying for?

A: Get a compounded inflation rider. A "simple" inflation rider does not keep up with inflation nearly as well. One basic problem is that health-care inflation runs at 8.1% a year; the maximum inflation protection you can usually get in a long-term-care insurance policy is 5%—that’s the best you can do. While that 5% rate will not keep up entirely with health-care inflation, it will give you a better chance of being able to afford your long-term-care when the policy pays out. I also like to see people have a 30-day waiting period or less—that’s the amount of time from when the insurance company determines that a person is eligible to use their long-term-care benefit to when the company begins to actually pay out for the benefit. All policies have some waiting period. People often get a 90-day or a 100-day waiting period because it lowers their premium, but you could end up paying thousands of dollars during the time you're waiting for coverage to start. Finally, I recommend a nonforfeiture-of-benefit rider. Typically, you're only eligible for the insurance benefits as long as you pay your premium. But the nonforfeiture rider lets you maintain some value in a policy even if you decide not to continue paying for it. That could be very important if the insurance company you're with decides to go out of this business and sells your policy to someone else who jacks up your premium so much you can't afford it anymore. The non-forfeiture rider means you will get some amount of the policy benefit—not all, but some—depending what you paid in over time. One last thing: Make sure the insurance company you choose has a solid track record. Call the National Association of Insurance Commissioners at (866)-470-6246 and get the phone number for your state health-insurance department. Then contact your state insurance department to find out if there are any reported problems with an insurance company you are considering.

Next Page: When should you buy the insurance?

Q: When should you buy the insurance?

A: At the latest, I'd say late 40s or early 50s. It's still affordable then. The premium is based on your heath status first, then your age. Generally speaking, the earlier you purchase a policy, the healthier you are and the more likely you are to qualify for insurance. People who have serious, chronic conditions may find their rates to be really high or they may even be uninsurable. The costs vary greatly from policy to policy, state to state, and person to person. Usually someone in his or her late 40s or early 50s will pay about $3,000 to $6,000 a year. That's for a very good policy. Someone in his 60s could pay several thousand dollars a year more for the same policy.

Q: When does the coverage start?

A: In order for the policy to kick in, you must have a certain level of need. Most providers define that as not being able to perform at least two of what are called "activities of daily living," in insurance-speak. Those are: bathing, eating, dressing, toileting, and transferring from bed to chair. So, you might have a hard time giving yourself a bath, and it might take you all day to do and then you're completely exhausted, but to the insurance company you're not compromised enough to use the insurance for that. The exception to that rule is folks with dementia. They may be able to perform those tasks, but they need supervision, so the insurance company will often pay out for their care.

Q: Can you run into problems collecting your insurance?

A: It's gotten better. Some of the companies that were the most difficult to deal with were on shaky financial ground, and they've gone out of business. Remember, the person who comes to do the assessment of whether you're able to perform the activities of daily living works for the insurance company, not for you. They'll be looking at your case through that lens. If you run into trouble getting them to pay benefits, you might want to enlist an advocate, like a geriatric care manager, if more than a simple follow-up phone call is necessary.

]]> "The earlier you purchase a policy, the healthier you are and the more likely you are to qualify for insurance." (KATHRYN VOTAVA) <![CDATA[How to Get Your Insurance Company to Pay for a Denied Claim]]>

If you can’t get your claim covered by talking with your insurance company over the phone, don’t assume that the first "no" you receive is final. You have a legal right to appeal the company’s decision, and there are resources available to help you. You need to help yourself too, however. "With many major health plans, it is routine to deny coverage on the first submission, so if patients are not willing to move through an appeals process, they will end up paying," says Nancy Davenport-Ennis, the cofounder and CEO of the Patient Advocate Foundation, a nonprofit organization that advocates on behalf of patients whose health-insurance claims have been denied.

Next Page: Preparing an appeal

If you do decide to appeal a denied claim, take action immediately. Your insurer may place time limits—often 30 or 40 days after the denial—on starting the appeals process. You should begin by asking, via certified mail, for a written denial from the company, which will explain the reasons for the denial in detail and help you craft a rebuttal.

Preparing an appeal
The next step is to outline your argument for why your claim should be honored. First, read your policy carefully to determine exactly which treatments are covered and which are not. It is not uncommon for insurance companies to deny coverage for a treatment that is explicitly included under the policy.

"Insurance companies frequently make errors," says Davenport-Ennis. "We did an audit in 2005 of all the cases we had worked on and found that 96% of the claims denied by the plan representative were fully covered benefits. In one case, a woman brought in a box of bills that she had paid when her husband was very, very ill, before he passed away. We audited them and found she had overpaid her hospital by $70,000. The patient was ultimately reimbursed."

During this stage you should enlist your doctor, who may be able to help you write a letter of appeal. Some denied claims, in fact, can be resolved by changing the way they are billed. If your insurer denied a portion of the payment for a colonoscopy, for instance, consult the language in your policy as well as your doctor’s staff. Colonoscopies may be fully covered by your plan if they are part of a checkup, but only partially covered if they are used for diagnostic purposes. Your doctor’s billing department may be able to change the bill and resubmit it.

Next Page: Finding Other Help

Finding Other Help
If your doctor can’t help you resolve a denied claim, there are other resources that can be tapped for assistance. If you receive health insurance from your employer, contact the human resources department and explain your predicament; some companies have a case manager who can help you make your appeal.

The government offers some assistance as well. The insurance departments in many states fund independent ombudsman offices or offer administrative help for citizens who are dealing with difficult claims. At the federal level, the U.S. Department of Labor’s Employee Benefits Security Administration has a staff of benefit advisors who can help you understand or obtain your benefits.

Nonprofit organizations are yet another option. In 1996, Davenport-Ennis started the Patient Advocate Foundation after she and her husband raised more than $200,000 to pay the medical bills of a close friend with breast cancer whose insurance company refused to fully cover her expensive course of treatment. (The friend ultimately lost her life to the disease.) Since then, the foundation has helped more than 21 million chronically ill people wrestle with their insurance companies or, if they are uninsured, search for free or affordable treatment programs. "We serve as an active liaison between the patient and his or her insurer, employer, and/or creditors," says Davenport-Ennis. Cancer patients (who were originally the focus of the organization) make up about 60% of its clientele, but the foundation now offers its services to those struggling with any long-term medical condition, including stroke and arthritis. "They are very, very good at calling insurance companies and negotiating," says Otis Brawley, MD, chief medical officer of the American Cancer Society.

Navigating the appeals process
One of the most valuable aspects of these potential advocates is that they can help you translate your argument into the language spoken by insurance companies. The emotion and stress that patients with serious illnesses (and their families) experience when faced with a denied claim is often counterproductive when channeled into an appeal.

Shauna Hatfield, a case manager at the Patient Advocate Foundation, tells the story of a North Carolina man who was mid-surgery, having half his cancerous liver removed, when his health insurer called the operating room and declared that it would not preauthorize the surgery. The surgeon was so furious—"Tell them I’m not putting the cancerous tissue back into the patient!" he sputtered—that he put together a 120-plus-page appeal letter on the man’s behalf. Two weeks later, the insurance company issued a verdict: Denied. "The patient submitted a very, very emotional letter—'Oh, my God, I’m dying and I don’t have money to pay for this,'" says Hatfield. "We were unemotional. We looked at it as a contract issue only. We wrote a concise 29-page appeal arguing that the treatment was standard procedure for the condition." The claim was paid.

Next Page: Stay organized

When appealing a denied claim, it is important to remain as calm, cool, and collected as you possibly can. As you navigate the appeals process, these tips will help you stay focused and maximize your chances of success:

Stay organized. Keep every scrap of paper that relates to your case and have everything at your fingertips whenever you contact the insurance company. "That way you can say, line by line, 'This is what happened, this is the date, this is what I had done, this is what I was told,'" says Karie Waddell Gallo, a senior account manager at Saxon Financial Consulting of Cincinnati, Ohio, which specializes in health-insurance claims. By the same token, keep detailed notes during the conversation and write down the date and outcome of each phone call, so that you have a record you can refer back to. Knowing your policy inside and out will help you present your case well, which will force the insurer to take you seriously. If you’re not sure of your facts or dates surrounding your procedures and have to scrounge around for your records, you could end up wasting a call.
Collect names and numbers. Each time you call an insurance company representative, immediately ask for the person’s name and extension. Try to deal with the same agent each time, so you don’t have to repeat your whole story over and over. Ask for a reference code for your claim, so if you do have to start with a new person, he or she can access the record of prior phone conversations.
Ask for a specific timeline. The review process for an insurance claim usually takes three to four business days. If it’s a major claim (more than $10,000), it may go through an additional review process with an underwriter, which can take up to 30 days, according to Gallo. Follow up with the same agent at the end of the allotted time.
Go up the food chain. If you don’t get the result you want from the person who answers your call, don’t stop there. Ask to speak to someone higher up, whether it’s a supervisor or underwriter or the president of the company. And be persistent. "Most people only talk to the agents who sell and service the policy. Above them are the underwriters who make decisions on risk. And then there are the medical directors, the MDs who make assessments of individuals and groups," says Stewart Perry, chairman of the board of the American Diabetes Association.

Don’t give up
Even in the face of repeated denials, determination tends to produce the best results. "In my experience, if people are asking for reasonable treatments for evidence-based medicine, the insurance company is very likely to pay if people persevere," says Dr. Brawley. "Often, if the insurance company says no, it’s either because they didn’t understand the situation or the insurance company thought the treatment was unproven."
Perry cites the case of an Ohio woman who went to battle with her insurance company when it refused to cover diabetes testing supplies for her daughter. She took her case all the way to the president of the company—who, as it turned out, also had a daughter with diabetes. "He said, 'What do you mean we don’t cover that?'" Perry recalls. In the end, the woman’s claim was covered. ]]> Insurance companies make errors, so know the ins and outs of your policy. (ISTOCKPHOTO) <![CDATA[10 Ways to Save Money on Health Costs During the Recession]]>

Although there is some evidence that recessions can actually improve certain health trends (e.g., people may indulge in unhealthy behaviors less often when they have less money), it is surely true that health-related money anxiety will rise.

But there are ways to prevent and lessen health-money woes. Here are 10 to start with, along with links to more detailed explanations of how to make these changes.

1. Make a prevention resolution. If you’re overweight (millions of Americans are prediabetic and don’t know it), get your weight down to reduce your risk of diabetes. It will also help with hypertension and other problems that can cost you big. Prevention isn’t a cure-all, but it’s a good bet if you want to avoid situations that can lead to major health bills.

2. Stick to your meds. If you’re on regular medication—a statin for high cholesterol, or aspirin to prevent a heart attack, for example—take your medicine. Failure to comply (including skipping doses to save money) is a common behavior, but it can reduce drug efficacy. If you lose your insurance coverage, you may be able to find a cheaper version of the drug, and most drug companies have programs to help people who cannot afford their medicines. But don’t stop taking a med without consulting your doctor.

3. Go generic if you can. Always ask about costs when your doctor prescribes a medicine. Request the cheapest effective drug—an older formulation or generic may cost less and do the same good.

4. Find cheap, good sources of medication. There are safe Internet options, and stores like Wal-Mart offer significant savings. There are also money-saving strategies such as buying pills in bulk, splitting larger-dose pills into the prescribed dosage, and more.

5. Eat better, save more. Healthy eating and cheaper eating can dovetail nicely. Reduce portion sizes to healthy levels and move whole grains and vegetables to the “center” of your diet: You’ll save money and be healthier. Simpler, natural healthy foods—dry beans, inexpensive vegetables—are often cheaper than unhealthy processed foods. And less costly cuts of meat can have more flavor when cooked properly. For hundreds of easy, healthy recipes, visit Health.com’s new Recipe Center.

Next Page: You can bargain with a doctor’s office?

6. Commit to recovery. If you’re recovering from surgery and facing rehab, follow the recovery regimen diligently. Get your physical therapist to maximize your “homework” routine to save on clinic visits. But don’t put off the pain: Incomplete healing can lead to reinjury or permanent disability.

7. Know your rights. If you lose your insurance, study the COBRA rules and 62-day insurance “gap” rules to avoid a costly coverage error, particularly if you have a preexisting condition.

8. Fight claim denials. Experts say that 70% of health-insurance claim appeals are successful, and there are Web resources and people who can help.

9. Get organized. Many people are sloppy about keeping copies of prescriptions, test results, insurance claims, and the like. If you have your documents in order, it will be easier to win a disagreement with an insurance company, and it can lead to more efficient appointments with your doctor.

10. Bargain down costs. Both doctors and hospitals will actually negotiate, and sometimes adjust their bills based on patient needs, ability to pay cash, and other factors. And if you’re facing a hospital stay, there are things you can do before and after to avoid overcharges, including packing your own drugs, keeping a treatment log, and asking for an itemized statement. ]]> (ISTOCKPHOTO) <![CDATA[How to Continue to Live at Home as You Age]]>

"The people for whom it is hardest to stay in their house want to stay the most," says Elinor Ginzler, coauthor of Caring for Your Parents and the director of livable communities at AARP, the Washington, D.C.–based lobbying group for older Americans. The good news: It may very well be possible. By carefully thinking through your options before you're in poor health, your home environment can meet your needs for the rest of your life. Here are some suggestions.

Modify your house
Narrow hallways, slippery floors, steps—homes are filled with hazards for an aging person. Research suggests that making modifications and repairs can prevent about a third of home accidents. "Falls are the leading cause of death and disability among older people," says Ginzler. Increase safety with these simple, quick methods.

Remove throw rugs to prevent tripping
Install motion-sensor lighting to make nighttime trips to the bathroom less perilous
Use a no-skid spray on slippery floor surfaces like tiles and linoleum
Install grab bars in tubs and on stairs
Remove knobs on cupboards and replace them with lever handles, which are easier to grasp

Of course, you may want to make more extensive renovations to your home, such as installing ramps or redesigning kitchens and baths. Think about working with a certified aging-in-place specialist (CAPS), a builder who has been trained by the National Association of Homebuilders to assess the improvements you may need.

Enlist your family
Make sure your family knows you wish to remain in your home as long as possible. You can do that in an advanced care directive, which lays out the type of care you want toward the end of your life. Better to have forthright discussions up front so that you can discuss how your desire to stay at home can be achieved. Adult children may not realize that parents can be safe at home if the right modifications are made.

Consider long-term-care insurance
Paying someone to care for you in your home can be enormously pricey. At an average of $19 an hour, the services of a home health aide can add up to more than $3,000 a month for 9-to-5 care, Monday through Friday. Medicare, the government insurance program for the elderly, and private health insurance usually don't cover long-term care. To get this kind of help in your home, you must either pay for it out-of-pocket or use long-term-care insurance. Policies differ, but long-term-care coverage often kicks in if you are unable to perform at least two activities of daily living—like bathing, dressing, going to the toilet, or feeding yourself—for 90 days. It tends to be most affordable when purchased in middle age, long before most people develop health-related disabilities.

meet your needs for the rest of your life. Here are some suggestions.

"It's really a product that works best for people who think it through early," says Ginzler. "It's rarely appropriate for someone in his 70s, and less appropriate for people who have acute, chronic conditions."

Find the money in your house
If you own your home, a reverse mortgage lets you convert the equity in your home into cash. "Quite often the house is the largest asset people have and it can be a good source of money," says Katana Abbott, a certified financial planner in Commerce, Mich., and the founder of Designated Daughter, a support network for caregivers. Those funds can then be used to hire a home help aide or make renovations.

The more equity you have in your home, the more cash you can borrow. "A reverse mortgage is a good way to pay off what remains of your first or second mortgage, and free up cash to pay for medical expenses," says Barbara L. Steinberg, a certified financial planner and registered financial gerontologist in Lincoln Park, N.J. The loan only comes due if you sell your home, move out, or pass away. In the last case, your heirs can either sell the home or pay off the loan balance themselves—if you owe more than the home is worth, the lender takes the loss.

You must be over the age of 62 to qualify for most reverse mortgages. In general, the older you are and the more your home is worth, the more equity you can access. (The AARP has an easy-to-use reverse mortgage calculator on its website.) For reverse mortgages insured by the Federal Housing Administration, you may borrow up to $362,790 (depending where you live), as long as your home is appraised for more than that amount. You can receive the money in several ways: a lump sum payment, a line of credit, monthly payments, or some combination of all three. Closing costs are subtracted from your remaining equity, so there are few out-of-pocket expenses.

There are a few drawbacks: Fees on a reverse mortgage are higher than on a regular mortgage, so it makes most sense if you intend to stay in your home for several more years. You also will not be able to leave the house unencumbered by debt to your children, which can be a factor if they have an emotional attachment to it.]]> Taking equity from your home can help older people stay solvent. (123RF) <![CDATA[How to Be a Caregiver and Not Go Broke Yourself]]>

survey, 38% of those caregivers reported some financial hardship as a result. Whether you are still eyeing the corner office or you’re thinking about reducing your hours to spend more time helping a family member, here are some of the issues you’ll want to consider.

What to watch out for:

Stalled career development. Your ability to nurture your own career can be imperiled by your caregiving duties. Difficulty focusing, the constant intrusion of family emergencies, emotional exhaustion, and, if you have cut back on office hours, less work capacity and face time with colleagues can all translate into fewer career advancement opportunities—and, ultimately, less financial security. "Your confidence and ability to develop your career is much different than someone who isn't a caregiver," says Katana Abbott, founder of DesignatedDaughter.com, a website dealing with caregiving issues for women.

Obviously you want to help your loved one, but there are limits. "If you're putting your own career at risk, remember that the person you're caring for probably doesn't want you to do that," says financial planner Bonnie A. Hughes of the Enrichment Group, a wealth management firm in Miami, Fla.

Next Page: Jeopardized retirement savings

Jeopardized retirement savings. If you're contemplating going part-time or even stopping work altogether in order to care for someone, think about your own retirement security first. Consider the situation of a 61-year-old retiree from San Francisco: When his mother, now 94, had a stroke three years ago, he quit his truck-driving job and took an early retirement package. He estimates that his pension is about 30% less than it would have been had he worked till age 65. "If I'd stuck it out the next three or four years, the higher pension plus getting a salary all that time, I'd be in much better shape financially," he says. "I sometimes wonder if I made the right decision."

At a minimum, try to work long enough at your job to become fully vested in your company pension or retirement plan. That way, you can take all your employer's contributions with you. Even after you leave work, continue contributing to an individual retirement account (IRA) on your own to make up for the lack of a workplace plan and diminished social security credits.

If you can’t stick around until you’re fully vested, think about cutting back on hours until you are, instead of giving up your job entirely. Part-time work may also allow you to keep some benefits, like health insurance. "Caregiving is so stressful, you want to make sure that you have your own health care covered in case something happens to you," says Hughes.

Next Page: Where to get help

Where to get help:

The government. All too often, caregivers think they have to stretch their own resources to the breaking point. But there are some other options. For instance, your disabled child may qualify for Medicaid, the government medical insurance program for low-income individuals and families, and Supplemental Security Income, which pays a monthly stipend once he or she reaches 18. "The child of Bill and Melinda Gates can still qualify for Medicaid because eligibility is based on the child's income once the child reaches 18," says Ron Pearson, principal of Beach Financial Advisory Service, a financial planning firm in Virginia Beach, Va., that specializes in families with special needs. Go to BenefitsCheckUp, a website hosted by the National Council on Aging, to find out about government programs that your loved one might be eligible for.

Long-term care insurance. Preferably way before your parents or other elderly relatives need care, talk to them about long-term care insurance, which can pay for home health aides, assisted-living facilities, or nursing homes. The earlier you purchase it, the less it costs and the more likely you are to qualify. If there's money for care, you can greatly reduce the amount of time you'll need to spend on it yourself. Abbott, for example, convinced her mother to purchase a plan 15 years ago when she was 58. Now her mother is in an assisted-living facility. The policy, which pays $3,000 a month, partially covers the cost. "She'll never have to spend down her assets," she says. "It gave us choices we never thought we had."

Your family. If your parents are older than 62 and own their home, they may be able to take out a reverse mortgage to tap the equity in their home. Or they might be eligible for something as simple as a Meals on Wheels program or participation in an adult day-care center. Contact your Area Agency on the Aging to learn about programs available for older adults where you live.

Have open, frank discussions about how you'll care for family members should the need arise, but do so while those family members are still healthy; it allows them to be part of the conversation. Ask lots of questions. If one sibling is willing to provide direct care to an ailing parent, can another pitch in financially? It might be a difficult conversation, but it will prepare everyone for what might lie ahead. "This lets a person see what they need to do and helps them get organized," explains Abbott. "This will prepare you for when you get that call in the middle of the night." ]]> Investing in long-term care insurance—which can pay for home aides or assisted living—can pay off in a big way later on. (ISTOCKPHOTO) <![CDATA[3 Legal Documents Caregivers Need]]>

caregiver, you want to make sure that the person you're caring for is as comfortable and healthy as possible. But that may not be possible if you don't have a few key legal papers. In a worst-case scenario, you might be forced to fight for guardianship in court, a time-consuming and costly process that you can avoid by preparing these simple documents.

1. Power of attorney
A power of attorney is a document by which people designate an agent to act on their behalf in financial or legal matters. "This deals with the business side of life, not the medical side," says Sanford J. Mall, a nationally certified elder-law attorney with Mall Malisow & Cooney, in Farmington Hills, Mich. "And it has nothing to do with how much money you have.”

Anyone with assets can benefit from a power of attorney, says Mall. It is usually a good idea for elderly or sick patients to designate a caregiver as an agent so that the caregiver can sign checks and conduct other banking transactions in support of care.

Some powers of attorney are in effect for a limited period of time and can terminate if the person who authorized an agent becomes incapacitated. If you intend to have a power of attorney in order to make financial decisions for someone who has impaired cognitive abilities and for whom you are providing care, make sure the person drafts what’s known as a durable power of attorney. This allows you to remain the agent even if the person is incapacitated.

2. Health-care proxy
Also known as a medical power of attorney, a health-care proxy enables you to make health-care decisions for someone else. Since there's no telling when an accident can strike, Mall advises everyone to have a health-care proxy, regardless of age. For example, Mall's daughter was in a serious car accident the day after her 18th birthday. When Mall and his wife arrived at the hospital, the staff refused to talk to them about their daughter's condition. "The birthday present for every 18-year-old should be a medical power of attorney," Mall says.

3. HIPAA authorization
The Health Information Portability and Accountability Act (HIPAA) keeps your health information and records private. So unless you authorize in writing someone else to receive that information, your doctors aren't obligated to share any details about your health. "In some states, a health-care proxy does not go into effect unless the patient is deemed incompetent or incapable of expressing his own wishes," says Timothy Wyman, a financial planner and lawyer with the Center for Financial Planning, in Southfield, Mich. "But there are instances where a person might want to have someone else talk to their doctor for them." Remember to give copies of the HIPAA authorization to health-care providers, and make sure you have several more on hand in case you must furnish them.

]]> Gathering documents now will make the caregiving process easier if unexpected events occur. (GETTY IMAGES) <![CDATA[Why Are Americans Being Forced to Buy Health Insurance?]]>

Others sound less favorable. Uninsured people will have to buy health insurance—a policy known as the "individual mandate"—or pay a fine. Some of those people will qualify for Medicaid (which will be expanded under the new law), and some may choose to buy into their employers’ health-care plans. Most, however, will have to select a private insurance plan through new, state-run insurance marketplaces (or "exchanges").

The individual mandate won’t go into effect until 2014, but it has already generated controversy. More than a dozen state attorneys general have challenged it as unconstitutional and an encroachment on state sovereignty, and some people have suggested that the fines—which are as low as $95 in the first year—won’t persuade people to buy an insurance plan that may be far more expensive.

What will the individual mandate mean for you? Will it actually work?

To find out, we asked Michael Doonan, PhD, an assistant professor at the Heller School for Social Policy and Management at Brandeis University, in Waltham, Mass. The buy-insurance-or-pay policy is closely modeled on the one that took effect in Massachusetts in 2006 as part of the state’s health-care reform. Doonan has studied the individual mandate in his home state extensively, and has suggested that the experience in Massachusetts holds many lessons for the national version.

Q. Why is the requirement to purchase insurance an important feature of health reform?

A: Ending preexisting-condition exclusions and requiring health insurance companies to provide insurance to all takers would be difficult without the mandate. If people knew they could get coverage for an illness at anytime, they might just wait until they were sick to sign up. Having a significant number of people paying premiums only when they’re sick would cause health-care premiums to spike and would be a disaster for the American health-care system.

The mandate will lead to more healthy people being covered, and adding these people to the health insurance "risk pool" will theoretically lower the per-person cost of insurance. Who’s buying individual health insurance polices right now? People who think they’re going to need health insurance. Therefore, costs are really, really high. And so if you say, "Alright, healthy people, you need to jump into that pool," then those costs are going to be lowered.

Former Massachusetts governor Mitt Romney made the argument [for a mandate] based on the concept of individual responsibility. For example, if someone is uninsured but gets into a car accident, they still receive care. And if they can’t pay, the costs are passed along in higher premiums to everyone who is covered.

Next Page: What will prevent employers from dropping health coverage for their employees?

Q: When the state insurance exchanges are up and running, what will prevent employers from dropping health coverage for their employees?

A: In Massachusetts there is no employer requirement to have insurance, so employers can drop insurance. But guess what? They haven’t. In fact, when employers in the rest of the country were dropping insurance, there was a slight uptick in the number of employers in Massachusetts that offered insurance. Why? If you have an individual mandate, health insurance becomes very important to your employees, so it’s a great benefit to have.

In the federal law, companies with 50 or more employees who don’t provide insurance are going to have to pay a penalty—as high as $2,000 per employee—if some of their employees go into the new health exchanges and get government subsidies. But the first 30 employees are exempt from that.

There’s no mandate for employers with 50 employees or fewer to cover anyone, and there’s no penalty if they don’t. In fact, tax breaks will help some small employers pay for the cost of providing health insurance to their employees.

Q: What is the minimum amount of health coverage that’s required to meet the mandate? What’s to prevent people from buying cheap, bare-bones plans?

A: Massachusetts requires fairly generous benefits. This includes things that you would want covered, like hospital services, physician visits, testing, and prescription drug coverage.

Federal legislation will require an essential health benefits package that provides a comprehensive set of services. Bare-bones, high-deductible plans will be discouraged. Catastrophic plans may be available for people under 30 years old who are exempt from the mandate because of income or hardship.

Existing individual and group plans are exempt from new benefit requirements but will be required to adopt other features of the law, such as coverage for dependents and prohibitions against excluding preexisting conditions.

Q: How will the insurance mandate be enforced?

A: In Massachusetts, the individual mandate is enforced through the tax code. Your health insurer provides something in the mail similar to your W-2 that shows you have insurance, and you attach that to your tax return. Nationally, it’s going to be imposed through the tax code as well.

Next Page: Are some people likely to pay the penalty rather than purchase insurance?

Q: Are some people likely to pay the penalty rather than purchase insurance?

A: In the first year that people in Massachusetts were required to have health insurance, 118,000 people—just under 3% of tax filers—did not obtain health coverage even though it was considered affordable for them. After exemptions for people without tax liability [who couldn’t afford insurance], approximately 66,000 were subject to the penalty.

The fines in Massachusetts—just over $1,000—are higher than what is being proposed at the national level. National penalties will be phased in beginning in 2014: $95 (or 1% of taxable income, whichever is greater) in 2014, $325 (or 2% of taxable income) in 2015, and $695 (or 2.5% of taxable income) in 2016. Time will tell if these numbers provide the proper incentives. The new law does include exemptions for hardship, and it will be important to see how exactly that is defined and implemented.

Q. What are some of the potential pitfalls of the insurance mandate at the federal level?

A: What we experienced in Massachusetts is that many of the people who were newly eligible for Medicaid were previously eligible [but never signed up]. These people need to think about housing and food and things like that, so they didn’t enroll, for some reason; it might have even been pride—you know, "We don’t want to go on government assistance."

Another lesson we can learn from Massachusetts is that there will need to be a big outreach campaign. In Massachusetts, they used the Red Sox in ads on TV, because the uninsured are disproportionately younger males. Another thing that really worked well here were small grants to consumer advocacy organizations to do grassroots outreach.

Q. For Americans who are uninsured or unhappy with their current health insurance, is health reform a net positive or negative?

A: Right now, if you’re in the individual market, you’re paying the highest rates of anyone. The insurance mandate is going to require healthy people to buy health insurance, so in the individual market, it’s going to be a lot cheaper.

It’s a net positive, but people are going to have to wait, since many of the protections and many of the subsidies don’t kick in until 2014.

]]> Istockphoto <![CDATA[What Really Buys You Happiness]]>

Nobody is splurging in these tight economic times. But a new study reveals that if you are going to part with your hard-earned dough, spending it on a day at the beach or a night out with friends rather than a new handbag is much better for your health.

The research, presented at the annual meeting of the Society for Personality and Social Psychology, shows that the handbag is likely to lose its appeal much more quickly than the happy memories of get-togethers.]]> Istockphoto <![CDATA[Money-Saving Ideas that Risk Your Health]]>

Avoiding the doctor because of the co-pay and lab costs. That’s being penny wise and pound foolish: A serious illness is sure to cost more than preventive care.

Using home-gym equipment that hasn’t been professionally set up. Even if you get the equipment for nothing, have someone check that it’s safe and sturdy, or you could pay in injuries or accidents.

Buying cheap processed food high in calories and cholesterol. Yes, the burger and fries are cheaper than the sushi or salad, but it’s gonna cost you in artery-clogging fat somewhere down the line.

Wearing disposable contacts longer than their useful life. You may save a few bucks but end up with an eye infection.

Starting a new workout routine without a doctor’s OK. A co-pay for a regular doc visit is a lot cheaper than a visit to the emergency room.]]> <![CDATA[Slash Monthly Bills and Surf the Web for Less]]>

From Health magazine

Q: I travel a lot, and I constantly pay exorbitant fees for Internet service at hotels. How can I stay connected for less on the road?

A: Your best bet is to buy an Air Card—a wireless modem you pop into your laptop that gives you unlimited Internet access. Available from wireless-service providers like AT&T, Verizon, T-Mobile, and Sprint, an Air Card typically costs $30 to $100, depending on the type you need. There’s also a monthly service fee of about $60, but if you’re gone for more than four days a month, it’s well worth it—some hotels charge as much as $15 a day, plus per-minute fees.

Check out www.cheapaircards.com for deals. You also can ask your hotel who their wireless-service provider is and then go directly to that company to buy a “day pass” that costs less than what the hotel charges. For example, my husband recently stayed at a Hyatt Regency in downtown Houston that charged $10 a day for Internet access from T-Mobile. He called T-Mobile and was able to purchase a day pass for just $4.99.

Q: I’ve heard of friends bargaining down bills with their cable, phone, and utilities. How can I do the same?

A: With more people slashing their spending, companies are more willing than ever to offer incentives to keep customers. Simply call your service provider, explain that you’ve been a loyal customer for a set period of time, and state that you’d like to get a better monthly rate or take advantage of any special promotions that are available.

If that doesn’t yield a good deal, call back and speak to a representative who handles new sign-ups. This time, tell the rep that you’re considering switching to a less-expensive package or provider, but before doing so you’d like to know if you can get any of the same deals being offered to new clients. (Cable companies, for instance, routinely offer nice sweeteners—like one month of free service, cash-back rewards, rebates, or goodies like prepaid phone cards—to new customers.)

Another bargaining chip: Consider getting multiple services from one company. For example, many phone companies offer local and long-distance phone service, plus Internet access and cable- or satellite-television service for less than $100 a month. That’s far less than what you’d pay for each service separately.

]]> Istockphoto <![CDATA[Tips for Caregivers: How to Cut Insurance Costs]]>

caregiving generation are likely to be overinsured, or paying for services we no longer need, or not receiving credits we're due.

Why is this so? Well, think about it—when was the last time you had time to pour over your policies and call for competing quotes?

Still, in this economy it's worth doing a little homework, as this is one area where the average household could reap several hundred dollars in monthly savings. (And don't forget—anyone in the family on long-term disability may be eligible for government-subsidized health insurance such as Medicare or Medicaid.) To save you time—since we all know that's the most valuable commodity of all—we've culled the experts' best tips for lowering insurance costs.

1. Car insurance
This is absolutely the place to start, since for many of us, auto insurance is the policy we've held longest and paid the least attention to. And you might be surprised—there's surprising variation in auto insurance costs for the same car and driver.

Get every possible discount: If a traffic violation raised your rates a few years back, ask if it's time to get your good driver discount back. Ditto if your car has antilock brakes, an anti-theft device, etc. If you've moved to a new neighborhood or changed professions, don't forget to mention that, too. Insurance is calculated according to strange, mysterious formulas, and you never know what might cause your rates to drop. And if you've stopped working or lost a job—well, you're probably driving fewer miles, and that definitely lowers your rates!

Raise your deductible: If your car's no longer brand new and you're not worrying about every ding, you can save big time this way. Investigate policies offered by professional organizations; membership in an alumni organization or business group often results in an automatic 10% or 20% discount with group coverage.

Check rates with competing insurers: Make sure to check with any other companies you have policies with (homeowner's, health, etc.). Combining several policies with one company can result in substantial savings.

Next Page: Homeowner's and health insurance

2. Homeowner's insurance
Another source of hidden costs. Raise that deductible high. Think of it this way; homeowner's insurance is essentially catastrophe protection. Unless you plan to use your policy to claim small repairs—not a good idea anyhow, since doing so can result in rate increases and even being dropped altogether—then paying higher fees for a low deductible does you little good. So given the low statistical likelihood that your house will burn down or blow away, consider setting aside some savings in case of natural disaster, and then reap the savings now.

3. Health insurance
Sorry, not the place to skimp. One Harvard study found that half of all bankruptcies were due to unforeseen medical expenses, and this is one type of insurance we're all going to need at some point or another. Still, experts say, lots of people are eligible for lower-cost policies they simply don't know about. Here's what to look for:

Employer-sponsored insurance: If your employer offers one, go for it, even if the company only covers a small amount of the costs. The group plans offered by employers are almost always the best bets. If you're not a full-time employee, don't hesitate to ask about the possibility of joining the company policy anyhow. Some companies (especially those with socially responsible employers) will find a way to get you on the policy, even if you have to assume the bulk of the costs yourself or even take a pay cut to make the numbers balance out.

Group plans: These are harder to find than they used to be, but you can find them if you look hard. (You may have to join a group in order to get their insurance.) For example, some unions, churches, and chapters of the Elks, Kiwanis, or Masons offer group health plans, as do professional networking and business groups. Because group plans have to take all members as-is, pre-existing conditions aren't exempted and the coverage is usually more comprehensive than individual plans.

The cheapest approach based on your family's total costs: This approach requires you to pull out the receipts and run some numbers. While a plan with lower monthly fees might sound cheaper, if family members go to the doctor often or need brand-name medications, you can end up paying so much in copays and deductibles that you'd save money with an HMO or other plan with higher upfront costs. On the other hand, if everyone's healthy and no one has problems requiring frequent, regular appointments, a plan with a high deductible and low monthly fees could save you several thousand dollars a year.

Courtesy of Caring.com]]> TK (JO ANN SNOVER/ISTOCKPHOTO) <![CDATA[The Real Gift of Life: How Medical Donations Help]]>

Hair
Thinking of trading in your long hair for a bob? Consider donating your clipped strands to an organization that provides wigs for cancer patients and children with hair loss. Hair must be clean, completely dry, and fastened into a ponytail 8 inches long (or longer, depending on the charity). Some charities accept gray and colored hair. Here are donation requirements for Childhood Leukemia Foundation, Locks of Love, Looks Like Me, and Beautiful Lengths.

Blood
The nation’s blood supply is provided exclusively by generous people. To meet the needs of cancer patients, accident victims, premature babies, and many others, the American Red Cross requires 38,000 blood donations every day, including holidays. Want to donate? You must be 18 or older, weigh at least 110 pounds, and be free of bloodborne diseases like HIV or hepatitis. It takes about an hour, and there are no significant risks or side effects. For more information, visit GiveLife.org.

Bone marrow and stem cells
For patients with leukemia or lymphoma, the best hope for a cure is often a transplant—during which all blood-producing cells are killed and replaced with healthy bone marrow or stem cells from a donor whose blood and tissue types match their own. The National Marrow Donor Program (NMDP) Registry solicits donors and matches them to those in need. For more information and to register, visit Marrow.org.

Umbilical cord blood
The blood cells in a newborn’s discarded umbilical cord can be used in a transplant and don’t have the same tissue-matching requirements as bone marrow or stem cells. Because the match can be less perfect, cord blood is especially helpful for patients who belong to an ethnic minority, in which the number of potential matching bone marrow or stem cell donors is much smaller. If you are pregnant and wish to donate your baby’s umbilical cord blood after birth, find out how at Marrow.org.

Breast milk
Breast milk is best for all babies, but for some—especially those with severe allergies or who are in intensive care—it can mean the difference between life and death. When a baby is adopted or the mother can’t produce enough milk (she has had surgery on her breasts, for instance, or has been treated for cancer), the only recourse may be donated milk. To volunteer, visit the National Milk Bank.

Organs
Today it’s possible for living donors to provide a kidney, a segment of the liver, even the lobe of a lung or the pancreas. For more information, visit LivingOrganDonor.org. To donate organs in the case of your death, simply be sure to indicate it on your driver’s license.]]> Istockphoto <![CDATA[8 Steps to Saving Money on All of Your Medical Expenses]]>

rising costs of health care were keeping them from getting the procedures and medications they need.

Receiving quality care costs quite the pretty penny, whether you’re insured or not. And while doctors may know what’s best for your health, they may not be as concerned with your wallet. So before you swipe that credit card, make sure you’re following these money-saving rules to cut back on medical expenses.

1. Choose lifestyle changes over new medication.
Don’t feel like adding to costs by filling a new prescription? Before your doctor signs the script, ask if there are any lifestyle changes that might have the same effect.

For example, losing weight can sometimes make diabetes or cholesterol drugs unnecessary, relaxation techniques often work better than sleeping pills, and keeping your home free of dust and mold might just liberate you from allergy meds.

2. Reevaluate your vitamins.
Taking a daily multivitamin may not be worth it in the long run—if your diet covers all the recommended daily nutritional bases. (This requires a diverse mix of fruit and veggies, lean meats, legumes, and whole grains, so if you’re a picky eater, a vegetarian, or have a food allergy, you may need a daily pill.)

Don’t bother with extra supplements, such as calcium, vitamin C, or vitamin D, unless your doctor recommends them for a specific reason. And you can ditch the vitamin-infused waters and beverages: They’re usually high in calories and chemicals, and can do more harm than good.

3. Ask your doctor: Do I really need that test?
A 2006 study in the American Journal of Preventive Medicine found that 43% of patients underwent unnecessary tests at simple, routine checkups. If your doctor orders an MRI, CT scan, or other medical exam, speak up: Besides the medical concerns of unnecessary testing, like additional exposure to harmful radiation, you could be billed for these extra procedures. Ask why it’s being ordered, whether it will cost you extra money, and what will be done afterward if the results are positive (or negative). If the answer is simply "routine screening," the test may be unnecessary.

4. Get your regular meds on the cheap.
Continuously shelling out for a regular prescription (we're lookin’ at you, birth control) can be a real drag. Find out if there are cheaper options, like ordering from legitimate, safe online vendors, or thriftier pharmacies with low-price plans. You can also try money-saving strategies such as buying the generic version of the medication, buying pills in bulk, and splitting higher-dose pills.

Next Page: Don't procrastinate

5. Don’t procrastinate.
If you plan to get the Gardasil vaccine to protect yourself against cervical cancer and HPV, make sure you have time to get all three doses of the vaccine before you turn 27. Administered over an eight-month span, the vaccine has only been approved by the FDA for women up to 26 years of age, so insurance will not cover any shots needed once you’re past the cutoff (even if you start the process before your birthday). Out-of-pocket, these jabs can cost up to $200 each, not counting administration fees tacked on by your doctor’s office.

6. Feel free to bargain.
Unlike the price tag on those fabulous (and completely out of your budget) new fall boots, medical costs aren’t always set in stone. If you’re uninsured and paying out-of-pocket for hospital or doctor services, don’t be afraid to try these proven ways to negotiate medical bills. Disclosing your income may knock off a chunk of the bill, as will offering to pay with cash on the spot—you could get as much as a 20% discount. If your doc wants you to try a new medication, ask if he or she has samples for you to try first, or check the drug’s website for coupons to use at the pharmacy.

7. Take a trip.
Consider planning your next vacation around your next medical procedure. Medical tourism could save you anywhere from 40% to 85% on health-care costs, although it does have its risks. If you’re fully insured, staying at home will be your best bet. But for things that aren’t covered (such as cosmetic surgery or dental procedures), or for patients without insurance, a trip to Mexico, Costa Rica, or even Thailand or India could add up to huge savings.

Just be sure to research the doctor, facility, and country extensively beforehand to avoid insurance and malpractice issues; check out the nonprofit Joint Commission International’s list of accredited hospitals and labs.

8. Get back to basics.
The best way to keep your medical costs down? Don’t get sick. Easier said than done, we know, but if money is tight, focus on the little things within your control—exercise more, drink less alcohol, wear sunscreen, floss your teeth, and wash your hands. Covering these basics will keep you out of the doctor’s office, plain and simple. Oh, and now is a perfect time to stop smoking too: Kicking that habit alone could save you thousands of dollars a year.]]> Getty Images <![CDATA[How to Negotiate for a Healthy Lifestyle]]>

Your personal trainer

Ask about a prepayment discount. Some trainers will reduce their per-session fee if you pay for several sessions up front.

Switch to an in-house trainer at your gym. They’re typically less expensive than a private trainer.

Try group training, where several people chip in to pay the trainer’s fee; it can reduce your price to nearly half.

Cut out any cardio you do with a personal trainer. You can do that on your own without his or her supervision.

Your doctor

Ask your doctor or dentist to reduce your bill. It can’t hurt, especially if the fee has gone up from last year, says Lee Weinstein, DDS, of Scottsdale, Arizona. Simply say, “In light of the current economic situation, I’m not able to pay more than what I paid last year.”

Broach the subject of discounts or reduced fees before any work is done.

Explain your circumstances. Saying, “I really can’t afford to pay this right now. Is there any way we can work something out?” can go a long way toward lowering a proposed bill for services, Dr. Weinstein says: “It never hurts to ask. Most people never do.”

See if your doctor will accept the amount paid by your insurance as payment in full, without any extra from you.

Push for a no-interest payment plan to reduce the impact of a larger bill, if having the fee reduced appears impossible.

Work out a deal. Andrea King Collier’s dermatologist in Lansing, Michigan, has occasionally given her a 20% professional-courtesy discount on procedures not covered by her insurance as thanks for Collier having referred new patients his way.

Other concessions: Offer to pay cash, pay up-front, or visit at non-peak hours.

The hospital

Take a close look at your hospital or medical bill. If it’s significantly more than you expected, review each charge; errors are common, from transposed coding numbers to double charges. You can also compare what you’ve been billed to average amounts paid for health-care services at the Healthcare Blue Book’s free Web site (HealthcareBlueBook.com). Armed with more information, contact the hospital to request a credit.

Consider a professional insurance negotiator for claims of more than $200. INSNET LLC, for example, has a 70% success rate in negotiating bills that average $1,400 to $1,500 down by around 20%. You pay 35% of your savings (28% if you identify yourself as a Health reader) as their fee. And if they can’t save you any money, there’s no charge, company president Jack Gillis says.

The gym

Find out about any upcoming promotions. Most gyms and fitness facilities offer promotional periods when the joining fee is waived or the monthly fee is discounted. Or head to the gym’s Web site to research special offers. Curves, for example, runs frequent national promotions, such as “Join now and get 50% off and 30 days on us.”

Wait for off-peak. Spring and summer are great times to join a gym because, as attendance declines during warmer weather, managers may be more willing to negotiate the fee. If you join at the right time, you can save yourself hundreds or thousands of dollars each year.

Ask about paying-as-you-go, rather than signing a long-term contract. This will save you money if you decide to slack off or go on vacation later in the year. Or request the ability to freeze your membership during the summer, when you’re less likely to be around to use it, and resume paying in the fall. It’s all about timing.

]]> <![CDATA[What Financial Steps Should I Take Before Staying Home With My Kids?]]>

From Health magazine
Q: I just had my second child and am considering quitting my job. We should be able to get by on my husband’s salary, but what other financial considerations should I take into account?

A: Before you make a move, make sure you and your husband have saved up three to six months’ worth of your expenses so you have a cushion if your husband loses his job.

Also, buy both life- and disability-insurance policies before you quit. (Your husband, as the breadwinner, should have both, too.) The American Council of Life Insurers recommends getting policies that are 10 times your current salary; you can also calculate how much to get based on your circumstances on their website. Many people think that only working people need this coverage, but that’s a mistake. Just think: If something should happen to you, the cost of replacing all the services you provide for your kids would be enormous. You are your children’s full-time doctor, chauffeur, teacher, day-care provider, and more. In fact, if the typical American stay-at-home mom got paid, she’d earn more than $116,000 a year for her work, according to Salary.com.

One final bit of info: Keep saving for retirement. The average married woman outlives her husband by 15 years. Try to set aside as much money for retirement as you did when you were working. Invest it in an individual retirement account (IRA) in your own name; you can put up to $5,000 in one this year.

Q: After the stock market’s dismal year, I’m tempted to stop making contributions to my 401(k)—just until Wall Street settles down. Is this a good idea?

A: The short answer: No. It’s a bad idea if you’re investing for the long-term, meaning your retirement is a decade or more away. The problem with stopping your contributions is that none of us has a crystal ball to tell exactly when the stock market will recover.

And if you put off investing until the market improves, you’ll miss out on the opportunity to “buy low and sell high,” which is time-tested financial wisdom. And though it’s tempting to switch out of stocks into less-risky investments, don’t: You’ll need stocks to help you recoup your losses once the market rebounds.

Take comfort in knowing that stock returns during each decade since the Great Depression have averaged out to around 10% a year—even during those decades when the market suffered big losses. After the 1987 crash, it took just less than two years for stocks to recover. By making regular contributions to your 401(k), you can ride out the volatility on Wall Street and still have a nice nest egg for your golden years.]]> <![CDATA[Surprising New Ways to Give Back]]>

Health magazine
You’ve finished your holiday shopping, and don’t you feel good? But there’s another way to feel even better—give to charity. We’ve known for a while that people feel good when they do good, says Margaret Clark, PhD, a social psychologist and professor of psychology at Yale University: “But research now shows that giving is good for you emotionally and physically.” Here, seven simple ways to give more.

1. Surf for charity

Online shopping mall GoodShop.com lets you choose from thousands of charities and schools (or add your own), then it links you to more than 700 stores, including Apple and Target. A certain percentage of every purchase is donated to your chosen cause (Gap, for example, gives 2.8 percent; 1-800-FLOWERS gives 7 percent). Other shopping sites that let you surf and give: GivingPal.com, iGive.com, and Care2.com/shopping.

2. Give a goat (or something somebody really needs)

Imagine the difference you could make by buying a goat for a family in Malawi. For $75, you help them feed themselves, bring in income, and even fertilize their soil to increase future crop yields. For ideas, visit WorldVisionGifts.org.

3. Help grow a business

Microfinance is another way to make the most of your spending. “The power of the concept is that you treat people not as recipients of charity but as businesspeople,” says Harvard Business School’s Michael Chu, who researches business and global poverty. Your donation of $25 could help a Pakistani woman grow a clothing business or an African mother of seven expand a teak-selling enterprise. For more info, check out TrickleUp.org or Kiva.org.

4. Gift your frequent-flyer miles

The American Red Cross uses donated miles to send volunteers to critical areas, where they can provide relief to disaster victims. And Operation Hero Miles uses them to send family members to visit wounded soldiers at military hospitals.

5. Click for a good cause

Every time you do a search at GoodSearch.com, a penny is donated to your favorite cause—the American Society for the Prevention of Cruelty to Animals, for instance, or your local temple or church. Other search engines that let you click and give: SearchKindly.org and SearchAndGive.com. If instant messaging is your thing, Microsoft’s “i’m Initiative” donates to your choice of 10 popular charities each time you chat online.

6. Donate your old cell phone

The National Coalition Against Domestic Violence collects and distributes working cell phones to victims of domestic violence. And Phones for Life will turn your PDA or cell phone into a 911-capable lifeline for seniors and domestic violence victims.

7. Volunteer your vacation

Thanks to CheapTickets.com and United Way of America, when you search for tickets at Volunteer.CheapTickets.com, you can look for vacay destinations and volunteer opportunities in the same location. That means the next time you hit Disneyland, you could spend a day of your trip volunteering at a soup kitchen. Mickey would be proud.]]> Istockphoto <![CDATA[Stay Healthy for Way Less]]>

Vitamins
Worth it? Yes, if your food choices aren't cutting it.

Most experts say you don't need to take vitamins if you eat a diverse mix of fruits and veggies, lean meats, legumes, and whole grains. Problem is, if you don't eat well, are a vegetarian, have a food allergy, or are pregnant (or hope to be)—categories that include most of us—you might not be getting the nutrients you need. In that case, an inexpensive multivitamin may give you peace of mind. Look for a brand that has 100% of the daily recommended values of vitamins and minerals and has the USP seal, which means that U.S. Pharmacopeia, the organization that verifies the ingredients and quality of dietary supplements, has given it a thumbs-up. Store-brand multivitamins go for about $3 to $6 for 100 tablets, compared with about $8 to $10 for brand names. Don't spend money on additional supplements (fish oil, vitamins D and C) unless your doc has ID'd nutritional gaps. For instance, if you aren't getting enough calcium from dairy (1,000 milligrams for 19- to 50-year-olds), pop a daily Tums with calcium (150 tablets cost $5 to $6).

Pumped-up toothbrush
Lazy brusher? Enter bells and whistles.

If you regularly brush and floss, you can stop reading. For the rest of us, the novelty of a fancy brush might help with the twice-daily two minutes required for healthy pearly whites. "Power toothbrushes can be worth the cost because they can help you brush for the appropriate amount of time," says Charles Perle, DMD, of the Academy of General Dentistry. Also, electric toothbrushes with rotation-oscillation action actually work better than manual, research says. We say whatever gets you brushing is healthy.

Prescription drugs
When available, generics can save you money.

"If a generic drug is available, it's almost always smart to buy it," says Don Kemper, CEO of Healthwise, a consumer-health-information company. Generic prescription drugs are legally required to have the same active ingredients as brand-name varieties, although they must look slightly different, so they may be a different color or shape. But they definitely cost less: Pharmacies receive $32 for generic meds, compared with $111 for name-brand versions, according to the Kaiser Family Foundation; and co-pays for generics are about $11, on average, compared with $24 to $38 for name brands.

Ask your doctor about the generic type of any prescription drug you take. If she thinks it's right for you (in rare instances, there may be a reason you should stick with a brand name), have her check the "Generic OK" box on the prescription.

Fancy bathroom scale
Weighing in can help with weight control—no matter how basic the scale.

If you've ever shopped for a scale, you know there are models that seem to do everything but cook your dinner. They measure body-fat percentage, hydration numbers, body mass index, even bone mass—and, of course, your actual weight. You also know that having a scale is important: Dieters who weighed themselves regularly melted more pounds over two years than those who didn't, according to a University of Minnesota study, and people who stepped on a scale every day lost the most. But do you need the $100-plus model with all the extras? "Unless you're a competitive athlete, probably not," says Cedric Bryant, chief science officer of the American Council on Exercise (ACE).

That said, digital scales, which are a bit pricier, are easier to read than analog and are generally more accurate. Look for load-cell technology, an advanced version of the levers and springs found in older (and cheaper) models; your scale will need less calibration and be less likely to break down over time. Make sure it has the ability to zero out before you step on it, and weigh yourself a few times on a hard surface to see if it's consistent. Cheaper digital scales start around $20 and will likely be made of plastic, which is fine if the underside that contains the weight mechanism is made of metal. Beyond that, it's all about aesthetics. If the fancy glass model will get you to weigh yourself, you'll pay a little more—but it'll be worth it.

Back to "Live Healthy for Way Less"

]]> <![CDATA[Danger at Your Doctor's Office]]>

In 1999, Susan Sheridan’s husband, Pat, went in for surgery to remove a tumor in his neck. After the surgery, the neurosurgeon gave the Eagle, Idaho, couple great news: The mass was benign—a fact the neurosurgeon confirmed after looking at the pathology report two weeks later.

“Little did we know that the pathologist had been conducting ongoing stains on the tumor and had released a final pathology report 21 days after the surgery,” says Susan, now 48. “It said ‘malignant sarcoma.’” Cancer. But the Sheridans never got this critical update because it was mistakenly filed away at Pat’s doctor’s office without the physician or patient ever seeing it.

Within six months, Pat’s cancer had spread dramatically; he died of it in 2002, at the age of 45, leaving behind two school-age children. Had Pat’s malignancy been aggressively treated after that first surgery, he would likely be alive today. “There was no system in place to make sure a life-or-death document was read,” explains Susan, who discovered the error after requesting Pat’s medical records.

The mistake that cost Pat Sheridan his life took just seconds. Even if most errors don’t have such tragic consequences, the circumstances that prompt them are everywhere—and screwups happen often. In fact, 95% of physicians report having witnessed a serious medical mistake, and 56% say they’ve personally been involved in a serious preventable error, says Sanjaya Kumar, MD, author of Fatal Care: Survive in the U.S. Health System. And these mistakes kill. "To Err is Human: Building a Safer Health System," the Institute of Medicine’s 1999 seminal report that first brought to light the problem of medical mistakes, noted that up to 98,000 preventable deaths happen each year in hospitals. But deaths in other settings, including doctor’s offices, were about three times that.

Next Page: Why the doctor's office is so risky

Why the doctor's office is so risky
Simply put, “Medicine is more complicated today. It’s a lot more daunting,” says Pamela Gallin, MD, author of How to Survive Your Doctor’s Care: Get the Right Diagnosis, the Right Treatment, and the Right Experts for You. “There are so many more treatment choices, often for diseases that once couldn’t be treated. There are more moving parts.” Here, four key factors that are making a trip to the doc more dangerous than ever.

Appointments are shorter
The average doctor’s visit lasts seven minutes. Blink-and-you’ll-miss-it appointments conspire against safe care, says Dr. Gallin, who is also a clinical professor at New York Presbyterian–Columbia University Medical Center in New York City. She likens medical care today to the famous I Love Lucy episode in which Lucy can’t keep up with the chocolates coming down the candy-factory conveyor belt. “The system has sped everybody up, and everybody’s multitasking more. If I have more time to think about a patient or a diagnosis, I’m going to be more attentive,” she says. “When doctors are forced to go faster, their judgments have to be formulated more quickly.” That pressure-cooker environment makes every decision ripe for error.

There aren’t enough primary-care physicians
By 2025, we will be down 200,000 MDs. Fewer students want to go into family medicine, internal medicine, and pediatrics—the areas in need of those workhorse docs who provide the great majority of year-in, year-out care. “Family care has become one of those jobs Americans won’t do, like picking grapes,” says Phil Miller, vice president of communications at Merritt Hawkins and Associates, the country’s largest physician-recruiting firm. If you’ve tried to get a last-minute appointment (or, in many places, any appointment) you know that the MD shortage has already arrived in some parts of the country. This means you may not be able to choose your doctor so easily, which might result in your inability to pick the safest ones.

People are playing “musical doctors”
Maybe you’re a patient in a practice with several doctors who rotate in and out of your appointments; half of all physicians today are in these plus-size practices (with three or more MDs). Maybe you’ve moved around a lot. Or maybe you’re seeing a revolving door of specialists. Whatever the reason, “you rarely go to just one doctor,” Dr. Gallin says. “The system mandates that you go to an internist to check your blood, a radiologist for a mammogram, a gynecologist for your Pap smear, and a pathologist is reading your Pap smear. You’re up to four doctors and nothing is wrong with you. Four people—any one of whom can mess up.”

A critical test result may go missing or not get to the office in time for a patient to schedule a follow-up appointment, or different specialists could be prescribing drugs that cause dangerous interactions. What’s more, safety experts know that any transition in care—as happens when a patient sees different doctors in a medical group—raises the risk for experiencing a slipup.

Safety isn’t on the radar of many practices
Safety is becoming more and more of a buzzword in hospitals. But doctors in stand-alone practices are on their own to educate themselves about medical errors and put in place protections (including costly technology) that could safeguard patients. “There’s also a lack of feedback—an error can occur, like a missed diagnosis, and the [physician] who missed it may never know,” says Tejal Gandhi, MD, executive director of quality and safety at Brigham and Women’s Hospital in Boston. “The patient may be [correctly] diagnosed a year later by a different doctor,” but this means the stand-alone doctor may not even grasp the size of the problem in her own practice.

Next Page: What goes wrong

Misdiagnosis
Misdiagnoses—and missed diagnoses—are perhaps the most-feared of all the kinds of doctor errors. And for good reason: “In about half of cases where a diagnosis is never made or delayed significantly, the result is real harm to the patient,” says Jerome Groopman, MD, author of How Doctors Think and the Dina and Raphael Recanati chair of medicine at Harvard Medical School.

How do well-trained MDs blow the call?
There are three main thinking traps physicians fall into, leading them to the wrong diagnosis, Dr. Groopman explains. The first happens when “the doctor makes a snap judgment by seizing on the first symptom or finding.” The second: sticking only to the diagnosis foremost in her mind. For instance, when a doctor has just seen 15 consecutive flu cases, “that’s what’s most likely to come to mind when he sees a 16th person,” Dr. Groopman says, even though patient number 16 may have something else. The last type has to do with negative stereotypes. “For example, if a woman in the middle of menopause has hot flashes and headaches and feels jittery, her doctor may attribute any of her complaints to menopause,” he says.

These assumptions can add up to a lot of wrong calls: About 15% to 20% of all diagnoses are missed or flat-out incorrect. One study of settled malpractice claims found that 59% of outpatient claims were for a diagnostic screwup. The most common errors? Incorrect reading of a test result; wrong or inadequate follow-up care; and missed or delayed cancer diagnosis. Breast cancer accounted for about 42% of missed cancer cases.

That’s what happened to Maureen Thiel. The 40-year-old Pennsylvania mother of two first found a lump in her left breast during a self-exam in late 1994. She followed up immediately with a mammogram and ultrasound and was told she had fibrocystic breasts. Although the lump didn’t wax and wane, as is usually the case with this condition, her initial doctor and two subsequent ones she saw failed to advise her to get a biopsy. By February 1997, Maureen had found a new lump—this time under her arm. She then saw a different doctor, who ordered not only a mammogram and ultrasound but a biopsy; the tests turned up stage III metastatic breast cancer. “She was positive [for cancer] in all 47 lymph nodes,” Maureen’s husband, William, says. “She lived 15 months.”

Communication breakdown
Many errors stem from a communication lapse. “These errors go to everything,” says Nancy C. Elder, MD, an associate professor of family medicine at the University of Cincinnati and one of the few researchers to study mistakes in doctors’ offices. In a 2004 study of 75 errors reported anonymously by family physicians, 47 were triggered by miscommunication.

So what is a communication error, exactly? It’s the rushed doctor who doesn’t listen and brushes off your concerns—or even your symptoms or pain; the lost medical record or referral that delays diagnosis or treatment; the rude office manager or nurse who makes it impossible to get information or an appointment when it’s really needed; or the phone that never rings with word about that lab result you’ve been losing sleep over. “Anytime you undergo a test, you should always get the result back,” Dr. Elder says. “‘We’ll call you if anything is bad’ isn’t an acceptable response.”

Medication mistakes
If you take even one prescription med, you’re at risk for an error. Your doctor could give you the wrong drug, wrong dose, wrong type (pill versus liquid), wrong timing (morning versus evening)—or you could even be the wrong person (i.e., you don’t need the drug). And the more meds you’re on, the more likely it is you’ll experience dangerous interactions. (A side effect shouldn’t be confused with an error, though.)

As tempting as it may be, bypass free drug samples, advises Allen J. Vaida, PharmD, executive vice president of the Institute for Safe Medication Practices, in Horsham, Pa. There’s a debate about whether physicians should dispense samples in the first place, because there’s no way for pharmacists and other providers to know you’re on that drug. “Sometimes labeling is really inadequate,” he adds, citing an example of an arthritis-pain-med sample that came in a blister pack of three capsules: “The box said to take 200 milligrams, but it never said that each capsule was 200 milligrams, so people were taking all three.”

Drugs can expire without a doctor or patient realizing it, too. "Pharmaceutical reps leave samples in the doctor’s drug cabinet—in front of their competitors,” Vaida explains. That means some drugs languish on the shelf for months before they make it to you. Finally, when you get a drug off the record, you’re less likely to hear about a recall because there’s no log of who got what sample and lot number.

Next Page: Can test results be trusted?

Testing blunders
Chances are good that, at least once, you’ve had some sort of medical test and then waited…and waited…and waited…to get your result back. Maybe the doctor’s office finally got in touch (after you’d driven yourself mad with worry), or maybe they never did. If you never got the result—good or bad—that’s an error. If you got a result saying you had a disease or condition when you didn’t, or that you didn’t have a disease when you really did, or that you had a disease but it turned out to be another disease, those are testing mistakes too, as is a lost lab result and mixing up your specimen with someone else’s. When you consider that the average family physician sees about 100 patients a week and orders tests for 39 of those, it’s not hard to imagine the opportunity for blunders.

In 2006 Darrie Eason, a then-33-year-old single mother from Long Island, N.Y., was one of those unlucky few. She’d gotten the news every woman dreads: She had breast cancer, and it was aggressive. Her doctor recommended a double mastectomy, so Eason went for a second opinion and brought along the test results her first doctor had used to make his recommendation. The second doctor gave her the same advice, and she decided to have both breasts removed. “I was told I had lobular breast cancer, which everyone said would come back,” Eason told the Today show last fall. But after her double mastectomy, she learned she had never had cancer: The lab had mixed up her biopsy results with those of another woman.

What goes wrong most often?
A 2008 study found that many mistakes happened in the doing of the test—it wasn’t done, the specimen was lost or improperly stored, or the wrong test was performed or scheduled. Most common, though, were glitches in getting test results to the doctor in a timely way (or at all). In fact, 39% of the time, one mistake led to another, and 60% of the errors took place in an MD’s office, not in a lab.

And 1 out of 10 times, the mistakes in the study resulted in pain and suffering, as in the tragic mix-up that cost Eason her healthy breasts. A doctor can also fail to get enough of a tissue, blood, or urine sample or take a sample from the wrong place, perhaps giving a false-negative result when disease is present, explains David S. Wilkinson, MD, PhD, professor and chair of the department of pathology at Virginia Commonwealth University, in Richmond, Va., and chair of the quality-practice committee for the College of American Pathologists, which accredits U.S. and foreign labs. Or, he adds, a pathologist can simply write the wrong thing in a report. “It can be a subtle error, writing ‘malignant cells seen’ instead of ‘no malignant cells seen.’”

It gets even dicier when a test is complicated to interpret. Tests that require analyzing a tissue sample are particularly prone to error, because there’s often no clear-cut interpretation. “Looking at a biopsy and deciding if it’s cancer and what kind is not as precise as measuring glucose in a test tube. Even knowledgeable, conscientious, well-trained people may have differences of opinion,” Dr. Wilkinson says. Hence the need for the all-important second (or third) opinion to interpret pathology results for biopsies.

Next Page: Take action now

Take action now
There are simple steps you can take to guard against mistakes. First, choose your physician very carefully. Be sure she’s affiliated with a top hospital. Remember: You’re not just picking an MD for an annual checkup; you may one day need her for something more serious. “A doctor affiliated with a top-notch hospital extends to you the high-quality care of all the specialists and support staff she knows there,” Dr. Gallin says.

Once you’ve found an MD you trust, stay loyal. Jumping from physician to physician—or popping in and out of in-store and after-hours clinics (see Urgent Care Center Alert!)—ups your odds that a key piece of information, like a test result or potential drug interaction, will slip through the cracks. If you’re seeing several specialists, consider it your job to make sure all parts of your medical story are filled in on all your records, kept updated, and, most important, consolidated with all records from your different care providers. Keep your own copy, too.

It also helps to be a good (read: organized) patient. Before you land in an exam room, “know all the details of your family history and how long you’ve had symptoms,” Dr. Gandhi says. Also bring a list of all medications and supplements you’re taking, because this can avert a medication disaster.

The time for a passive, blinders-on approach to our medical care has passed. “A lot of people are worried about alienating or insulting their doctor by asking questions—when I was a patient I felt the same way—but a good doctor welcomes that kind of input and questioning,” Harvard’s Dr. Groopman says.

This approach can go a long way toward protecting you, Susan Sheridan believes. In addition to losing her husband to a delayed cancer diagnosis, her son, Cal, now 13, was the victim of lack of treatment for too-high bilirubin levels as a newborn, which resulted in kernicterus, or brain damage from severe jaundice.

“Don’t be afraid to be demanding,” says Sheridan, who now works as a patient-safety advocate. “Don’t be afraid to ask too many questions. Women are the number-one health-care purchasers for our families, so we can be very influential in safety. And maybe we’re better wired to be, because we’re mothers, we’re wives, we’re caretakers. We have a huge opportunity to keep ourselves and our families safer.”]]> <![CDATA[3 Ways to Bounce Back From Money Trouble]]>

From Health magazine
If you've just lost your job, are in over your head with credit card debt, or have watched your investments tank, these finance gurus will help you deal.

Bounce-back situation # 1: You’ve Been Fired
The day you get the news, put yourself on an austerity budget, says money expert Jean Chatzky, author of Money 911. Make a list of the extras you can cut (read our lips: no new handbags!) and the essentials you can’t (your rent or mortgage).

Stick to this plan until you start seeing income again. Money spent on getting out and networking is well spent. Money used to numb the pain of unemployment? Not so much.

Bounce-back situation # 2: You owe big-time on your credit cards
For each card, figure out exactly how much you owe and the respective interest rate. Then, put any extra money you have toward the one that has the highest interest rate first and pay the minimum on the rest, Chatzky says. When that credit card is paid off in its entirety, move on to the card with the second highest rate, and so forth.

And, whatever you do, be sure you make all your payments on time. If you’re in way over your head (as in, your minimum payments each month total more than 20% of your take-home pay), seek debt counseling, says Farnoosh Torabi, author of You're So Money. The National Foundation for Credit Counseling (NFCC.org) can set you up with a counselor to help you negotiate with creditors and come up with a budget.

Bounce-back situation # 3: Your investments have tanked
Do not—repeat, do not—rush to sell. Although the markets haven’t returned to their pre-recession highs, they had an incredible year in 2009, Chatzky says. So while things continue to improve, rebalance your portfolio to make sure you have the right amount of stocks, bonds, and cash for your age and risk tolerance.

Hint: Subtract your age from 100—that’s the percentage of your portfolio you want in stocks, Chatzky adds. If you're not sure what to do with the rest, talk to a financial planner. Then continue to buy during the down times; these are the investments that will pay off in the future.]]> Istockphoto <![CDATA[A Big Fat Health Insurance Problem]]>

From Health magazine

Need to lose weight? That’s not going to make your insurance company happy. If you’re overweight or obese it probably costs them more. Even if you’re in an employer’s health-insurance plan, you may all have to pay higher premiums if there are a lot of overweight people in the office filing more health claims.

But the real challenge is for those women who are trying to get private insurance—finding affordable health coverage can be difficult, if not impossible, if you’re overweight.

Rules vary by insurance company. But, in general, heavier women are likely to take a financial hit. For instance, a woman who is 5 feet 4 inches tall and has no other health problems will likely need a medical exam and pay higher premiums if she weighs more than around 180 or 190 pounds, says John Barrett of Health Insurance Brokers in Pasadena, California. Rates may range from 20 to 100% higher, depending on the carrier. And if that 5-foot-4 woman weighs more than around 220? She could be automatically declined coverage.

Women who try to lose weight don’t get much help, either. “Weight counseling and early preventive treatment of obesity aren’t covered by many plans,” says John Wilder Baker, MD, president of the American Society for Metabolic and Bariatric Surgery. And insurance plans often won’t cover bariatric surgery or other obesity treatments.
]]> Istockphoto <![CDATA[20 Ways to Get Healthier for Free]]>

From Health magazine

Dip into our smart batch of strategies to stay happy and healthy (at no cost!).

1. Borrow (don’t buy) your next fitness DVD
Join the local library—for the workout DVDs. Most libraries have a big selection, the perfect antidote to a boring (and pricey) gym routine. And because the key to sticking with exercise is to keep it interesting, you can switch it up (cheaply) as often as you want.

2. Get a free skin checkup
The Skin Cancer Foundation will provide free skin screenings during its Road to Healthy Skin Tour from April to September 2010. Check SkinCancer.org this spring for availability in your area.

3. Order a free health calendar
Go to WomensHealth.gov/pub/calendar for the National Women’s Health Information Center’s 2010 calendar. It lists recommended health tests, reveals surprising symptoms of serious health conditions, and offers important advice on how to read drug labels and get a second opinion.

4. Surf for deals
Thunderfap.com, FreakyFreddies.com, and Freemania.net have free-by-mail samples and coupons for items like hand sanitizer, bandages, deodorant, tampons, and toothpaste. Ebates.com gives cash back for purchases at stores like Drugstore.com, Bath & BodyWorks, DERMAdoctor.com, GNC, Kiehl’s, Nutrisystem, and many more. CouponCraze.com has discounts for anti-allergy bedding, humidifiers, and dehumidifiers. And RetailMeNot.com features coupons for contact lenses and supplements.

5. Get a free radon test
Radon, an odorless natural gas present in many homes, is the leading cause of lung cancer deaths among nonsmokers. January is National Radon Action Month, so visit EPA.gov/radon/whereyoulive.html to check the availability of free or low-cost test kits in your state.

6. Click off the weight
Studies show that interactive online-weight-loss programs help people drop pounds and maintain weight loss, too. Visit Health.com—Health magazine’s free site for diet plans, recipes, and nutrition and fitness information reviewed by experts. To get diet counseling, try SparkPeople.com. And to access calorie-counting tools, visit CalorieCount.about.com.

7. Strike a pose
Try your Downward Dog for free—or pretty cheap—thanks to the Internet. Every week, Yoga Today streams a free, one-hour class. (Downloads cost $3.99.) Also, mark January 23 on your calendar: it’s Yoga Day USA, when yoga centers around the country will offer free classes. (Check YogaDayUSA.org for availability in your area.) Why yoga? It hikes flexibility and strength, provides help for relieving stress and controlling weight, and lowers risks of heart disease and sleep problems.

8. Bargain hard
Many health clubs and gyms are willing to cut you deals or give you free passes to try their facilities. Bally Total Fitness, Gold’s Gym, and 24 Hour Fitness offer free seven-day trials. Remember: everything is negotiable. And once you’re a member, train with a buddy to cut trainer costs in half, or sign up for 30-minute training sessions instead of hour-long ones. Bonus: Besides being cheaper, the shorter workout may move faster and be more intense.

9. Do a smoke checkup
Some local fire departments offer smoke alarms (a potential lifesaver, considering up to 20% of the alarms installed in people’s homes don’t even work) for free or at discounted prices. Speaking of smoke: if you’re trying to stop smoking, call 800-784-8669 to find a coach who’ll help you kick the nasty habit for free. Quitting will not only save you money but also lower your risks for heart disease and cancer.

10. Create a medical family tree
Start planning a healthier future today by asking relatives about their health conditions and those of your ancestors. Then visit FamilyHistory.hhs.gov to create a free Family Health Portrait that reveals your risks. Raising health awareness this way can help lower your risk of major diseases.

11. Save $170 in the shower
That’s how much you can cut from your water bill each year by taking shorter, cooler showers, according to the Environmental Protection Agency. Your budget and your skin will thank you. Hot water causes blood vessels to expand, causing you to lose more moisture, says Jeannette Graf, MD, assistant clinical professor of dermatology at Mt. Sinai School of Medicine in New York City. To keep your skin soft and supple, limit showers to around five minutes and think warm, not hot.

12. Snag free health apps
There are about 3,000 iTunes applications designed to boost your health and fitness—and many are free. Swine Flu Tracker Map pinpoints where people in your area are sick with the H1N1 virus. MyNet Diary has 91,000 foods in its database to help you plan healthy meals, and its community forum is reviewed by a registered dietitian. Free Menstrual Calendar helps you predict your periods and fertile days. Fitness Keeper uses GPS tracking for runners who want to keep tabs on their distance, speed and calories burned. And one of our personal favorites: Vibrating Massager literally turns your iPhone into a feel-good massager. (Yep, there’s an app for that!)

13. Boost your immunity
To help keep winter colds at bay, get free samples of Emergen-C powdered multivitamin packs at EmergenC.com. Each packet contains 1,000 milligrams of vita-min C—more than 10 times your daily requirement—plus other antioxidants and energy-boosting B vitamins.

14. Moisturize for free
Stop by Sephora stores across the country and ask for a free sample (you can literally try out hundreds of moisturizers), and you’ll get three more freebies—like Dylan’s Candy Bar Birthday Cake Batter Body Smoothie Lotion or Bliss All-Around Eye Cream—if you buy something at Sephora.com. And at Aveda.com, you’ll get a free Tourmaline Charged Exfoliating Cleanser sample when you buy any two Tourmaline Charged skin-care products.

15. Eat healthier, no cookbook required
Got a tummy ache that needs some soothing? Try the Belly Balance Smoothie (developed by Health magazine nutrition guru Frances Largeman-Roth, RD)—and find loads of other good-for-you, low-calorie options for every meal at recipes.health.com.

16. Tweet for discounts
Follow your favorite stores on Twitter and get hot sales alerts and great advice. Twitter.com/targetdailydeal offers new discounts every day on items like vacuums, healthy cookware, and bedding. Twitter.com/walgreens brings you deals like 25% off eco-friendly makeup applicators, $10 off purchases of $40 or more on vitamins and supplements, and other discounts on products like diabetes tests. And Twitter.com/Clinique_US features all kinds of useful free tips like this one: to give parched skin a dewy look, mix foundation with a drop of moisturizer in your palm and smooth over your face.

17. Try a new sport
You’ve always wanted to try cross-country skiing, right? As part of its anniversary sale Jan. 9, WinterTrails.org will help you try it for free at a location near you.

18. Give and get for free
Loads of useful items from babyGap, Science Diet, Tempur-Pedic, Love My Belly, and more great brands are available for free on the grassroots network Freecycle.org, a smart online location for secondhand giveaways. The site’s goal is to keep good stuff in use instead of letting it get thrown away and end up harming the environment. Keep in mind: available items change daily.

19. Sign up for a free pedometer
JustKeepMoving.com, a healthy-lifestyle-information site from the company that makes Tylenol, will send you a pedometer (while supplies last) if you register. Studies show that using the simple gadget is an effective weight-loss tool.

20. Talk it out
There’s a free self-help group out there for whatever is bothering you, whether it’s physical or mental. Check Mentalhelp.net/selfhelp, a searchable database of about 1,000 support groups for people dealing with acne, addictions, allergies, breast cancer, headaches, infertility, eating disorders, OCD, parenting, and many more issues.]]> Ericka McConnell <![CDATA[3 Ways to Cut Health Care Bills]]>

From Health magazine

Health-care costs are expected to rise 6 percent in 2009. To keep those expenses from burning up your bank account, consumer health-care advocates offer these tips. :

1. Know what’s covered

your insurer

2. Do the math.

3. Think prevention.

eat healthier

]]> Istockphoto <![CDATA[9 Secrets Health Insurers Don't Want You to Know]]>

Fighting back against this kind of trickery—and winning—is a lot easier than you think, says Kevin Flynn, the president of Healthcare Advocates, a Philadelphia-based firm that helps patients wrangle with their health plans. We checked with Flynn and other insurance-industry insiders, lawyers, doctors, and regulators to uncover nine little-known ways to get the health coverage you deserve—for less.

Don’t pay if you don’t have a say
When you purposely see an out-of-network doctor, your plan usually makes it clear that it’ll cost you. But when you have surgery, the hospital chooses the anesthesiologist. If you get that annoying “out-of-network” bill, Flynn says, draft a strongly worded letter stating you had no say about the anesthesiologist—in-network or otherwise—and, therefore, won’t pay any additional fees.

“If you don’t have direct control, you are not liable,” Flynn says, adding that this tactic is likely to work every time, but few consumers know about it.

You may be eligible for more coverage
Depending on your state, you could be eligible for more benefits than your plan is telling you about. Take Maryland, for instance. Health plans operating there must pay for expensive infertility coverage. But one state over, in Virginia, they don’t. It’s unlikely that your plan is trumpeting info about state-mandated coverage, though. It’s up to you to get the scoop.

One good place to check is Families USA, a consumer group that keeps tabs on state rules, suggests Kevin Lembo, Connecticut’s official health-care advocate for consumers. Another option: Contact your state’s insurance commissioner.

Next Page: When to advocate, when to hesitate

To get tested, talk up your symptoms
Your insurer doesn’t want to pay for a colonoscopy if it thinks it’s not necessary. But if you believe you need one, here’s how to get it covered: Talk to your doctor in detail about your symptoms and why you think you need the test. Your plan has to pay for it if you have gastro complaints, health experts say. (Only 21 states require insurers to cover colonoscopies for general screening.)

Stall first, answer questions later
When Wendy Decenzo became pregnant with twins, she wasn’t worried about health insurance. Her husband, Chris, had made sure to get a health plan that covered pregnancy well before they started trying. But when Wendy began going for prenatal visits, coverage was denied. Their plan, Blue Cross of California, wouldn’t say why. Instead, the insurer asked the Decenzos to sign release forms allowing the plan to view their medical histories, which the law says are private.

Chris believes the company was looking for any info that the Decenzos may have accidentally omitted when they applied for coverage. If an omission were to be found, the couple might have been denied coverage. “It seemed like a fishing expedition in order to deny us,” Chris says. So they refused to sign, and three months later the plan started paying for the prenatal appointments, even going back and paying for earlier visits that hadn’t been covered. Flynn says lots of insurers try this trick, but since their review process usually lasts only 60 to 90 days, they often drop the inquiry after that. Sometimes, procrastination pays.

Next Page: Getting the most from your health plan

Letters are your best bet
It may seem a bit inconvenient, but the old-fashioned letter is by far the best way to communicate with your health plan. “Don’t do anything over the phone. It takes forever and when you’re done there’s no record of it, so it didn’t happen,” says Rhonda Orin, a Washington, D.C.–based attorney and the author of Making Them Pay: How to Get the Most From Health Insurance and Managed Care.

Letters almost always get a response, adds Lembo, the Connecticut health-care advocate. Some plans will answer email, but many won’t. And to whom, exactly, should you address your mail? Experts recommend following your plan’s appeal process for letters and sending copies to your state insurance commissioner. Also, keep copies of every letter you’ve sent your plan and everything they’ve sent back. That way, when your insurer says, “We never said we’d cover that,” you can say, “I have it right here in writing.”

Doctors can be good weapons
You just got four massage sessions, under doctor’s orders, for lower-back pain—but your insurer refuses to pay for them? Ask your doctor for help. He can tell the insurer he’s going to complain to the state board that regulates health plans.

“Health plans may not fear you, but they do respect the board,” says James Moss, MD, a retired Kentucky surgeon. He intervened on a patient’s behalf and, by pressuring the board, helped the patient win coverage. Another option: Say you’ll call your congressman and/or state Medicare office to lodge a formal complaint, Dr. Moss says.

Caveat: Don’t actually contact your state board yourself if a claim is denied. Janice Weiss, a Jupiter, Fla.–based attorney who fights health plans for consumers, says some of her clients who went this route ended up hurting their cases when the state agency ruled their claims invalid; that left them little recourse with their insurance companies. Instead, while working your plan’s appeals process, just suggest you may take the matter to your state.

Next Page: Being proactive

A little research can go a long way
If you want a special CT scan or MRI, your doc probably won’t authorize it unless it’s an absolute must. Persuade her with expert info from the American College of Radiology’s Appropriateness Criteria, says Anne Roberts, the executive vice chair of the department of radiology at the University of California, San Diego.

Used primarily by doctors but open to the public, it’s an up-to-date list of the types of imaging that are right for various conditions. Arming yourself with the info doesn’t guarantee coverage, but it’s a proactive step in the right direction.

There are ways to get drugs cheaper
Doctors are often wowed by the latest and greatest drugs, which tend to be the most expensive. Make sure these newer, high-end meds are what you need before you leave the doctor’s office. Sometimes your insurance plan won’t pay for them at all; other times it’ll charge higher co-pays.

In many cases, drugs have generic versions that are just as effective but cheaper than the newer ones. Always ask your doc (or pharmacist) for generics. And if you really need a medicine that doesn’t have a generic version, order it by mail. Many plans have a less-expensive mail-order pharmacy option. Another prescription trick for people who have chronic conditions like allergies: Ask your doc to write you a prescription for two or three months’ worth of medication instead of one. Good-bye, extra co-pays.

Next Page: Using an advocate

An advocate can help you win
Imagine being turned down for coverage after running up $125,000 in medical bills. That’s what happened to the parents of a daughter with anorexia just before they sought help from Kevin Flynn, of Healthcare Advocates. For $400, he took over the fight with their insurer and—after a year’s worth of combat—won.

Flynn is a patient advocate, part of a growing industry that makes its money from helping you. Some advocates help you interact with your doctor, while others specialize in insurance disputes. Most of all, firms like Flynn’s keep the letters going out on your behalf, saving you time, energy, and headaches. “The insurers know that advocates know the laws, the regulations—things a regular consumer might not know. That makes them nervous,” Flynn says.

Advocates can even get policies changed. One of Flynn’s clients, who had rectal cancer, was having trouble getting his insurance plan to pay for a new radiation therapy. The insurer claimed the treatment wasn’t ready for prime time, but Flynn found six studies showing its usefulness for the disease, got the coverage—and got the insurer to rewrite its policy.

To find an advocate, contact the Patient Advocate Foundation, says Laura Weil, the interim director of Sarah Lawrence College’s Health Advocacy Program. Another helpful resource is the Society for Healthcare Consumer Advocacy.

Also try checking with the medical association for a particular condition, like the Multiple Myeloma Association or the National Association of Anorexia Nervosa and Associated Disorders; many of these groups keep lists of advocates.]]> <![CDATA[How to Keep Money Problems From Getting You Down]]>

The Difference: How Anyone Can Prosper in Even the Toughest Times, who blogs at JeanChatzky.com. “The people who assert control over finances are significantly happier than the ones who don’t,” she says.

For instance, worrying about the stock market, something you can’t control, is useless, she says. Instead, go to the retirement calculator at ChooseToSave.org and crunch your numbers.

“Then say, ‘All right, what if I saved this much more? What if I work a little longer?’” she says. If you can’t figure out what to do, hire a certified financial advisor, Chatzky advises. “Just have them do an annual assessment, as you would a checkup with your doctor.”]]> <![CDATA[Optimize Your Health Insurance Plan]]>

Q: It’s open enrollment season for health insurance. What should I compare policies on to make sure I get the best one for the price?

A: Generally, you want to look at price, coverage, and ease of use. Clearly, affordability should weigh heavily in your decision, but don’t let that be the sole criteria. If you have a preferred doctor, make sure he or she accepts the plan you’re considering. Also, look at the prescription drug costs in the plan, the deductible you have to pay before benefits kick in, and the overall amount you can be expected to shell out in any given year.

If you’re in good health and single, you can save money by picking a low-cost, high-deductible plan that will cover you mainly for major procedures. However, if you go to the doctor a lot or have kids, don’t make the mistake of picking a cheap policy only to later discover that it only covers major injuries or catastrophic illnesses.

On the coverage front, find out what services and procedures are included—as well as which treatments are excluded. Then, figure out how you would fare in a typical year, based on your expected use of benefits, the premiums, co-pays, and prescription drugs you may need. For instance, if you take specific medications, you might choose a plan with higher premiums if the drug costs were low enough to offset it.

Finally, check how easy it is for you to access benefits: How do you submit claims? Is phone or online assistance readily available? And what’s the process for seeing specialists or consulting doctors of your choice? Weigh all three of these areas—cost, coverage, and ease of use—on what your likely medical needs will be for the upcoming year, then go with the plan that has the best fit.]]> <![CDATA[How to Get Free Help With Your Medical Bills]]>

More than 60% of U.S. bankruptcies are ultimately caused by mounting medical bills. Before a major health issue spirals into a personal financial disaster, consider getting help.

Medical companies, hospitals, and nonprofit organizations have programs that can help you cut costs. For instance, drug companies typically offer free or discounted pills to those in need (you can get the details on each company’s website). You may also qualify for charitable aid—even if you’re not completely broke. Check with your hospital’s social worker, or use the United Way’s national referral website.

Here’s a sampling of organizations that help patients pay for care.

HealthWell Foundation
This nonprofit organization helps needy patients pay their insurance premiums, as well as prescription drug and other out-of-pocket costs. You can apply online (your doctor needs to fill out a form too) for up to a year’s assistance. After that, you’ll need to reapply.

Patient Access Network Foundation
For U.S. residents who are being treated for one of 21 diseases on this organization’s list—which includes breast cancer, cystic fibrosis, and multiple sclerosis—Patient Access offers $1,500 to $8,500 of assistance toward medication costs for one year. You’ll hear back on your online application within 48 business hours.

Chronic Disease Fund
This fund provides help for prescription drug co-payments for chronic disease or cancer patients. Typically, patients receive $2,500 to $8,000 of aid per calendar year. If you choose to use a pharmacy associated with the fund, you can avoid having to submit claims for reimbursement.

Patient Advocate Foundation
If you’re insured, Patient Advocate can help with your pharmaceutical co-payments. The foundation offers assistance to those with diseases such as diabetes, osteoporosis, rheumatoid arthritis, and various cancers.

UnitedHealthcare Children’s Foundation
This organization helps families with insurance plans that don’t fully cover their children’s needs. For instance, it pays for speech therapy and hearing aids that families typically have to pay for out-of-pocket. Only those with a commercial health benefit plan—and not a federally funded plan like Medicaid—can qualify. ]]> Istockphoto <![CDATA[How to Protect Yourself From Bankruptcy and Medical-Bill Disaster]]>

From Health magazine
It’s a fact of life: Everyone gets sick at times. The scary thing is that illness or medical bills cause nearly two-thirds of all bankruptcies, according to a study from Harvard Medical School. And in 78 percent of cases, the person goes bankrupt despite having health insurance. “Typically, it was a relatively brief illness that led to bankruptcy,” says study co-author David U. Himmelstein, MD, associate professor of medicine at Harvard Medical School. Here’s how to protect yourself.

While you’re well …
Never let your policy lapse.
It’s tempting to forgo insurance premium payments if you’re jobless. But “not having insurance is as risky as not wearing your seat belt,” warns Atlanta financial planner Mary Claire Allvine, co-author of The 7 Most Important Money Decisions You’ll Ever Make. “It takes only one accident or illness to financially ruin you.” Thankfully, the federal government will, in most cases, pay 65 percent of your COBRA bill for nine months if you’re laid off this year.

Budget for health care like you do for gas.
Factor your annual deductible, doctor-visit fees, and drug co-pays into your budget, Allvine says. Divide what you pay in a typical year by 12 to see what to save monthly. And use your employer’s flexible-spending benefit, so you can pay for uncovered medical expenses with pretax dollars.

Get to know your policy.
You’re more likely to get claims covered when you strictly follow your insurer’s requirements, says Erin Moaratty, chief special-projects officer at the nonprofit Patient Advocate Foundation in Newport News, Virginia. Read your policy thoroughly to see what the rules are for seeing out-of-network doctors, getting preapproval for procedures, etc.

Next Page: Check your disability coverage

Check your disability coverage.
Find out if you have this important insurance from your employer (most offer it). Even if you do, many companies pay only 60 percent of your salary should you become unable to go back to work, so consider getting a supplemental policy that makes up the other 40 percent. Compare quotes from different companies at eInsurance.com.

View healthy living as a money matter.
See a doctor even for small issues to avoid bigger, costly problems down the line. Eating right, exercising, and quitting smoking are also smart ways to save.

If you’re already in health-related financial trouble …
Don’t take “no” from your insurer.
“Appeal every claim that is denied,” Moaratty advises. “In our experience, a majority of denials are eventually overturned.” In some cases, fixing a simple coding error (via a quick call from your doctor) will do it. If that doesn’t work, craft a written appeal with care, working with your MD and following the timetable spelled out in your policy. This is important not only because it can help you win, but also because, if you don’t appeal and later want to sue in court, you’ll be limited to arguments you raised in your appeals.

Enlist an ally.
Consider hiring a medical advocate who knows the ropes, so you don’t have to battle your insurance company’s or hospital’s billing office alone. Fees vary, but start your research at the Medical Billings Advocate of America’s Web site. For free guidance, go to the Patient Advocate Foundation’s site.

Negotiate with your doctor and hospital.
If you get a huge bill, ask for the billing or finance department (not your doc) and tell them what you can afford. Most will slash fees for the promise of a speedy payment or set up a payment plan. “The best time to do this is early in the process, “ Moaratty explains. “Once it goes to a collection agency, you’ll have fewer options.”

Get cash to pay your medical expenses.
Many charities and organizations offer financial aid to those who can't pay their health-related bills. Click here for a sampling of companies, hospitals, and non-profits that can help you cut your costs. ]]> Istockphoto <![CDATA[How to Get Your Medical Insurer to Cover Alternative Medicine Treatments]]>

More insurers are covering alternative therapies like acupuncture.

By Jeanne Lee

Although it may seem obvious that acupuncture helps relieve, say, your chronic back pain, insurance companies often consider such therapies—from massage to herbal supplements—outside the medical mainstream. They are, after all, still referred to as complementary and alternative medicine (CAM). However, many insurers do cover selected therapies on a case-by-case basis, depending on the way you request reimbursement.

“If you talk to insurance people, they quote you by the book and say massage is not covered. Yet, I would say one-third of our Blue Cross Blue Shield patients are getting some reimbursement,” says Paul Rubin, a chiropractic physician at WholeHealth Chicago, a medical center that integrates traditional and alternative medicine. And even if your insurance company refuses to cover alternative treatments, there are ways you can reduce your out-of-pocket expenses.

Insurance coverage
The best way to get reluctant insurers to cover alternative therapies is by making a good case that your treatment is medically necessary. The simplest way to do this is to get a prescription. Ask your primary care doctor to write one that includes the diagnosis and the frequency and length of treatment. Although they may not advertise the fact, some insurers will rubber-stamp CAM treatments if they are prescribed by a physician. Some of the most frequently covered therapies include chiropractic care, massage therapy, acupuncture, herbal remedies, homeopathy, and mind-body stress management.

One of Rubin’s patients, a woman in her mid-50s, came to his office with fibromyalgia; she had chronic pain and fatigue. She was treated by an internist, who prescribed the pain medication Lyrica, and she also saw an energy healer, an acupuncturist, and a massage therapist on staff. WholeHealth Chicago submitted a detailed claim to the insurer that included a prescription for the CAM treatments and receipts that used standard diagnostic and treatment codes. Her insurance paid for the internist and therapeutic massage, says Rubin, although the acupuncture and energy work were denied.

Another strategy is to convince the insurance company that covering alternative treatments may save them money in the long run. Some conventional treatments for chronic back pain, for instance, cost far more (and in some cases may be less effective) than alternative options such as acupuncture and biofeedback. "To a certain extent, it’s playing the insurance game," says Rubin. "I would never ask anyone to not tell the truth, but if you can make the case clearly that what is being done is clinically necessary as an alternative to pharmaceuticals or surgical procedures, the insurance company can see, 'Gee, this treatment is $200, while medication would be $600 and surgery would be $10,000.'"

Next Page: Get a receipt

Get a receipt
Even if you can’t get a prescription from a physician, you should get a detailed receipt whenever you pay out-of-pocket for an alternative treatment. This will increase your chances of being reimbursed. "The receipt should include more than 'XYZ Acupuncturist, $65,'" Rubin advises. “You need to put it in the insurance company’s language, which is ICD and CPT codes.” The International Classification of Diseases (ICD) is an internationally standardized system of codes for medical diagnoses, while Current Procedural Terminology (CPT) codes are five-digit numbers assigned to specific treatments by the American Medical Association (AMA) in order to facilitate communication between (and among) medical specialists and insurers. CPT codes exist for alternative treatments such as acupuncture, therapeutic massage, and biofeedback, and you can search for other codes by keyword on the AMA’s website.

In addition to the official diagnosis and CPT codes, ask the practitioner to outline the treatment plan (the duration and frequency of visits, for example). If you do have a prescription, make sure the treatment on the receipt falls within the plan that was prescribed. Indeed, when you are choosing a practitioner, it’s always a good idea to ask if they have experience submitting insurance claims for alternative therapies.

If your insurance claim for an alternative treatment is denied, try appealing the decision. Sometimes the insurer can be convinced with additional documentation, such as medical notes from the CAM practitioner. “The carriers don’t want to spend their money unless it’s helping,” says Jennifer Gibbons, the office manager at Wall Street Physical Medicine & Rehabilitation, a New York City facility that offers acupuncture and therapeutic massage, among other treatments. “They want to see improvement. They want medical notes that show that pain has gotten better, or that impediments to acts of daily living—such as not being able to put on your shirt because you have a frozen shoulder—are improving.”

Limiting out-of-pocket expenses
If you have to pay your own way for all or part of your treatment, you should explain your circumstances to the CAM practitioner. “It is always beneficial if the patient discusses the financial issues with the practitioner prior to the first appointment,” says Janet Borges, a licensed acupuncturist and spokesperson for the American Association of Acupuncture Oriental Medicine. “Often they will negotiate a fee for service that may be even more beneficial for both parties than insurance coverage, such as a sliding-scale fee structure.”

You may also be able to save on CAM treatments by using pretax money from a health savings account (HSA) or flexible spending arrangement (FSA). If you have a high deductible health plan ($1,100 or more), sometimes known as a “catastrophic” insurance plan, you are probably eligible to open a tax-free health savings account (HSA). As with an IRA, contributions to HSAs are tax-deductible and the money is tax-exempt upon withdrawal if used for a qualified health expense. Offered by many employers, FSAs allow you to set aside an annual amount of pretax dollars for health care that must be used by year's end. Depending on your tax bracket, the tax savings from these vehicles can add up to a substantial discount on treatments. Eligible expenses may include therapeutic massage, acupuncture, and more (check your plan’s language for details). Even travel expenses—such as bus, taxi, and train fare—that are used primarily to get to essential medical care are eligible.

Next Page: Discount treatments

Discount treatments
If all else fails, you may be able to find affordable treatment in your area. Alternative medicine colleges often offer treatment from students or interns at reduced rates. The Pacific College of Oriental Medicine, for example, has clinics in Chicago, New York, and San Diego, where you can receive acupuncture treatment or herbal medicine consultations for a fee ranging from $10 to $60. Similarly, the National College for Natural Medicine in Portland, Ore., which offers graduate professional degrees in naturopathic medicine, oriental medicine, and acupuncture, has 11 community clinics offering free or low-cost medical care by naturopathic physicians in and around the Portland area.

For affordable acupuncture, try what is known as a community acupuncture center, where treatments are usually offered on a sliding scale ranging from $15 to $40. Patients often receive treatment while sitting in recliners in a shared room. “The community acupuncture model is an option offered primarily to low-income or underserved populations,” says Borges.

Act now! Spa Week (with massage and other treatment discounts nationwide) is October 12 through 18.]]> Istockphoto <![CDATA[Do I Qualify for Free Breast Reduction Surgery?]]>

From Health magazine
I was 14 years old when I went from flat-chested girl to voluptuous woman—almost overnight. Every girl’s dream, right? Not really. Having a D cup in your teens and a DD in your 20s is not so much fun.

Besides being uncomfortable naked and in a bathing suit, my neck and shoulders were killing me. And my belief that I looked OK in clothes was shot to pieces one day in my late 20s when I reviewed a taped segment of myself (I was an on-air TV reporter) and saw that I looked like I had two huge grapefruits under my sweater. I was horrified and never appeared on-screen again in anything but a business suit.

Life could have gone on like this—with me enduring the pain in my neck and rib cage, being tired of the sweat that accumulated at night between the two mounds of heavy skin while I tried to sleep, and strapping on several sports bras before every jog—if my mother hadn’t met a woman who’d had breast-reduction surgery. I’d considered reduction mammoplasty, sure, but I really couldn’t afford it. (The average cost is $6,000-plus, according to plastic surgery organizations.) But the woman my mother told me about had the surgery and loved it, and her insurance paid for it.

I had no idea my top-heaviness was a medical condition that might be covered. But I was about to find that out. Here’s my journey and what you need to know.

Next Page: The approval process

The approval process
Insurance companies need to be convinced that breast reduction is medically necessary. And convincing them requires more than just a doctor’s recommendation. You need real proof. To get it, I went to see an aesthetic-and-reconstructive plastic surgeon. After a quick examination, he told me what I already knew. My breasts were large for my frame, one was a good deal larger than the other, and I had the typical indentation marks on the top of each shoulder where bra straps had pressed into my skin for years. In his opinion, I was a good candidate.

The next step was harder. I had to be photographed from the neck down, and the pictures were sent to my insurer. A panel of doctors would determine if a reduction was appropriate and, most important, if my bill would be paid.

Insurance companies typically make the call by relying on a set of charts that consider height, weight, and the amount of removable tissue in each breast, according to Amy S. Colwell, MD, a specialist in aesthetic-and-reconstructive breast surgery at Massachusetts General Hospital in Boston. The surgery is covered 90 percent of the time when the tissue to be removed meets insurers’ standard criteria. (It weighs between 400 grams to 2,000 grams, or about 1 to 4 pounds.) Women with DD, DDD, and H cups usually qualify. But Dr. Colwell says the criteria of different insurers can be fuzzy, and a recent study in Plastic and Reconstructive Surgery found that insurers’ breast-reduction rules aren’t always based on medical science.

Weeks passed as I waited to hear what a panel of strangers had decided about my naked body. When the call finally came, I was shocked and thrilled all at the same time: The insurance company had approved my surgery, and I would probably go from an overflowing DD to a B. At 5-foot-4 and 130 pounds, I thought that sounded a little bit small, but I knew I needed the surgery. And now, finally, at 30 years old, I could afford it. The cost? My small deductible of $150.

Next Page: The surgery

The surgery
There are several ways to perform a breast reduction. In my case, tissue was removed from the bottom of each breast, and my nipples were moved up without disconnecting them from the blood flow, allowing me to quickly regain sensation. “Nobody’s leavin’ till they’re even,” was my surgeon’s motto in the operating room.

What about the risks? They include infection, wound breakdown, scarring, and the need for re-operating. Studies suggest that 10 to 50% of women undergoing a reduction may have some complications. But the healthier you are, experts say, the more likely surgery will be a success. Dr. Colwell says most women are extremely satisfied.

With mild pain medication and a full week of rest, recovery was easier than I had anticipated. Early on, I had feeling in one breast but not the other. With time, sensation returned to both, just as the doc said it would.

Two years later, the scars around my nipple and the lower-middle section
of each breast are barely visible. The scars underneath each breast are light-colored and hidden by the natural shape of perky boobs. Because they’re around and below the nipple, they don’t show in bikini tops or plunging necklines. To be honest, I love the scars. They are a reminder that I took control of a part of my body that was out of control.

Next Page: The happy ending

The happy ending
Although it takes months for breasts to take on their permanent shape after a reduction, I quickly looked and felt different. The weight on my neck and rib cage was gone, and, for the first time in a long time, I felt proportional. And my bra size? I turned out to be a perfect 34D. (Once in surgery, my doctor was able to meet the weight-removal requirements set by the insurance company and still leave me with breasts that felt right to me.)

Now that I’m out of the Big Bra Club and feel great, I’m on a mission to convert other women whose large breasts are a health issue. They need to know that feeling top-heavy, uncomfortable, and embarrassed isn’t just a part of life that they need put up with. They need to know it’s not normal to have to search constantly for a bra that fits or to have backbreaking pain. And although a reduction can limit a woman’s ability to breast-feed, it’s unlikely to affect mammograms. Ultimately, these women need to know that big-breast problems can be fixed. For good.]]>