When it comes to group health plans, employers, brokers, and consultants have come to expect that competitive change will come from within the insurance company marketplace. The expectation is that insurance companies will create a new plan, a new process, a new program, or a new procedure that will lower the cost of insurance for businesses and employees alike.
With so much innovation in our world today, why would we think any differently? After all, we have the expectation that change will continue and improve everything we do every day. The new iPhone 8, self-driving cars, new apps, voice activation such as Alexa, faster computers, and on and on.
While insurance companies have brought some new things to the table to assist employees in the navigation of health care, they really haven’t done much to make it more affordable. Sure, they given us tools with which to shop for care in cost and quality (transparency), but it hasn’t helped lower costs. When everything in the healthcare world is overpriced to begin with, simply shopping for the lowest inflated cost doesn’t give the consumer much of a benefit at all.
When you get a Chevy that’s priced like a high-end Mercedes, Lexis, or Ferrari, but is still a Chevy – what are you paying for? It’s still a Chevrolet. You can shop price for a MRI at different locations, but if they’re all priced at a high-end price, what good does that tool do for you?
Everyone needs to step back from the paradigm that we’ve become so accustomed to, and rethink what is possible. Reexamine how, why, and what we’ve done for so long in the healthcare benefits world. We’ve simply accepted the historic process of purchasing health insurance – whether self-funded or fully insured. Quite frankly, we continue the Definition of Insanity.
If your health care costs are giving you and your employees heartburn and angst, how about challenging the status quo? Change your approach. Re-tool and consider other “non-traditional” options. Don’t go through the same historic processes. Change your tactics, viewpoints, and perspectives. Of course, if you are happy with your costs, don’t rethink what is possible – continue what you’re doing until you feel the pain.
A couple of weeks ago, an employee of one of my clients emailed me with a balance bill from a facility on the front range of Colorado (Denver area). The balance bill was 10’s of thousands of dollars more than what his Explanation Of Benefits from the Claims Administrator indicated what was really his responsibility – deductible, coinsurance, etc. He asked me if he should send it to the Advocacy Center at the Claims Administrator’s offices. I responded yes -send it to them. He emailed me again and said, it’s crazy how little the facility was paid. I responded again that I look at in a different way – it’s crazy how much they charge. He agreed, and said that the balance bill didn’t even cover the doctor or the anesthesiologist for this outpatient procedure!
Sometimes we don’t know what we don’t know, and sometimes we don’t know what is possible.
If you want to know what is possible and what you can do, call me at 970.349.7707 or email me at [email protected]