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5 simple tips to help your employees get more from their healthcare benefits

By David C. Fortosis  bio

Health insurance and the U.S. healthcare system have become increasingly complex and confusing. Despite promises for a better consumer and patient experience from insurance companies and niche vendors, that dream is still elusive.

Dr. Sachin Jain, Harvard MD and CEO of CareMore Health recently said, “The U.S. healthcare system is never so ugly and frightening as when you or a family member has to enter it for care.”

Insurance benefits feel less like a benefit than ever. Why? First dollar coverages, such as office visit copays have evolved into higher deductibles and out-of-pocket cost=sharing and are placing heavy financial burdens on American working families.

A 2018 Survey of 1,000 patients by 20/20 Research noted that 64% of patients avoided care due to high out-of-pocket costs (the majority had deductibles greater than $1,000/year). In fact, 44% of those patients said that they would NOT seek care if the bill was $500 or more even if it put their health at risk.

FDIC data (documented by Magnify Money) indicates that half of Americans have less than $4,830 in savings. On top of that, many employees are buried in debt. Northwestern Mutual’s 2018 Planning and Progress Study found that Americans have an average of $38,000 in personal debt that excludes home mortgage debt.

This would all suggest that paying for healthcare has become a barrier to care for many.

Tips to help your employees get the most out of their benefits

So, how can your employees and their families squeeze value out of a system that is just not very user friendly?

Tip #1: Take advantage of first dollar coverage!

The Affordable Care Act mandated that insurers had to offer a free, annual preventive care visit for insured members. Sadly, many American workers do not take advantage of this no cost benefit. The reason that the ACA promoted a no cost annual Primary Care visit is that there is ample evidence that healthcare costs are lower for adults that established a relationship with a Primary Care Physician (PCP) early in their adult lives and stayed with that physician over the years. It is not too bold to expect that every adult should select a provider from this list: Internal Medicine (preferred), Family Practice, or General Practice. Sometimes an Ob-Gyn can serve as a well woman physician and infrequently also as a primary care physician but that is not ideal. Ob-Gyn physicians would likely not have office visit slots for a patient that just had the flu or needed to diagnose a sprained knee. So primary care is really important. One advantage of having a PCP is that he or she gets to know their patient over the years and can offer better counsel and support because a relationship has formed. And it is easier for a PCP to provide advice over the phone if he/she knows their patient well.

In this era of hospital mergers and acquisitions it is important to note that your care, should you need it, will be better coordinated within one hospital system. So understand which health system/s your PCP is aligned with or employed by. Finally, it may help to do your homework. Consider reading Dr. Peggy Rothbaum’s book, “I Have Been Talking with Your Doctor,” which contains useful insights on how to interact with and develop a meaningful relationship with your PCP.

Tip #2: Understand all provisions of your coverage

There are compliance regulations placed on insurance companies and employers that require them to provide employees with a Summary of Benefits Coverage or a Summary Plan Description. Your employees should ask for a copy and actually read it to understand all the provisions of coverage BEFORE they need care. Some employers also provide a document that is given to new hires that documents all benefits at a higher level. That is also a great document to keep handy, especially the phone numbers of the various vendors and insurance companies that you may need to call.

Tip #3: Plan ahead for urgent care

Hospital emergency rooms and free-standing emergency facilities are the worst possible place to get urgent and routine care. These are very expensive sites of care. And with deductibles as high as they are, you’ll be paying a lot of money out of your own pocket until your deductible is met. Instead, get the most out of your PCP office. You can do this by:

  • Researching the hours that your PCP offices are open as your doctor/nurse will be able to address some urgent medical issues (e.g. migraine headaches) by phone; and
  • Knowing exactly where the Urgent Care centers are near your workplace and home. It is too stressful to try and find one if you have an urgent medical need. In fact, put their address into your GPS for easy use if needed.

Tip #4: Take advantage of telehealth

More employers are offering virtual medicine or telemedicine (e.g. TeleDoc) for medical issues that are not emergent, such as pink eye or a child with a high fever. These are very affordable (usually just a flat fee) just-in-time consults with an M.D. that can bring immediate attention to a condition that needs to be discussed with a physician. These services can be provided via telephone or video chat. Today, these services have very low utilization. Why? Because employees don’t the time to register and enter key information into the app, such as insurance company, user cell phone numbers, and a credit card. So, when they need the service, they are too distracted to register and then just go to the ER or an urgent care center. If you register before you need the service, you will likely gain the advantage of expert medical advice faster, cheaper, and in your own home.

Tip #5: Ask your doctor to watch for patterns

I was in a meeting with physicians recently and one of them remarked that the information gleaned from regular blood lab values (sometimes call biometric screening values) is still the most impactful way to develop a meaningful, personal dialogue with a PCP about your health risks. For example, if she sees an annual pattern of high blood pressure, high blood glucose, or high blood lipids, she is more able to diagnose a condition that needs attention. And provide counsel about nutrition and activity that can address the source of the health risk not just treat the symptoms.

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