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Info, tools & tips for the insurance savvy....
Unfortunately, medical care doesn't come in packages with clear price tags. Often, finding out exactly how much you'll pay to get the care you need requires perseverance and -- no pun intended -- patience.
The California HealthCare Foundation recently had a small army of "mystery shoppers" -- people posing as uninsured patients -- call or visit hospitals in the state asking for specific medical procedures. The mystery shoppers found that pricing information often resides with off-site billing personnel whom few hospital staffers could identify.
In more than 600 calls and visits, fewer than one-third of the mystery shoppers could get a firm price or estimate with a single inquiry. In an extreme example, one mystery shopper was routed to 17 different people before getting any pricing information.
The problem is not limited to California, nor is it something only the uninsured face. A survey by the Kaiser Family Foundation and USA Today found that 52 percent of people polled nationwide said their doctors never or rarely discuss the costs associated with the procedures they recommend.
What's more, employee benefit plans are raising deductibles and co-pays, forcing individuals to bear more of the burden of medical care. As this trend deepens, individuals will need to be able to compare prices before committing to medical procedures.
"People need to be better shoppers for health care because more of their health care costs will be paid directly from their pockets or will come from health savings accounts," says Maribeth Shannon of the California HealthCare Foundation.
Among other things, Shannon recommends that people get plenty of information from doctors before visiting hospitals. "It's important to have as much information as possible to help the hospitals identify what you need," said Shannon. "This way they can price procedures accurately." A key piece of information is the diagnostic code that doctors assign to ailments.
Shannon also recommends phoning the hospital before visiting. Mystery shoppers who called were able to get pricing information faster than those who visited.
Finally, Shannon recommends asking for discounts and payment plans to reduce costs and space out bills. "If you don't ask for a discount," she says, "it almost certainly won't be offered."
Health & Wellness Information, Physician Locator from WebMD
Read about today’s most current information and news on healthy living and medical issues by visiting WebMD. Find a quality physician near you by using the Physician Locator.
FirstGov’s Comprehensive Site for General Health Information
Stay informed about health issues with this comprehensive site targeted especially for consumers.
Reliable Health Information from Healthfinder
Search this government-backed, one-stop information source for health issues, using the health library, news, lists of organizations, online check-up and more.
Visit these sites for more information on choosing quality health care:
Hospital Quality & Safety Survey Results from the Leapfrog Group
Find out how your hospital ranks in the most recent quality and safety measures recommended by the Leapfrog Group.
California Healthcare Quality Rankings from HealthScope
Searching for quality health care in California? Visit HealthScope, one of the top independent resources for information on doctors, health plans and medical groups.
Physician, Hospital & Nursing Home Ratings from HealthGrades
What grade did your hospital receive? Find out with HealthGrades, the leading independent health care ratings company. More than 125 of the nation’s largest employers and health plans rely on HealthGrades’ ratings and advisory services.
Top 100 Hospitals from Solucient
Did your hospital make the Top 100? Find out by visiting Solucient’s list of Top Hospitals with information on benchmarks for success.
Guide to Choosing Quality Health Care from AHRQ
Find the information you’re looking for using the Agency for Healthcare Research & Quality (AHRQ). Search this comprehensive guide for information on choosing health plans, doctors, treatments, hospitals and long-term care providers.
U.S. News & World Report: Best Health Rankings
Find out which hospitals ranked the best nationally for treatments in cancer, geriatrics, psychiatry and many more areas.
Visit these sites for more information on choosing the right health plan:
Q-Biz
Using the latest technology, Q-Biz is a leading provider of retirement programs and employment benefit programs to small- to mid-size corporations and public organizations. Find out how Q-Biz can help your company today!
Designed for families & individuals without access to employer benefits, Family 1st Network is a resource for individual insurance coverages. Access plan info, get quotes, and apply online for a variety of coverages. Great service is always available online, over the phone, or in person!
Health Plan Report Cards from NCQA HealthChoices
How does your health plan stack up? Find out by viewing report cards issued by the National Committee for Quality Assurance (NCQA).
Health Plan Comparison Checklist from CMA
Need help when comparing health plans? Use the California Medical Association’s Health Plan Checklist to compare plans or summarize your current plan.
Family Health Budget Generator
Keep health care costs under control by budgeting ahead. Use Humana’s step-by-step guide to create a family health budget.
Americans enrolled in a relatively new type of health coverage designed to make them more cost-conscious are less satisfied with their health plan than those with comprehensive health insurance and are less likely to recommend the new plans to a friend or colleague, according to a new survey released by the nonpartisan Employee Benefit Research Institute and The Commonwealth Fund.
High-deductible health plans of $1,000 or more for individuals and $2,000 or more for families can be combined with tax-preferred savings accounts, such as Health Savings Accounts or health reimbursement arrangements. Employers can contribute money to HRAs and both employers and individuals can contribute to HSAs, which can then be used to pay for health care expenses not covered by the health plans. These consumer-directed health plans frequently have been called the latest big idea in health insurance in the United States. By giving more responsibility for costs to the consumer and theoretically providing cost and quality information about providers, the plans are designed to encourage participants to make informed, cost-conscious decisions about their health care.
The survey also found that those covered by these new plans, both with and without savings accounts, are more likely than those with comprehensive insurance to avoid or delay needed care. When they do get care, those in consumer-directed plans encounter larger financial burdens, compared with those with comprehensive insurance.
But individuals in the new plans do exhibit more cost-conscious behavior in their health care decisions – as the new plans intended – compared with those having comprehensive insurance, the survey found.
A full report on the study can be found at www.ebri.org and www.cmwf.org.
1. The year 2006 will mark the biggest change -- and biggest free-for-all
-- to hit the Medicare program since its inception -- Between 11 and 20
organizations are offering Medicare Prescription Drug Plans (PDPs) in
each Medicare-defined region. Nine organizations are offering PDP
coverage nationwide. In addition to PDPs, seniors face a huge range of
coverage choices, from Medicare Advantage PPOs and HMOs to private fee-
for-service plans. The Centers for Medicare & Medicaid is heavily
promoting regional PPOs as a way to extend access to rural areas, but
local health plans are still drawing the most interest.
2. Health plan mergers and acquisitions will continue -- In 2005, the
largest plans, UnitedHealth Group and WellPoint Inc., increased market
share through purchases of other health plans. Expect to see further
activity in 2006: CIGNA and Aetna have spare cash, and Coventry Corp.
seems ready for another acquisition.
3. Consumer-directed plans generate more media coverage than healthcare
coverage -- A lot of health plans and financial institutions like the
new Health Savings Accounts (HSAs) and their associated high-deductible
health plans. However, traditional first-dollar-coverage health plans
have loosened their restrictions in recent years and remain the first
choice among consumers. Despite a lot of discussion, this is unlikely
to change in 2006.
4. The uninsured remain uninsured -- Employers and government tried a
variety of innovative ways of getting healthcare coverage to the
uninsured in 2005. Attempts included "three-share" style plans in which
government, employers, and employees each kicked in a third of premium,
and Maine's launch of its Dirigo Health, but both saw poor uptake.
Small-scale attempts to deal with a large-scale problem are no more
likely to succeed in 2006.
5. Medicaid moves back toward managed care -- Texas, Ohio, and Georgia all
extended their managed care Medicaid programs in 2005, moving large
numbers of beneficiaries out of fee-for-service. This won't sweep the
country in 2006, but expect to see several companies, including Aetna,
extending their management of Medicaid.
6. Health plans continue their progress on encouraging electronic medical
records (EMRs), and 2006 could be a break-out year -- Health plans love
EMRs, which make tracking and quality checking of healthcare easier and
cheaper, and want providers to love them too. So the upgrading of
systems will continue, with dramatic initiatives by Kaiser, Blue Cross
and Blue Shield of Massachusetts, and others.
7. HMOs decline -- HMOs have been losing market share. A few bastion
states, like Michigan and Massachusetts, will have high HMO
participation, but, as employers move more and more to self-insurance,
HMO market share nationally will continue its decline.
8. Disease management expands -- Health plans will rely on disease-
management programs to attempt to control costs, and are beginning to
see results. The newest programs are in managing complex chronic
conditions such as hemophilia, scleroderma, and multiple sclerosis.
Such conditions are relatively rare, but greater oversight of each
expensive case can show good financial return.
9. Individual insurance plans with basic benefits increase market share --
As the cost of health insurance rises for employers of all sizes,
insurance is becoming more of an individual game. Health plans are
tapping into this market with basic-benefits plans for recent college
graduates, early retirees, and people between jobs.
10. Pay-for-performance shows its hand -- Health plans have been pushing
pay-for-performance measures on physicians for several years. 2006
will be a critical year for measuring return on investment now that
some P4P programs have several years' worth of data to evaluate. Does
P4P improve physician performance or pay already high-performing
physicians more for work they would do anyway? Results in 2006 will
help answer these questions.
If you're still mulling over the alphabet soup of health coverage options, here's a quick primer.
HMO (health maintenance organization): A prepaid health plan in which you pay a monthly premium and the HMO covers your cost of care to see doctors within its network at negotiated rates. Co-pays usually apply. You must choose a primary care physician who coordinates all of your care and makes referrals to specialists. If you don't use the doctors, hospitals and clinics in your plan's network, you usually will bear the cost.
PPO (preferred provider organization): A network of health care providers that provide medical services to a health plan's members at discounted costs. PPO members typically make their own decisions about their health care rather than going through a primary care physician.
POS (point-of-service): A type of managed care plan combining features of an HMO and PPO. You can go to a network provider and pay a flat dollar amount or go to an out-of-network provider and pay a deductible and/or a co-insurance charge.
HSA (health savings account): Lets you set aside pretax dollars for future medical, retirement or long-term care expenses. The funds roll over from year to year, and you can take them with you when you change jobs. You must be enrolled in a qualified health plan with high deductibles, which you pay out of your savings