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Op/ed: The New Year is a great time for a new strategy for health care expenses

January 2, 2015

As published in the Pacific Coast Business Times (January 2, 2015).

By Lisa Spiwak

With insurance covering less and less these days, it is essential to take responsibility for our own finances, and that should include medical expenses.

I’ve had the good fortune of always being able to afford health insurance. For years I had PPO plans that had small deductibles and covered at least 80 percent of my medical expenses. As time has gone on, I am consistently paying more for health insurance and finding that less and less is covered under my plan. This appears to be a widely experienced phenomenon.

When a person’s budget tightens, it is common to engage in careful comparison shopping for any given product to get the best price for that product and stretch your dollars. People also tend to consider what is truly necessary in tough times and what they can do without. However, this common practice does not seem to hold true with health care expenses. We go to our doctors and follow their advice like sheep without questioning the necessity of any of it.

The time has come to take a more proactive role in keeping our own medical expenses down. This is done by becoming better informed. Information must be gleaned by asking a lot of questions of your doctor and questioning whether the medical procedure being recommended is really necessary or if there is a more cost-effective alternative.

I recently had a pain in my foot and went to the podiatrist. He X-rayed it and said that I had a stress fracture and that I should wear a boot for eight weeks. He then suggested that I go and get a bone density test done to determine whether I have a bone density issue. In the old days, I would have made an appointment immediately for that test. Now things are different. If the podiatrist was the one that had to pay for my bone density test, would he still have advised it? Probably not. There is nothing wrong with getting the test, but if it is not necessary, then why do it?

Another important question to ask your doctor when he prescribes medication is whether there is a generic brand of the drug that you can take in the alternative. Again, since your doctor is not paying for the prescription he writes, he is not concerned with the cost of it. Many doctors will only write a prescription for a generic brand of drug if you ask them to. Otherwise, they will just advise your pharmacist to give you the name-brand drug.

When my son got a throat infection and had to go on antibiotics, his pediatrician prescribed a particular antibiotic. I had the prescription filled and it was over $200. I asked the pharmacist why it was so much money and he told me that this drug was particularly expensive and that there is a much cheaper generic brand available. I asked him why my doctor did not prescribe the cheaper generic brand, and he said that doctors usually only do that if they are asked to. Otherwise, they just prescribe the name-brand drug regardless of its expense. I am confident that if the doctor had been buying the medication for his own son, he would have prescribed himself the generic brand.

Last year my colleague had a kidney stone and ended up in the emergency room. They ran a battery of tests on her, including an MRI, and sent her home with pain killers and told her that she would have to wait until the stone passes. The stone did eventually pass and she was given a bill for $15,000 from the emergency visit for which $4,500 of it had to be paid out of her pocket. Were all of those tests really necessary? Probably not. If she had been savvy enough to ask the right questions, her exorbitant medical bills could have been avoided or at least drastically reduced.

The bottom line is that we have to take responsibility for our own finances and that should include medical expenses. With insurance covering less and less these days, it is essential to your economic well-being.

Lisa Spiwak is a partner with the firm Spiwak & Iezza in Thousand Oaks specializing in commercial collection litigation. Reach her at


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