  
The paradigm of how health care is paid for via health insurance and other benefits is changing, and you will do well to know what is happening so that you can maximize your care at a minimum of expense. Here is a simple overview discussing the past, why the past no longer works, what's happening now, and why it is important to be informed.
In the past, the standard was to get a comprehensive plan of health insurance through work. The plan functioned like this: you paid your premiums through a payroll deduction, and if you needed medical attention, you would see a doctor any pay a copay ($10, $20, etc.). Then you would get a prescription and pay another copay.
The problem is that this system masked the true cost of healthcare. Most people would not conside the behind the scened operations: insurance companies would get billed by doctors, hospitals, and pharmacies, and a lot of dollars were trading hands without the patient really knowing about it. As a result, the insurance companies kept profitability by increasing premiums. For example, a health plan from a mainstream provider that cost my family $300 a month in 2001 now costs $1200 today.
Because regular health insurance is cost prohibitive, other options are arising. As an alternative to not providing health plans at all, employers are offering plans that do not cover as much as plans once did. This point is so important that I'll repeat it with bold, underlined font: employers are offering plans that do not cover as much as plans once did. The purpose of this essay is to create awareness and give advice on how to maximize our new options.
Two popular plans now available are the High Deductible Health Plan (HDHP) and the Limited Medical Plan (or Mini-Med). HDHPs are plans that replace deductibles with a co-pay. For example, if you or a child has a fever, when you go to seek care, you have to meet your high deductible, likely in the $2600 (single) or $5200 (family) range before the plan starts paying.
Why this is worth a lengthy post is that these changes require a new way of doing business with health providers. If you don't, you will be surprised like us: a $10,000 medical bill we thought was covered by insurance was not. We found ourselves with a medical plan that was nothing like we expected.
So we got informed:
- Learn what your current plan covers and does not. Find out first if something you are thinking about doing will cover you as you think. Read all of your plan documents, even and especially the fine print. If we had studied our documents, we would have found out ahead of time that our $50.00 co pay would balloon 200 fold.
- Discover the lost art of negotiation. Our $10,000 bill has been reduced to $4700 because I called the hospital, the surgical center, and the physician and they all agreed to rate reductions. They do it all the time with insurance companies. In fact, health care providers are really retailers: they mark up to mark down. One ultrasound bill went from $705 to $60 (that's seven hundred down to sixty)!
- You can also negotiate before the fact. When with your doctor, explain how your plan pays and see if they can mark your paperwork so that your out of pocket is reduced. If they know you're footing the bill, they may adjust the billing.
- Shop around. If you're going to comparison shop for a TV, for a car, or for clothes, doesn't it make sense to shop for doctors and prescriptions? Just as a 24 pack of Pepsi doesn't cost the same depending on the store, neither does health care.
In conclusion, know that health care is now "consumer driven," meaning that the consumer (not patient, but consumer, because health care is a retail commodity) is bearing more and more responsibility for health care and its expenses. If we assume this responsibility well, we can all reduce the cost and improve the quality of our care. |
