Each open enrollment period, as employees evaluate the best plan for themselves and their family, transparency in health care costs is a top concern. And with the ever-increasing popularity of High Deductible Health Plans (HDHPs), this topic is not going away anytime soon.
A question we often hear from employees is, “Am I better off paying more to be in a copay plan, or will I come out ahead if I go with an HDHP?” When a discussion about potential health care utilization ensues, the conversation shifts from the cost of insurance to the cost of care. Employees want to know how much their expected medical procedures will cost so they can make the right “buying” decision.
Unfortunately, as most of us know from firsthand experience, shopping for health care is much more challenging than shopping for groceries, so it can be difficult to pinpoint exact costs or “find a good deal” for the services your primary care provider thinks you may need. This leads to patient frustration and even impacts health care choices. In fact, a Kaiser Family Foundation survey showed that almost half of patients with insurance either delayed or opted not to seek follow-up tests or treatment recommended by their PCP.
In recent years, health insurance carriers have responded to marketplace demand for improved transparency by providing health care treatment calculators. For example, Excellus BlueCross BlueShield promotes average estimated out-of-pocket medical costs for more than 1,600 treatment categories and 400+ procedures, including treatment timelines with a breakdown of costs throughout. MVP Health Care has a Treatment Cost Calculator powered by Truven Health Analytics which allows users to access cost estimates for hundreds of medical treatments and services, research health care expenses while estimating out-of-pocket costs based on their enrolled health plan, and compare costs from different providers within a specified area.
United Healthcare’s internal claims analysis showed that those who look at costs first may pay up to 36% less for their care. In addition to potential savings, UHC’s cost estimator touts the ability to obtain quality ratings and reviews by provider, hospital, or facility. And Aetna’s cost estimator allows users to compare costs for over 650 medical tests, services, and procedures at up to 10 doctors, facilities, or hospitals at once. The cost estimator tells you where in your area you can find these services, and it uses your own plan details, such as your deductible and coinsurance, to give a more accurate estimate.
Beyond health insurers, there are innovative companies that are helping employers control costs by engaging employees with health care price transparency tools. Healthcare Bluebook is a pricing transparency solution available to employer-sponsored health plans. It allows members to shop for providers based on costs and quality rating. To help promote this with employees, Healthcare Bluebook offers an engagement rewards program that includes 400+ rewardable procedures such as diagnostic mammogram, colonoscopy, and CTs, as well as more involved procedures like total hip and knee replacements. Reward amounts range from $25 to $1,500. Healthcare Bluebook uses digital engagement to educate, reinforce, and remind members of this resource. It even lets them know when they miss an opportunity to get a reward, in hopes of helping them in the future.
Lastly, the federal government has also taken some big steps to improve transparency in health care. In late 2019, the U.S. Department of Health and Human Services announced two significant regulations in response to an executive order. One rule was directed to health insurers; it requires them to give members estimates of their out-of-pocket costs and disclose negotiated rates for in-network providers. The rule is scheduled to be phased in beginning January 1, 2022. A second HHS rule, which became effective on January 1, 2021, requires hospitals to publish the negotiated rates they reach with insurers.
Navigating the cost of health care can be difficult, but we are here to help. If you have any questions, don’t hesitate to reach out at info@bondbenefits.com.