Fool me twice and a third time please

Imagine having a high deductible health plan (HDHP) and finding out (after your visit) that the cost of your MRI is $5,500 of which you are responsible for $2,000 plus another $1,050 towards your 30% coinsurance? All in, your out-of-pocket is $3,050. Then to add insult to injury, you discover you could have had the very same MRI less than a 1/4 mile away for $500. 

This is the reality for many Americans, except for one important exception; they never discover the $500 alternative. Which of course means they run a high chance of doing the same thing next time.  Of course this costs the employees substantially more AND drives up the employers claims resulting in higher premiums.  Now, plug in Colonoscopy for $13,000 or $1,800 OR total knee replacement for $77,000 or $27,927.  

Now imagine that you're an employer with 250 employees and you had 30 employees do the same thing last year.   You can see we have a problem.

Why is this? Many Americans and my benefit advisor colleagues would like to blame the system. There is, of course, some truth to this. We can debate whether insurance carriers should play a more proactive role in steering members towards high value lower cost alternatives, but that would be a waste of time. Many others blame the monopolistic hospital-owned healthcare systems that steer patients towards the higher cost services. Again, those arguments fall on deaf ears. Healthcare and health insurance are BIG business and businesses provide the services that they perceive their customers want. The message that employer sponsored health plan members have made lound and clear is that they want larger networks with access to the most doctors (whether they see them or not). 

Yes, they wish for lower premiums and out-of-pocket expenses but to what extent are they willing to work for them?  The truth of the matter is many employers especially those that aren't impacted by community rates have tremendous potential to reduce their insurance costs by better managing their healthcare costs.  Whether an employer is fully-insured, uses alternative funding, or has an HSA or HDHP with employer funding there are solutions that can help reduce the healthcare spend by 15-40%.  It seems unbelievable but it is happening every day throughout the country at companies that have had enough with the out of control insurance costs and are willing to spend some additional time with their benefits advisor.  Yet, there are many more that simply accept the status quo and move on without exploring new and creative alternatives that can have a significant impact on their business, their employee and their families.

Notice I said benefit advisor not insurance broker.  There is a big difference!  A broker focuses on the insurance, an advisor focuses on what drives the insurance spend; the claims.  Focusing only on the insurance is like changing credit card companies to take advantage of lower interest rates for the first 10 months.  Your in the exact same spot next year and haven't even looked at the cost of the merchandize your buying.  Make no mistake, when you secure insurance you are simply financing your companies health insurance costs.

You need to know your data, what your specific company is spending on healthcare and prescriptions.  Once you know your data, you can address the areas that can have the greatest impact always with the attention of getting your employees the very best care at a fair price.

So I don't blame insurance carriers or healthcare system.  We have no one to blame but ourselves.  While we may have been ignorant or placed too much trust in others, the truth is we all know or can see the information and we are still allowing ourselves to be fooled.

So it would be easy to tell the hospital 'shame on you' for fooling you once, but we have to say 'shame on me' when we allow them to fool us over and over again.

If you have been looking for solutions or creative ideas so you can take back control of your health insurance spend start by understanding your healthcare spend.  If your current broker won't help you or simply doesn't understand, you should reach out to a Health Rosetta Advisor.  To learn more about Health Rosetta and find an advisor near you go to https://healthrosetta.org/who-we-are/health-rosetta-advisors/

Lou Bernardi, President, Group Planners Inc.