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July 6, 2022, 5:02 a.m. EDT

A veteran medical practitioner offers tips for how to navigate America’s confounding health care system

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By Barbara Sadick

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Being the largest health insurer and payer in the U.S., Medicare, if it were able, could buy in bulk and bring drug costs down. It is, however, prohibited by law from negotiating drug prices. If that were allowed to happen, it would seriously cut into the profits of pharmaceutical company lobbyists who pay off politicians. During the 2016 elections, pharmaceutical companies spent $62 million to finance and influence candidates.

Another little-known fact is that drug prices vary from pharmacy to pharmacy. That’s because insurance companies are unregulated and pharmacy-benefit managers set the out-of-pocket prices you pay using rebates and coupons that benefit the pharmaceutical and insurance companies. To find the best prices, you can use the resource guide,  Dr. David Helps , and compare the price of your medication at  Good Rx  to ensure you’re paying the lowest cost.

Also see: New laws blocking surprise medical bills are already preventing unexpected bills — here’s how many so far

Congress enacted the Health Insurance Portability and Accountability Act in 1996 to protect sensitive patient health information from being accessed without a patient’s knowledge or consent. Since then, health-care technology has increased dramatically and it’s not difficult for your information to get into the wrong hands. What should patients know to prevent this from happening?

When your healthcare information becomes publicly accessible, there can be serious consequences. It can be used by insurance companies to deny you coverage. Be aware that genetic testing kits like 23 and Me and Ancestry.com can test for genes that influence your risk of developing certain conditions.

These companies de-identify your data and sell or give it away to researchers who can then re-identify you. Insurers often look for information that allows them to deny coverage. If, for example, your genetic information shows a predisposition to a serious, chronic disease, that might cause a health or life insurance company to refuse to insure you.

Before you decide to find out about your genetic profile or to seek genetic testing, think seriously about why you want the information and what you are going to do with it when you get it.

The Consumer Financial Protection Bureau says that in 2021, U.S. consumers owed more than $88 billion in medical debt. The figure is likely to be larger because not all debt is reported to consumer agencies. What should people do when they find themselves owing out-of-pocket expenses for healthcare?

Many Americans live just one crisis away from a health emergency. If you find yourself in a position where you’re paying out-of-pocket for medical care, speak with a hospital finance office. You may be eligible to have your debt wiped out completely or you may be able to come to an arrangement for paying it off over time.

If you make a good faith agreement with the hospital and you’re paying something, no matter how little, on a regular schedule, your creditor can’t hand your bills over to a bill collector. But don’t miss even one payment. If a bill collector gets hold of this information, it will affect your credit rating.

Never take out a loan or use a credit card to pay your debt as that will cause you to incur more debt in interest charges. Negotiation is the key.

Read : Credit monitors to remove medical debt from credit reports

A recent analysis by the Commonwealth Fund shows that the U.S. ranks only 17th in the world in healthcare efficiency, outcomes and equity despite spending significantly more than other wealthy countries. Do you see this changing?

In our current fee-for-service system, the healthcare provider makes money only when a patient show up sick, so there is no incentive for keeping you healthy. In a value-based care model administered by an accountable care organization (ACO), doctors get a fixed amount of money each year for your care. If you get sick and end up in a hospital, your doctor will have to pay additional costs. That’s an incentive for physicians to keep you healthy, and while some physicians are part of these ACOs, I hope we see healthcare continue to move in that direction.

Barbara Sadick is a freelance health writer whose stories have appeared in the Wall Street Journal, the Washington Post, the Chicago Tribune, Kaiser Health News, AARP, Cure and others. 

This article is reprinted by permission from  , © 2022 Twin Cities Public Television, Inc. All rights reserved.

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