Advocacy Services That Will Save Money for Clients

Article

Client Services Tip

Increasingly, insurance companies, Medicare or other payers are making it more and more difficult for our clients to know what will, or won’t, be covered, and therefore, if the cost is a consideration in their care, how they can go about making wise choices.

But you, as their advocate, can help them be sure they aren’t spending any more than they have to.  In fact, it’s entirely possible that you can save them enough money by offering these services that they can pay for your service – a double savings!

At the very least, by offering these services you may simply be saving some strife later.  If you were to suggest a service for your client, and he or she found out later that it wasn’t a payer-covered service, then they might be upset with you.

These ideas are a start.  Over time you may think of more.  If you do have some to add, please forward them to us at info@aphadvocates.org.

Possible Money Saving Services

  • Prior to your client seeing a new doctor, or visiting one who hasn’t been seen in the same year, or most certainly for hospitalization, confirm that all professionals and services are covered by the client’s payer. It used to be that “in-network” was set for a year at at time, but that is no longer necessarily true. Your best bet is to do this through the payer, but as a back-up you can do it through the provider. And of course, get it in writing. This includes doctors, testing labs, hospitals, therapists – any provider who is reimbursable. (this can be particularly important with hospitalization where some services may not be covered – that’s why it’s important to check ahead of time.) 

    More on in-network and out-of-network.

  • Help your client save money on drug prescriptions by asking about (or encouraging your client to ask about) generic versions, or even alternatives that will be found in a different tier in the formulary. Doctors don’t know what drug is covered on which tier, so they just write something that will work. But often there are alternatives that may, on your client’s insurance, be less expensive. The insurer may have a smartphone app, or you may need to call, or there may be a website where you can get the information (using an iPad or smartphone in the office) – and figure out before leaving the doctor’s office the one that the doctor thinks will work which is also the least expensive. 

    More on drug formularies and tiers.

  • Once any sort of prescription or order has been written, double check pricing for your client in other ways. Surprisingly, generic drugs may be less expensive if paid for with cash than they are if they are processed through insurance! Many drug stores offer free or low cost drugs that cost less than a co-pay. The same is true for equipment. If your client needs a walker, it may be far less expensive at a store front, than letting the hospital or doctor order it.

    More ideas for saving money on prescription drugs.

    More about drug stores that offer free and low cost generics.

  • Know which services are now “free” – those preventive services that no longer require co-pays or co-insurance because of the Affordable Care Act. Help your client by explaining that there may still be add on services, but that no payment will be due for anything on the list.  

    More about the no co-pay or co-insurance preventive services.


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