It’s open enrollment season, and that means you may be deciding whether to change or add to the insurance coverage you currently have. And while most people recognize that medical coverage is necessary, dental and vision plans might seem less essential. In many ways they are: healthy people can go without a dentist or optomologist for a few years. But in the long term, the benefits of a dental or vision plan may pay off. This is especially true if you are covering family members.

First of all, let’s get clear on what these plans cover:

Dental Plans

Dental plans can come in many forms: HMOs, PPOs, and indemnity plans. Dental HMOs work well for people who only need basic preventive care. They usually cover routine care 100%, but have big cost shares for more complex care. You are also required to stay within a network of dentists.

PPOs offer more coverage and allow you to see any dentist, but they will pay more when you see an in-network dentist. For example, a PPO plan may pay 80% for an in-network dentist, but only 50% on an out-of-network dentist.

Finally, indemnity plans offer the most freedom: you can see any dentist you want, but the premium and co-insurance is usually higher. Indemnity plans are ususally only offered through employer group plans are are not available for individuals to purchase. The average dental plan can range from $15 to $75 per month, depending on the type.

Vision Plans

Vision plans offered through employers are often just discounts–not true insurance. They are only designed to cover vision exams and glasses or contacts. For pretty much anything that is a real health issue (such as cataracts, detached retinas, or injuries to the eye), you should turn to your medical insurance. Still, your vision plan should cover basic eye health such as screening for eye disorders, glaucoma tests, and tests for your eyes’ ability to change focus or focus at different distances.

Individual vision plans are more rare. You can find them if you shop around, but if you are only planning to purchase frames or lenses and already have a current prescription, the plan may not be worth the benefits.

Here’s how to decide if these plans might be right for you:

Review the Benefits

As with any insurance product, make sure you know what you’re buying. For a dental plan, the exams, x-rays, basic care, and which dentists you can see are most important. If you have children, you may also want to consider orthodontic benefits. For a vision plan, how frequently exams are covered and how much is allowed for glasses or contact lenses is key.

Compare Other Out-of-Pocket Costs

Don’t forget to consider the deductible, co-pays, and coinsurance in the plan. After all, it’s not really a health plan if you’re still paying on your own. Watch out for plans that have a deductible for preventive care, because you will most likely be paying out-of-pocket for the very services you intended to have the plan cover. A good cost-comparison method can be to look back and see how much you actually used these services in the past (which a site like Simplee or Cake Health can help with).

Consider your Timeframe

Will your health insurance situation will be changing in the future? Are you pretty much caught up on your dental exams and vision prescription? If so, you might decide that you can go without dental and vision benefits for the moment. Remember, they are meant to provide routine, preventive care and basic eyewear. For medical issues, you have your health plan. However, putting this routine care off for too long could result in more expensive cavities or eye diseases later. If in doubt, check with your doctor. How long is too long?

The bottom line? If your employer offers dental or vision, odds are, it’s a good benefit for a small cost.  My company, Simplee, recently took a look at the dental expenses of our members for 2011 and found that a typical family of four saved about 60% with their dental plan, including premiums:

But, as always, read the details and understand your own history to make sure you’re getting your money’s worth.

Tomer Shoval is the CEO and Co-Founder of Simplee, a free online personal health care expense management tool. Connect with him on twitter, facebook or email.

Most health plans have an annual deductible—the amount you are responsible for paying before your insurance starts to cover you. If you’re lucky, you’ll have a very low deductible, or even none at all.

In many ways, the deductible is what stands in between you and your full health insurance benefits. It’s like the first hurdle you have to clear before your health plan starts to give back those premiums you paid. So, managing your deductible is key to understanding your plan and saving money.

If you’re one of the many people who find it difficult to keep track of where they are on their deductible, you might try one of the new online services, like Simplee or Cake Health, which are designed to make this much easier.

Essential Things to Know About Your Annual Deductible

 How much is your deductible?

You should know this before you ever enroll in a plan. If the plan has a low premium, there is a good chance the deductible will be high. You should ideally have the money to pay your deductible ready on hand—or at least be saving for it. High Deductible Health Plans (HDHPs) often come with a Health Savings Account, a tax free account where you can deposit money specifically to be used for medical costs. Aim to have saved in your Health Savings Account at least as much as the deductible. What counts as a HDHP? For 2011 and 2012, the deductible is at least $1,200 for individual plans or $2,400 for family.

 The date your deductible rolls over

This usually occurs every January, but some plans may use a different date—for example, health plans through schools or universities may use the academic year. This date is important because you may want to plan your appointments and procedures to occur after your deductible is met and before the year rolls over. Or, you may need to budget more money for the early part of the year.

Let’s say you have a $1,000 deductible and you meet it in June. Any other services you get for the rest of the year will only cost you co-pays or coinsurance. But if you wait until January, you will have to pay $1,000 all over again. Scheduling bigger procedures before January could save you some cash if you are not planning other expensive services (that will again exceed $1,000) for the next year.

 What doesn’t count towards your deductible

Many health plans waive the deductible for services such as preventive care or the emergency room fee if you are admitted to the hospital. Check your policy so you know where you get a free pass, and take advantage of it.

 Whether you have different deductibles

Some plans have separate deductibles for in-network care versus out-of-network care. This could cost you more money unnecessarily if you’ve met one deductible and then see a doctor that counts towards the other.  So, find out the rules and always check whether providers are in-network before you go (don’t make assumptions—doctors in the same office may not all take the same insurance).

If you have a family policy, check if there are separate or combined deductibles for each member that is covered. The rules can vary on this one, too.

 How often you actually meet your deductible

Odds are, if you purchased health insurance, you hope that it will pay for the health care you use. So if you find that every year you come close to meeting your deductible but never do, you may be tempted to get a plan with a lower deductible so that you end up paying less out of pocket.  Be aware, though: premiums for lower-deductible plans might be higher than you would end up saving.  Make sure you consider the full cost spectrum of premiums, co-pays, coinsurance, and how much health care you expect to get that year when you weigh this decision.

Tomer Shoval is the CEO and Co-Founder of Simplee, a free online personal health care expense management tool. Connect with him on twitter, facebook or email.

First, the top three things to keep in mind (no matter what type of plan you’re changing to):

• Be aware of dates.  Many transitions have limited enrollment windows or periods that coverage is available. Missing a date could mean losing coverage. Check with your company’s HR department, or speak directly with your insurance provider to confirm the applicable dates.
• Get your Certificate of Creditable Coverage. This document can be your ticket to getting coverage right away for pre-existing conditions; without it, new insurers may balk at covering pre-existing conditions. It should be sent to you when you stop an insurance plan. Keep it safe.
• Know your options. COBRA, employer plans, individual plans, and short term, temporary plans can all have very different rules. Don’t just assume that insurance is insurance.

 If you are switching from an employer plan to COBRA:

This can be the smoothest of transitions because you are essentially keeping the same plan you’ve always had—but now, you are paying the full cost (both your share and your former employer’s). You have 63 days to complete the paperwork to enroll in COBRA from the time you are first notified that you are eligible. Once you have enrolled, you have 45 days to pay the premium (directly to your former employer–not the health plan). You will probably receive new insurance cards, but your coverage should be the same. Pre-existing conditions will still be covered. You can usually keep your COBRA coverage for 18 months (sometimes 36 depending on how you qualified for COBRA in the first place). After that, it’s time to start shopping for something new.

If you are switching from an employer plan to a temporary or short-term plan:

Temporary plans are often marketed as more affordable alternatives to COBRA. Before you choose a temporary plan, be sure you understand the benefits and limitations. Temporary or short-term plans offer coverage for anywhere from 30 days to 1 year. After this length of time, there is no guarantee the plan will extend your coverage—these plans are not required to renew coverage the way that full medical insurance must. They are also not required to cover pre-existing conditions and often don’t cover routine, preventive care–only emergencies and catastrophic care. The plus side? Temporary health plans can usually start immediately (as soon as you pay) and the application is shorter and simpler, so the switch can be easier to coordinate.

If you are switching from COBRA to a private individual plan:

If your COBRA benefits run out, you have a special right to buy an individual health plan without detailing your pre-existing conditions. However, you do not have this right if you voluntarily decide to leave COBRA or just stop paying your premiums. Translation: there’s no guarantee the new plan you want will take you, so make sure you are covered before cancelling your COBRA.

When your COBRA plan ends, you should receive a “Certificate of Creditable Coverage” from them. Keep this paper as proof you had prior health insurance coverage, which you may need to show your new plan for any pre-existing conditions to be covered (see more below).

If you are switching from one private plan to another.

Do your research and make sure the new plan will work for you. Apply for the new plan and make sure you have been approved before you do anything with your current plan. Your new health plan may require a “Certificate of Creditable Coverage” which is a document that shows how long you have had continuous health insurance coverage. If you have had a “significant break in coverage” before applying (generally 60 days or more), the insurance company has the right to deny coverage of any pre-existing conditions for a waiting period (usually six to twelve months). If you know you will be canceling your plan, you can request the Certificate of Creditable Coverage ahead of time. Then, you’ll need to line up the dates that one plan ends and the other begins (such as the first of the month). As soon as you receive your new insurance cards and have confirmed the dates, you can cancel your current plan.

Tomer Shoval is the CEO and Co-Founder of Simplee, a free online personal health care expense management tool. Connect with him on twitter, facebook or email.

Medical debt is an increasing problem in America. More than 25% of people under 65 report having some medical debt (an all-time high). Even people with insurance report having problems paying medical bills.  So what do you do when you just don’t have the money to pay-off your recent hospital stay?

Before you panic, try these steps:

Check things out: A shocking number of medical bills contain errors (estimates suggest anywhere from 30%  to 80% of bills). If something doesn’t look right, it’s worth investigating. Some errors are easy to spot, such as staying in the hospital two nights but being billed for three. Or, you may have been billed twice for the same thing. But most errors are not obvious; for complex situations, you might consider hiring a medical billing expert to review your bills. But for single bills, these services can be expensive. You may first want to see what consumer assistance your state’s Department of Insurance offers – they may offer or be able to direct you to free or low cost help.

Call your provider: If you do find an error in the bill, call the doctor or hospital and explain what is wrong. Ask them to resubmit the bill to your insurance company.

Call your insurance plan: If your provider is unable to help, or if the mistake belongs to the insurance company, call your plan and ask them to make the correction. Be sure to record the name of the person you talked to, what they promise to do, and how to get a hold of them again. If the plan says they cannot help you and you still believe the bill is incorrect, file a formal complaint (or grievance) with the plan. If this still does not change your bill, you can file an appeal.

Negotiate with your provider: If the bill is in fact correct, talk to the doctor or hospital about discounts, financial assistance policies, or payment plans.  If you want to negotiate something specific over your bill, it may help to ask your provider for an itemized bill so you can see individual charges.

Find a foundation: If you have a chronic or rare disease, there may be a foundation or financial assistance program specifically designed to help with yourmedical bills. Depending on your particulars (such as age, health condition, or insurance status) these foundations can help with co-pays, co-insurance, drug costs, and more – sometimes up to a year back. Be aware of the funding timelines; for example, some give out assistance by the calendar year, so you may have better luck earlier in the year. Some foundations to try:

Cancer Care Co-Payment Assistance Foundation: www.cancercarecopay.org

Caring Voices Coalition: www.caringvoice.org

Chronic Disease Fund: www.cdfund.org

Healthwell Foundation: www.healthwellfoundation.org

National Organization for Rare Disorders: www.rarediseases.org

Partnership for Prescription Assistance: www.pparx.org

Patient Access Network Foundation: www.panfoundation.org

Patient Advocate Foundation:  www.copays.org

Patient Services Incorporated: www.patientservicesinc.org

Get help from friends and family: If you still can’t get the money together, then try getting the word out.  Fundraising platforms like GiveForward make it easy to create and publicize campaigns to help a friend or family member who needs money for medical expenses.

Tomer Shoval is the CEO and Co-Founder of Simplee, a free online personal health care expense management tool. Connect with him on twitter, facebook or email.

It’s the middle of the night, and your child has a fever. Or maybe your spouse is having some mystery pain that has you worried. How do you get the care you need—while avoiding that ominous emergency room cost?

The best plan is to know what options are available to you before you need them. Your health plan may have services specifically designed to help you in these situations. And in the long run, by avoiding unnecessary hospital costs, you’ll be doing your part to keep your insurance premiums lower.  Here are some places to start:

Nurse Advice Lines: Many health plans provide free 24-hour nurse advice lines to their members. A nurse may be able to advise you on whether it’s appropriate to wait until morning to see the doctor – or if you should head to the ER right away. Check to see if your plan offers this benefit and if they do, keep the number handy—in fact, just save it in your phone right now so you don’t have to look for it again.

Community Primary Care Clinics: Find out which clinics are located in your area and how they work with your health plan. If you have a PPO, some doctors there may be covered by your plan. If you have an HMO, you can ask about sliding scale rates, but most of the time, if you have some form of insurance, you will not be eligible for sliding scale. And since your care will not be covered without your primary care physician’s referral, this option could become pretty expensive.

Urgent Care Clinics: Some hospitals operate urgent care clinics that have extended hours. They may be part of a public health system or associated with a private hospital. Fee scales can vary for these clinics depending on your insurance (and be completely different from that of the primary care clinic).

Retail or Minute Clinics: These privately run clinics can provide quick, walk-in health services for a low flat fee (fee for service). Many minute clinics have evening and weekend hours. However, they are not equipped to handle emergencies, serious injuries, or complex issues. What can they do? Think basic sprains and strains, cuts, strep throat, pink eye, or poison ivy. For anything more severe, these clinics won’t be able to help.

Plan ahead with your primary care physician: If you are especially concerned about being in the midnight-ER-visit situation, consider choosing a doctor that prioritizes patient access. Ask their office:

- If they have expanded evening or weekend hours

- If they provide same-day appointments

- How long it usually takes to get an appointment

- If physicians are available via email

Most of the time, your primary care physician is your best bet for getting low cost, reliable care, so start with them (the exception can be if you have a PPO and an established relationship with a specialist).

And as a last resort, you do have the emergency room. But keep in mind that ERs are not designed to provide routine health care. So while you might get your health issue addressed, it most likely will not be in a timely or cost efficient manner. Emergency rooms are supplied with physicians and equipment to handle severe trauma, so when you go there with a minor health issue, you are still paying (and waiting) for this specialization.  Plan ahead and know your options, and you might find a way to take care of your problem without emptying your pockets.

Note: I am not qualified to give medical advice. If you ever feel your health is in danger, getting appropriate medical treatment should come before financial considerations.

Tomer Shoval is the CEO and Co-Founder of Simplee, a free online personal health care expense management tool. Connect with him on twitter, facebook or email.

One of the great battles raging in the underworld of consumer credit is the conflict between what’s best for consumers and what’s best for banks. Consumer advocates argue that anything that isn’t in the best interest of the consumer is, well, bad. Banking trade associations argue that anything that isn’t in the best interest of the bank is bad for consumers because it limits choices and increases costs.

The latest battle is over H.R. 2086, more affectionately known as the Medical Debt Responsibility Act of 2011. The Act, among other things, would require that the credit reporting agencies remove medical collections once they’ve been paid or settled as long as the amount was less than $2,500. This means an almost immediate improvement to your credit scores, unless your credit reports are still awash with other negative information and/or excessive credit card debt.

H.R. 2086 is potentially the second significant blow to the credit reporting agencies and credit scoring systems this year, and we’re only in June. In February the IRS announced new rules, which would likely result in the removal of Federal tax liens from credit reports if the consumer pays them in full. I wrote about the new tax lien rules here.

Is this a good idea?

On the surface, the potential to have paid medical collections removed sounds fantastic, especially for the consumers who had them on their credit reports. But, is it really a good idea for everyone else involved? And at what point do we have to consider the lenders who use this data to make smarter loan decisions?

There’s little honest resistance to the fact that medical collections are, in fact, predictive of elevated credit risk. FICO, who is not in the business of being dishonest, even posts as much on their analytics blog referring to medical collections as being “highly predictive of credit risk for years after the fact.” The real question that needs to be answered is whether or not the removal of a paid medical collection reduces the effectiveness of credit scores and whether or not the lack of that information can be subsidized by something else from a credit report.

The goal of H.R. 2086 seems to be to protect consumers from having medical collections ruin their credit IF they were caused by billing mistakes. How many times have we had to argue about medical bills that were screwed up because of insurance carrier issues? I don’t think anyone would object to the removal of those collections because they are misleading.

Why the $2,500 limit?

It also begs the question…why condition the removal on a $2,500 balance? Isn’t it just as easy to have a $3,000 medical collection caused by billing errors, as it is to have one of $2,000? Why not remove all medical collections once they’re paid? Why the compromise? Was it to make the passage of the proposed legislation more palatable? Last year a similar proposal didn’t have the $2,500 exception.

The proposal would also result in the removal of collections that are the result of consumers not paying their legitimate medical bills. There is simply no way to look at a credit report and identify a medical collection that was caused by an insurance snafu versus one that was caused by the refusal or inability to pay for services. This leaves no options to be more surgical.

Today, paid medical collections (and all other paid collections) remain on the credit report for seven years from the date the account went terminally delinquent with the original creditor, in this case a medical provider.  And, ever since a 2003 amendment to the Fair Credit Reporting Act, medical collections have been required to include specific indicators that identify them as being medically related.  The insurance industry has not been allowed to use ANY medically related credit report information since that time.

Would you lend to someone with unpaid medical collections?

I think an interesting exercise would be to put yourself in the position of lending money. And I’m talking about lending YOUR money, not someone else’s money like what mortgage brokers do. What kind of information would you want to see before you let someone borrow $300,000? Would you want to see all of their medical collections or do you think you could make a smart lending decision without it?

Keep in mind that they’re proven to be very predictive of elevated credit risk.  So, it’s not like we’re talking about a superfluous piece of credit report information.  If you’re struggling with the answer then you just realized that the world of pretend lending is no easier than the world of real lending.

John Ulzheimer is the President of Consumer Education at SmartCredit.com, the credit blogger for Mint.com, and a Contributor for the National Foundation for Credit Counseling.  He is an expert on credit reporting, credit scoring and identity theft. Formerly of FICO, Equifax and Credit.com, John is the only recognized credit expert who actually comes from the credit industry. The opinions expressed in his articles are his and not of Mint.com or Intuit. Follow John on Twitter.

Infertility continues to rise sharply among American women, while more of them are seeking medical treatment to help their chances of having a child.

At the same time, there’s been little change in success rates for the $3-billion-a-year industry and costs remain high, even for those with health insurance coverage.

“Insurance doesn’t pay what the physician charges,” says Dr. Cristina Matera, infertility specialist at Columbia University’s Medical Center. “They will reimburse what they deem ‘reasonable and customary.’ How they figure that out, no one knows. You can go through ten or twenty thousand dollars out-of-pocket pretty quickly in infertility.”

Some 7.3 million American, or 12 percent of those in the so-called reproduction age group, have a fertility problem, according to the Centers for Disease Control. That’s 20 percent higher than 2006. Treatments to correct the problem are up at growing at a slightly lesser pace  — 16 percent — according to the Society for Assisted Reproductive Technology, SART.

Though many major health insurers — Cigna, Empire BlueCross BlueShield, EmblemHealth and Unitedhealth Group’s Oxford unit  — provide infertility coverage, it does vary.

Figuring out what’s covered, and what’s not

What’s more, sorting your way through the maze can be difficult and out-of-pocket expenses considerable. Read your policy carefully and pay close attention to coverage limits.

“There is not a ‘one size fits all,’” says Dr. Joel Batzofin of Batzofin Fertility Services. “For the most part, companies cover investigation and some treatment. Most will put a lifetime limit on the amount they will cover [ranging from] $10,000 to $30,000.”

Some, however, opt out of a lifetime limit and prefer to cover a fixed number of procedures.

For one couple, dealing with coverage has been difficult. Christine (her last name is being withheld upon request) and her husband say it has already resulted in a delay in starting treatment.

“Right now we’re using Cigna HMO, and are covered for one IVF treatment per year.” she says. “We are limited to $10,000 for the procedure and medications. We haven’t done it yet, because we’re in the process of fighting with Cigna because now they’re saying they don’t want to cover the meds, which could cost us around $5,000 out of pocket.”

Fertility doctors say Christine’s case illustrates the importance of getting a detailed pre-authorization letter from your insurance provider at the start of the process. It should confirm that your dollar or cycle limit, type of procedure, and doctor and or clinic is covered.

The chart below shows base fees for the major kinds of infertility treatment. Prices, of course, vary by clinic, and not all procedures are covered by insurers.

Source: Data confirmed by Batzofin, and NYU Fertility Centers

These fees are for one treatment cycle — medical jargon for ovarian stimulation with hormone injections, egg retrieval, fertilization, “embryo” – or fertilized egg culture, and finally the embryo “transfer”, which is the placement of fertilized eggs into the uterus.

Calculating the odds

For most, the key to treatment and cost is the number of cycles, and success rates vary by age.

“Statistics show that most women who have the potential to conceive using IVF will do so in three cycles,” says Dr. Nicole Noyes of the NYU Fertility Center,

The latest SART data from The general rate, 40 percent, has been relatively stable since 2007, according to SART data; in 2009, for instance, 367 clinics reported 142,241 treatments with l56,778 live births.

Of that group, 41.4 percent under the age of 35 gave birth following one cycle. About half that many women between 38 and 40 were successful; for the over 42-group, the success rate slipped to 4 percent.

Using an donor egg may increases the odds of success for all groups; in 2009, 11.3 percent of all cycles used a donor egg, resulting in a 55 percent success rate.

“Clearly this is a better outcome, but at a substantially higher cost,” says Dr. Batzofin.

Deborah Spar, president of Barnard College and author of the book “The Baby Business,” says, “Only in the past five years have women become more comfortable with the idea of using a donor. Now, reportedly clinics are urging older women to move to donor eggs after one or two failed cycles.”

Regardless, infertility treatment is clearly a procedure where patients are sadly reminded that there is no guarantee and even multiples attempts can be unsuccessful.

How to mitigate the costs

Financing this venture can be daunting, especially given insurance variables. So keep these tips in mind.

Shop wisely for your clinic. Some try to mitigate patients’ out-of-pocket risk.

Batzofin Fertility, for example, offers a refund.

“At $18,750 for three cycles, you’ll get a refund of 75 percent, if you have not achieved a positive outcome after three cycles.”

Another cost-saving approach is to look for clinics staffed by multiple doctors, which negotiate group rates with insurance companies for themselves, and ultimately, for you.

“Many of the big IVF centers now are contracting and accepting insurance for infertility,” says Matera. “If the center has contracted that rate with an insurance company, the only out of pocket expense for the patient will be co-insurance.”

If you opt for an egg donor, doctors can offer cost savings by divvying up the eggs from one donor between multiple recipients.

“In most circumstances, we can split the eggs – half to one couple, half to another couple,” explains Madera. “This is about $10,000 cheaper because the couples are splitting the cost of monitoring and treating the donor.”

Dr. Matera also suggests freezing and storing extra embryos if you can, as an insurance policy all its own, which costs about $1,500 the first year and $1000 per year thereafter.”

If costs remain insurmountable, several companies offer treatment loans such as Springstone Patient Financing and the Advanced Reproductive Care. The interest rate range for an ARC loan ranges from 5 percent to 17.9 percent, depending on your credit history, debt-to-credit ratio and employment status.

What’s behind the confusing cost structure?

Finally, if you’re frustrated by what appears the absence of industry standards, there’s good reason.

The U.S. stands alone among developed nations in lacking ART regulation. Here, the governing body for infertility clinics is the American Society for Reproductive Medicine, ASRM, which gives guidelines and recommendations – not legal mandates.

“Lack of regulation causes massive uncertainties,” says Spar. “So, buyers beware. What happens if the egg doesn’t take? Is it the clinic’s liability? In this country, it’s proven close to impossible to get a regulatory response.”

How to Navigate the Commerce of Conception was provided by © 2011 CNBC.com

“Getting overcharged on a medical bill? Won’t happen to me.” Sure it’s easy to ignore, but with eight out of 10 medical bills containing errors (according to Medical Billing Advocates of America), the odds are really stacked against you. You are getting inaccurate bills, and if you haven’t yet, you likely will.

On top of this, hospitals are getting more aggressive and waste little time sending people to collections or filing liens against them for outstanding medical bills. The Federal Reserve reported in December that medical bills account for over half of all debts in collection. If that happens, your credit score could be hurt.

Also, did you know there is a lifetime cap on most insurance plans? It is often limited to $500,000 – $1 million per person, which sounds hefty enough, however continuous treatment in a hospital for several days can pile into hundreds of thousands of dollars, quickly eating through this limit.

To protect your health and your wallet, here are four steps to identify medical billing errors, and three steps to fight them:

Step # 1  Request an “Itemized” Bill

You should never pay the total summary bill. Also, never pay the total bill when you leave the hospital, even if you are told it’s mandatory. Instead, request the itemized bill. In a summary bill, you won’t be able to see if the individual services are really the one you received, nor could you spot duplicates.   Always ask for the itemized bill.

If you received the summary bill in the mail, call the hospital or clinic and request to speak with the billing department and request that they send the itemized bill to you. Larger hospitals and clinics often have dedicated staff for accounting and auditing bills, so use them.

If it’s a co-pay or coinsurance that should have already been paid at the time of a doctor’s visit, you may still accidentally get a bill. This happened to me recently for a $30 co-pay, which was paid during that visit yet I later received a bill. Look over your credit card statements or your receipts for transactions paid on the same day of the treatment if you think the bill should have already been settled.

Step # 2  Look for duplicates

Every little item has a different charge, from the tools on the surgical tray, to every screw in a pacemaker. So many people are entering these individual charges within a hospital or clinic, that there are bound to be mistakes…and there are.  If your see a charge for a procedure, then see additional charges for the individual items, chances are these are duplicate charges.  Now that you have your itemized bill, these are easier to spot.

The most common errors: Bundled items…

Say you get charged for a surgery.  Then you get charged for the tray being used for the surgery. You are probably being overbilled.  Hospitals are notorious for doing things like this.

Beware of items such as:

• -Shampoo
• -Soap
• -Toothbrushes
• -Toilet paper
• -Kit
• -Tray

If you are charged for these items and also billed for “room and board” or “doctors office visits” fee, then you’re likely being double charged.  Call the hospital or clinic to ask what amenities are covered under those vague terms.

Step # 3  Look for Upcharges

Sometimes your hospital or practitioner bills for a more expensive service than was actually performed.  These are called upcharges and are often clerical mistakes made from office staff when entering procedure codes.  This can often include services that you didn’t receive at all.   By contacting your physician, you can confirm if these services were truly the ones performed.

Step # 4  Compare

In addition to the medical bill, you will also get an explanation of benefits (EOB) from your health insurance company, if you have one.   Compare the two documents to make sure each has matching charges.  If they match, but you believe the bill is too much, then contact the hospital or clinic.  If the EOB doesn’t match the bill, then your insurance company may be overcharging you.  If you have a co-pay, this will not matter much to you since you are paying a flat fee regardless, but if you have a co-insurance, you are paying a percentage of the services and will want to keep the total cost of care as low as you can.

What To Do About It

Now that you have your checklist of services you identified as being questionable, here are three steps to take that will help save you money.

Step # 1  Request a review

If the error is on the medical bill, a simple call to your doctor or hospital asking to review the bill may clear things up quickly. Among larger clinics or hospitals, this is sometimes called an “internal audit”, and they have in-house auditors who are there to do this, so make use of them.

If you notice different charges on your insurance explanation of benefits (EOB), you should call your insurance company to ask the reason for this difference.  It may be an error and easily corrected.

Step # 2  Ask your physician if they ordered the service

Check with your doctor whether the services in question on your bill were indeed requested for you.  You can’t be charged for a service that your physician didn’t order…in writing.  When your doctor orders treatments or services, they send them directly to the labs or other facilities where your treatment takes place.  Often times you will never see this order, so if you are unsure about a treatment, call your physician and ask that they confirm in your medical records.

Step # 3  Challenge health insurance denials

For any case where your health insurance has denied coverage, you should always challenge it.  It could be a clerical error, wrong diagnosis code, missing modifiers. At best it will be approved, at worse you will have lost nothing by trying.  Calling your insurance company could resolve the issue over the phone. If that doesn’t work, look over your insurance plan to understand the appeals process, including timelines.  Request a letter from your physician explaining why it was necessary to use that facility or treatment (e.g. the only hospital with that equipment; the only specialist; etc.). Write a detailed letter of your own as to the reason why you are appealing, any details about the service charge, claims numbers, dates, doctor name, and so on.  When you submit your appeal, include both of these letters to your insurance company’s appeals address. I’d recommend photocopying them, and mailing them with some type of confirmation (certified mail or equivalent), as proof you sent it if required in the future.  You should also follow up if you don’t hear a response after 30 days.

Alert:  Beware of 30-60 day markers

If you are not able to resolve the charges in question by the time the medical bill is due, then you should consider paying the itemized charges you are not challenging. Some hospitals or clinics have 30-60-90 day notices, but it’s best to watch them closely.  After 60 days, if things are not resolved, your unpaid bill could be sent to collections, and this could hurt your credit score. If you suspect this of happening, run a credit report to see if your unpaid medical bills show up. If so, contact your credit card company to inform them of the dispute, which often will lead to them reviewing or even correcting the report.

Alert:  Beware of “medical” credit cards

These are often promoted through the doctor’s office as a way to pay for pricey procedures up front. The terms are enticing, such as promising no interest for 2 years, however if you miss one payment during this time, it immediately cancels the deferred interest and you often must pay all the accumulated deferred interest up to that point.  Ouch. Since the interest rates on these cards are typically higher (around 30 percent  in many cases), this can be a hefty amount.

Need More Help?

If you suspect egregious errors or even fraud, then you may want to seek help from a professional reviewer.  Patient advocacy groups often have reviewers on hand who are familiar with spotting medical overcharges and are there to help.  A couple of good resources are the Patient Advocate Foundation and the Medical Billing Advocates of America, who have professionals on hand to help.

Rebecca Woodcock is an entrepreneur and cofounder of Cake Health, a free online tool for managing your health insurance. You can connect with her on Twitter and Facebook.

Photo: Jasleen Kaur

With healthcare costs rising, and companies passing more of the burden onto employees, expect out-of-pocket medical expenses to continue ballooning.  The good news is that there is a way to ease the pain if you are taking on a lot of expenses yourself.   It’s time to check your bills and insurance claims to see what you spent this year, and how much of it came out of your own wallet.  Whether you are covered by your employer or are one of the growing many who are opting to get individual coverage that is reimbursed by your employer, use these tips to see what deductions you may be able to take.  You might be surprised.

Tip 1:  Use the 7.5% Rule

If you took a pay cut last year or were unemployed temporarily, your lower income could qualify you for this even if you never qualified in the past.   Taking a closer look at expenses will show if your lower income now meets the 7.5% rule.

Use this quick calculation to see what your expenses must be in order to qualify for the rule:

[YOUR GROSS ADJUSTED INCOME] x 0.075 = ____________________

Now Tips 2-10 will tell you what things to look for to help you determine if you meet the 7.5% rule.  If you do spent 7.5% of your income on medical expenses, check to see if it’s more than the standard deductions.  If not, you’re better off just deducting using the standard deduction.

Standard lump sum deductions are:

• -Single or filing separately if married:  $5,700
• -Head of household with dependents:  $8,400
• -Married and filing jointly: $11,400 (Add $1,100 for each spouse 65 or older)
• -Self-Employed:  If you’re self-employed, then you can deduct 100% of the premium cost from your income.  The 7.5% rule does not apply to you.

Tip  2:  Visitors’ Rights

Whenever you get a service or treatment, the cost you pay out of pocket for that visit is deductible.  This includes co-pays or what you have paid from your plan’s annual deductible (it’s deductible, get it?).  Look for any of these services in your medical history to include:

• -Doctors visits, examinations, treatments
• -Dental visits
• -Eye exams
• -Lab fees
• -Surgery
• -Hospital care

Tip 3: Medications

It’s nearly impossible to go through the year without having some medication prescribed to you.  If you have a chronic condition, the cost to fill these can start to stack pretty high.  Take an inventory of your prescriptions either on the explanation of benefits your insurer provides, or by contacting your pharmacy (or multiple, if you filled your meds at more than one company).  What to include:

• -Prescriptions
• -Birth Control pills
• -Insulin
• -Over-the-counter drugs that a doctor has prescribed to you (NOT ones you bought without a prescription)

Do NOT include:

• -Over-the-counter drugs (such as aspirin or cold medication, even if a doctor recommends it.  A recommendation is not necessarily a prescription  The only exception: insulin)
• -Vitamins or supplements
• -Any medications you acquired from another country (e.g. Canada or Mexico)

Tip 4:  Going the Distance

Travel to and from the doctor’s office or the hospital for treatment can rack up if you have frequent health treatments…or accident-prone children.  The good news is that you can take 16.5 cents per mile driven for each medical visit.  Didn’t record your mileage at the time? Calculate the miles by using Google maps, then apply this distance for each office visit.  If you took public transportation, include the fare instead.  If there are parking fees, which many hospitals now impose, you can deduct those as well, and don’t forget to include any tolls you paid along the way to or from these visits.  Airfare to another city if seeking medical services, including up to $50 per night for lodging, is also a medical tax deduction.  This does not include days you take for vacation or pleasure on this trip, but nice try.

Your checklist:

• -Calculate 16.5 cents per mile (rate for 2010 taxes)
• -Parking and tolls
• -Airfare/bus fare
• -Up to $50 per night lodging for trips required for treatment

Tip 5:  Eye of the Beholder

While visits to your eye doctor may be a more obvious health care tax deduction, many other costs associated with taking care of your eyes are also tax deductible.  If you have a vision problem, or have worn either contacts or glasses, for a while, this is good for you.  Look for the following eye health-related items to deduct:

• -Contact Lenses, including maintenance such as saline solution and enzyme cleaner
• -Glasses
• -Laser eye surgery
• -Radial keratotomy

Tip 6:  Dental Deductions

Believe it or not, any time you seek dental treatment, whether you are simply getting a cleaning or undergoing a more advanced dental surgery, you can add these to your tax-deductible expenses list. Things to look for:

• -Cleanings
• -Treatments
• -Artificial teeth (Veneers and dentures can be a grey area, and can often only be included if it necessary to improve a deformity related to disease or treat a condition, and may require a diagnosis.  It would be best to call the IRS at 1-800-829-1040 to walk through your particular situation to determine if these qualify)

Because simply having teeth is not a condition, everyday care items such as toothbrushes, paste, floss, and mouthwash are NOT to be included in your health-related tax deductions.

Tip 7:  Alternative treatments

Sometimes traditional medical treatment doesn’t do the trick for specific conditions.  If you are seeking any of these treatments as an alternative or supplement to treat a medical condition, then you may deduct these health related costs.

• -Acupuncture for medical reasons
• -Chiropractic treatment for medical reasons
• -Therapy
• -Psychologists, psychoanalysis, and psychiatric care
• -Christian Science Practitioner

Some treatments such as going to therapy or to an acupuncturist can also be a grey area.  These can be a medical care expenses only if it is to treat a diagnosed condition, and must be prescribed treatment rather than simply a doctor’s recommendation.  For these situations, it would be best to call the IRS to determine if these qualify.

Tip 8:  Medical Equipment

Some conditions require additional help beyond a doctor or medication, and involve purchasing support equipment.  These, including equipment added to a home or vehicle, are also health care expenses that can be tax deductible.

While this is by no means an exhaustive list, here are just some examples of what is deductible:

• -Crutches
• -Hearing Aids
• -Oxygen
• -Blood/glucose monitor
• -Artificial Limbs, prosthetics
• -Wheelchairs
• -Guide dog or other service animal (buying, training and maintaining)

Tip 9:  Premiums

This one can be a little bit tricky.  There are certain limitations that should be followed.  If you are employed and your employer sponsors your health insurance, then only include medical and dental premiums if they are included in Box 1 of your Form W-2.  If not, your premiums are already taken from your salary pre-tax, and therefore cannot be deducted.

Now if you are self-employed, 100% of your premiums are tax-deductible and for the first time for the 2010 tax season, so are Medicare contributions, as we previously mentioned.

Premiums can be included for policies that cover:

• -Hospitalization, surgery, x-rays
• -Prescription coverage
• -Dental coverage
• -Prepaid Insurance premiums
• -COBRA

Do NOT include policies for:

• -Life insurance
• -Policies for payment in place of lost earnings,
• -Policies for loss of life or dismemberment
• -Supplemental insurance (e.g. medigap)

Tip 10:  Baby?  Baby!  No-baby.

Pay attention, ladies…and men.  Whether you are planning for a pregnancy, or trying to prevent one, the costs associated with your efforts can be a medical tax deduction, including:

• -Pregnancy test kits
• -Birth control pills
• -In-vitro fertilization (including the cost of storage for both egg and sperm)
• -Sterilization such as vasectomy or tubal ligation (aka “getting tubes tied”)
• -Surgery to reverse sterilization
• -Abortion
• -Midwife for delivery (If they are a registered nurse, they would be categorized in the medical service category, and if not, they could still fall under nursing services.)

Tip 11:  Repeat for Dependents

Now that you have done this for yourself, use the same checklists to tally up related costs for your dependents and spouse.  If you paid for medical expenses for a family member that does not qualify as your dependent (e.g. adult child, or elderly parent), you may be able to deduct those medical expenses.  Something new for 2010 filings: you can deduct medical expenses paid for your child up to age 27, even if they no longer qualify as a dependent, nor are covered by your health plan.

(And for future planning, try to bunch elective medical procedures into years that you’ll qualify for a medical deduction.)

Now, here is a tricky part.  If you are sharing the cost of a loved one with others, use caution.  You may only write off the medical expenses that you pay directly.  Say, if your brother pays for your mom’s expenses in full and you reimburse him later, you cannot write that payment off.   Also, your brother couldn’t write off the whole expense, only the portion he was not reimbursed for.  So he wasn’t being sneaky and trying to get the full write off, but you aren’t getting the tax deduction you could be.  Plan carefully.

Speaking of planning, when it comes to elective procedures (a knee surgery, for example), try to bundle all of them for your family into one tax year so you qualify for the deductions, assuming your cash flow allows you to do this.

What you can NOT deduct:

Just because something is good for you, doesn’t mean it can be tax deductible.  While a gym membership will help you get in shape (in theory) and a vacation might improve your mental health, unless you have a prescription for these, they are not a medical tax deduction for you.  You should keep the following off your returns unless you meet the exceptions:

• -HSA-, FSA-paid services (Health Savings Account, Flexible Spending Account).  FSAs are contributions that are already pre-tax, and HSAs are deducted separately.  Use IRS Publication 969 for reference
• -General health-related vitamins or supplements, etc., unless with a doctor’s prescription
• -Over-the-counter drugs (such as aspirin or cold medication, even if a doctor recommends it.  The only exception: insulin)
• -Everyday personal use items unless used for an illness (you can’t write off your toothbrush)
• -Gym or spa memberships
• -Weight loss programs (unless prescribed to treat a diagnosed condition such as obesity)
• -Vacations (even if it would improve your general wellbeing)
• -Cosmetic surgery (unless to repair a deformity caused by a condition or accident)
• -Teeth whitening
• -Hair transplant, or hair removal
• -Babysitters, childcare, or diaper service for a healthy child
• -Medical marijuana or other controlled substance (your state may allow it, but it’s still a federal violation. Don’t go there.)

More Info

Now that you have itemized your medical expenses using tips #2-11, go back to the first tip to see if the itemized deductions you just calculated are at least 7.5% of your adjusted gross income AND are more than the standard lump sum deduction you would qualify for.  If the itemized deductions are ONLY 7.5% of your income but NOT higher than the standard lump sum, you are better off taking the standard deduction.

This list is by no means exhaustive, so find more scenarios and details on additional tax deductions at IRS publication 502.  It is always best to seek the advice of a CPA when dealing with complex tax situations, so do forward this article to yours to start the conversation and to avoid potential misinformation.

Rebecca Woodcock is an entrepreneur and cofounder of Cake Health, a free online tool for managing your health insurance. You can connect with her on Twitter and Facebook.

AOL’s WalletPop recently wrote about this program, which caught our attention because… well, how couldn’t it? We all know how expensive healthcare is these days, especially for the uninsured.

So here’s how the Artist Access program at Woodhull Hospital in Brooklyn, NY, works. Say you play the piano, but have no health insurance coverage: a common situation among self-employed artists.  Through the program, you arrange to perform for the hospital staff or patients. You are paid with “credits” that you can then use to cover your hospital bills.

At this point you’re probably wondering how many hours one would have to clock in to cover a doctor’s or emergency room visit. This is where the other pleasant surprise comes in. Uninsured patients at Woodhull Hospital actually pay a flat fee of $15 to $60 for doctor’s visits, including things like x-rays and lab tests. Most artists end up paying around $20 per service.

Since most artists earn about 40 credits for each hour they perform at the hospital, they earn enough credits to cover two visits. By the end of 2008, WalletPop writes, more than 400 artists had earned credits this way.

So what kind of skills can you barter in for healthcare?  Some have painted, others – trained in yoga breathing – have worked with breast-cancer patients, yet others have read to children in the waiting room. The hospital even has a program in the works through which photographers will take pictures of newborn babies to give to the mothers as a thank-you gift.

You already wish you lived nearby, don’t you? So do we. But even more, we’re hoping that more hospitals throughout the country will take after Woodhull Hospital’s example and start implementing bartering programs of their own.

As a side note, WalletPop tells us in its video report (above), bartering for healthcare isn’t unheard-of in the United States. In the last years of his life, President George Washington bartered for healthcare services. He traded in 30 gallons of whiskey.

To learn more about this program, be sure to check out this video from WalletPop.