HOW CAN I BE A BETTER
HEALTHCARE CONSUMER?
MOTT COMMUNITY COLLEGE
Chadd Hodkinson
SET SEG Employee Benefit Services
Senior Benefit Consultant
The content in this presentation is informational.
Each employee should review the benefit
summary and network information specific to
their plan and discuss specific circumstances and
questions with their carrier.
TOPICS OF DISCUSSION
• What makes a wise healthcare consumer?
• Why should I become a wise healthcare
consumer?
• How can I become a wise healthcare consumer?
• What resources are available to me?
WHAT MAKES A WISE
HEALTHCARE CONSUMER?
Wise Healthcare Consumers:
• Know how to choose a healthcare plan to fit their family
• Choose their care providers carefully
• Ask questions about procedures
• Practice preventative care
• Understand their prescriptions
• Review bills and EOBs
WHY SHOULD I BE A WISE
HEALTHCARE CONSUMER?
• Control your healthcare costs
• When members…
o engage in conversations with their doctors
o access in-network doctors/facilities
o ask questions before partaking in expensive medical
procedures
…they can save money
HOW CAN I BECOME A WISE
HEALTHCARE CONSUMER?
• Educate Yourself
o Make more conscientious healthcare decisions
• Put in Effort
o Become more engaged with your healthcare
IN-NETWORK DOCTORS AND
FACILITIES
• In-network providers have agreed to see
patients at lower, negotiated rates of
service, saving you money
• Out of pocket costs (deductible,
coinsurance, copayments) are lower when
visiting an in-network doctor or facility
MAKING THE MOST OUT OF
DOCTOR VISITS
• According to a study by UCLA, patients usually have
questions, but ask them less than 10% of the time
• Before you see a provider, prepare a list of questions
about:
o
o
o
o
o
Symptoms
Diagnosis
Treatments
Medications
Testing
MAKING THE MOST OUT OF
DOCTOR VISITS
Be able to describe your symptoms.
• Describe your problem
• Are you in pain?
• When did the problem start? Has it changed since then?
• What makes it go away?
• Have you felt like this before? If so, when?
• Have you had any other symptoms (e.g., fever, shortness of
breath, insomnia, nausea)
MAKING THE MOST OUT OF
DOCTOR VISITS
Ask questions about your diagnosis.
• How certain are you about this diagnosis? Are there
additional symptoms to look for?
• Will this diagnosis increase my risk for other conditions?
If so, are they preventable?
• Is my condition chronic or acute?
• Is my condition contagious?
MAKING THE MOST OUT OF
DOCTOR VISITS
Ask questions about your treatment.
• Why would this treatment be good for me?
What are the chances it will work?
• How much will this treatment cost?
• Will this treatment cause any side effects?
• Are there other treatment options?
MAKING THE MOST OUT OF
DOCTOR VISITS
Ask questions about your prescription medication.
• What will this medicine do?
• When, how often, and for how long should I take it?
• Could there be side effects? What should I do if they occur?
• Is this medicine OK to take with other medications?
• Is there anything I shouldn't do while taking the medicine?
• Is there a less-expensive, generic equivalent?
MAKING THE MOST OUT OF
DOCTOR VISITS
Ask questions about your test.
• How will this test tell what is wrong?
• How accurate is the test?
• Is the test invasive or non-invasive?
• Where will I go for the test?
• How and when will I get the test results?
• Will more tests be needed?
• Is this test necessary? If so, why?
MAKING THE MOST OUT OF
DOCTOR VISITS
Provide as much background information as possible.
• Medical history and your family's medical history
• Allergies
• Medications you’re taking
• Daily habits (e.g., how much you sleep, whether or not you
smoke)
• Occupation
• Pressures/stress
HIGH DEDUCTIBLE HEALTH
PLANS (HDHP)
• Have a deductible of at least $1,300 for a single
person and $2,600 for a couple or family
• Employee pays 100% (except for preventive care) of
medical and prescription drug costs (less any
carrier discounts) until deductible is met
• Copays do not apply until deductible is met
HIGH DEDUCTIBLE HEALTH
PLANS (HDHP)
• HDHPs encourage member engagement and
awareness of costs
• Employees generally look for ways to decrease
their own healthcare spending
• HDHPs can help generate discussion between
members and health care providers
HIGH DEDUCTIBLE HEALTH
PLANS (HDHP)
• Monthly premiums are typically far less than a traditional
plan
• Premium savings can be contributed tax free to a health
savings account (HSA)
• In years when less healthcare is needed, savings stay with
the member
• In years when more healthcare is needed, overall
spending (premium cost share and deductible/copays) is
generally less than with a traditional plan
HEALTH SAVINGS ACCOUNT (HSA)
• The account and its contents belong to you (not
your employer)
• Rolls over year after year (no “use it or lose it”)
• Fully portable should you decide to leave the
high deductible plan or the college
• Accessible in retirement
HEALTH SAVINGS ACCOUNT (HSA)
•
Money goes in tax free, can grow tax free and comes
out tax free (if spent on approved medical expenses)
•
Can save 25% or more on medical expenses if HSA
contributions are made through payroll deductions
(Use on dental or vision expenses to increase overall
savings)
•
Cannot contribute to an HSA if enrolled in a nonqualified health plan (including Medicare)
EMERGENCY ROOM, URGENT
CARE OR PRIMARY CARE?
• Know when to seek medical care at the ER, Urgent
Care or through your primary care physician
• Seeing a primary care physician is substantially
cheaper than visiting an Urgent Care or ER
• If you think it might be an emergency, go to the
emergency room!
PRIMARY
CARE
URGENT
CARE
PRIMARY
CARE,
URGENT
CARE
& EMERGENCY CARE?Typical business
Hours
Typical business
hours:
9 a.m. – 5 p.m.
Accessibility
Typically by
appointment
Uses
hours, but also
weeknights and
weekends
Walk-In or by
appointment
Acute illness
Checkups, physicals,
illnesses that can wait (rapid onset and short
duration; regulated with
for an appointment
OTC prescriptions)
EMERGENCY
24/7
Walk-In
Threat to life or limb
SAMPLE COSTS:
Urgent Care
Emergency Room
Acute bronchitis: $127
Acute Bronchitis: $595
Earache: $110
Earache: $400
Sore throat: $94
Sore throat: $525
Sinusitis: $112
Sinusitis: $617
Upper respiratory
infection: $111
Upper respiratory
infection: $486
PREVENTIVE SERVICES
• Approved services are covered at 100% for plan
enrollees with no deductible or copay liability (no
enrollee out of pocket cost)
• Services must be received in-network
o Ex: annual physicals, well baby check-ups, some
immunizations, etc.
• Confirm with carrier that scheduled services are
preventive
MANAGE CHRONIC CONDITIONS
• Although it’s not considered preventive, it is
often less costly to manage a condition rather
than to treat an unmanaged condition
• Learning to control your condition can help you:
o
o
o
o
Improve your quality of life
Save money
Avoid disability
Prevent untimely death
PRESCRIPTION MEDICATION
MANAGEMENT
• Talking to your doctor about generic alternatives
can save large amounts of money
• If it is determined by your doctor that the name
brand will work best for your condition, prior
authorization may be required
PRESCRIPTION MEDICATION
MANAGEMENT
•
•
•
•
Always ask for a generic medicine
Remind pharmacy to use prescription card
Ask pharmacy if the claim went through Blue Cross
Ask doctor for a 90 day prescription for
maintenance drugs
• The majority of Tier 3 drugs have a less expensive
alternative or equivalent in Tier 1 & Tier 2
PROVIDER BILLS AND
EXPLANATION OF BENEFITS (EOBs)
• Medical billing is complicated and mistakes happen
• Review your bills as they come in from providers to
make sure services you were charged for were
rendered
• Contact the provider if you believe there is an error
• Compare the charges and member responsibility
on your bill to the amounts listed on your EOBs
PROVIDER BILLS AND
EXPLANATION OF BENEFITS (EOBs)
• Your EOB is a window into your medical billing
history
• Review EOBs carefully to make sure:
o you received the service you’re being billed for
o the amount your doctor received and your share
are correct
o your diagnosis and procedure are correctly listed
and coded
HOW TO READ A PROVIDER BILL
• Ensure your insurance is on file/was applied
• Ensure services you were charged for were services you
received
• Find your patient responsibility total
• Find out where you can pay
• Locate a customer service number if you have questions
or find an error
Ensure insurance is on
file/was applied
Find your patient
responsibility total
Find out where to pay
provider
Ensure services you were
charged for were services
you received
Contact customer service if
you have a question or there
is an error
HOW TO READ AN EXPLANATION
OF BENEFITS (EOB)
• Ensure your personal information is correct to avoid
processing errors
• Compare charges on an individual basis
• Make sure charges match bill provider has sent (date of
service, services rendered and approved charges)
• If you find an error, contact provider and/or Blue Cross
EOB SAMPLE:
EOB SAMPLE:
EOB SAMPLE:
EOB SAMPLE:
EOB SAMPLE:
EOB SAMPLE:
WHAT RESOURCES ARE
AVAILABLE?
WWW.BCBSM.COM
•
•
•
•
Online health assessment
Informational resource library, calculators and quizzes
Smoking cessation tools
Blue Cross Blue Shield’s website also offers ratings and
other information about providers and facilities
Find out if
Provider
accepts
your plan
Compare
ratings of
Providers
BLUE CROSS BLUE SHIELD OF MICHIGAN
TRANSPARENCY TOOL
WHAT RESOURCES ARE
AVAILABLE?
www.webmd.com
• WebMD provides information on various
conditions
• Knowledge empowers you to ask your doctors
questions about generic prescriptions, alternative
therapies and recommended procedures after a
diagnosis as been received
Tools and
Resources
can aide in
education
General
Overview for
education
WHAT RESOURCES ARE
AVAILABLE?
www.guroo.com
• GuRoo allows members to price shop medical
procedures
• Provides national average pricing
• Powered by the Health Care Cost Institute
• Described as an independent, nonprofit organization
oriented to provide honest, clear insight into health care
costs
WHAT RESOURCES ARE
AVAILABLE?
www.healthcarebluebook.com
• Healthcare Blue Book also provides a tool for pricing
surgeries, testing, medication and more
• Provides local pricing
• Partners with organizations and providers who strive to be
transparent
• Prices are based on information gathered from these
partners
Local
prices of
procedures
Alternative
options
Healthcare Blue book offers a variety of
services to price shop
WHAT RESOURCES ARE
AVAILABLE?
www.ahrq.gov
The Agency for Healthcare Research and Quality
• educational videos
• Question Builder for doctor visits
• Health Priorities self-assessment and free printed
materials
http://www.healthylife.com/
The American Institute of Preventative Medicine
• An authority on the development and implementation
of health promotion, wellness, medical self-care, and
disease management programs and publications
QUESTIONS?