Being a Smart Health Care Consumer Ain’t Easy!

Yesterday, we found out one of our WOT sons has a torn ACL. Ouch! The doctor wanted him to get an MRI right away and set up an appointment at a local facility. Since we have a high deductible plan, the MRI costs $1,000 out of pocket. Wowsers! I pointed out to his mom that she could probably get the MRI cheaper at another place, but she felt she had to follow the doctor’s orders. After all, her son is in pain, he may need surgery and she wants to get everything handled ASAP before school starts up again.

I tell you this story to make a point: being a “smart health care consumer” sounds good on paper, but it ain’t easy.

As a caring HR professional, what can you do to help guide your employees? Be open and honest. Tell them it takes effort to do the research but it’s worth it because it will save them money. Then do your own research to identify the best tools they can use and point them in the right direction.

During annual enrollment

  • Open employees’ eyes to the fact that not all providers cost the same. In fact, costs can be dramatically different among providers, even though the quality is the same.
  • Make sure employees understand the cost they pay under a copay plan is much lower than the “real” retail cost.
  • Strongly encourage the use of “health plan comparison” or “run your own scenario” tools.
  • If employees are moving from a copay plan to a high deductible plan that requires them to pay the full retail cost:
    • Provide direct links to your prescription administrator’s site where they can find average retail costs; or
    • Tell them to take their list of monthly prescriptions to their local pharmacy and ask for the current retail cost. (Prescription out-of-pocket costs are usually the biggest shock to new enrollees in high deductible plans.)
    • If available, provide links to health plan service/procedure estimators; or
    • Suggest they reach out to their caregivers to determine the full retail cost for services.

After annual enrollment

Continue to educate throughout the year on topics such as the importance of asking questions, using generics versus brand-name drugs, taking advantage of provider selection tools on your health care administrator’s website, choosing urgent care versus emergency room care and so on. Be sure to use a variety of communication vehicles such as newsletter articles, blog postings, brown bag meetings, Q&A forums or one-on-one coaching sessions.

The better people understand how to access and use their plan, the more positive they will be about the plan. They may not become smart health care consumers overnight…but knowing where to go to get reliable information is a good first step.