Cost transparency vs. your favorite doctor?

November 6, 2015 Ray Catudal

Did you know that your doctor belongs to a certain network? When you’re shopping for health plans during this open enrollment, make sure to understand if your doctor is in the network. Health and Human Services (HHS) has understood this need and has launched a new tool that “allows consumers to search plans by their preferred provider or health facility.”

HHS also prides itself with how much money you can save by shopping around during open enrollment. However, switching plans to save $400 may mean you have to give up the doctor that you’ve been seeing. Studies show that doctor selection is still one of the most important factors when choosing a health plan. It’s not as critical for younger people as it is for older folks, but it’s important enough that the government has toughened provider network directory rules for health plans. They’re now obligated to keep their provider search tools up-to-date on a monthly basis.

Cost could be a deal breaker

However, it may not be about your doctor anymore. Even if you’ve figured out that your doctor is part of the plan you’re considering, what if the procedure you’re planning for next year is more expensive than with another in-network provider?  What if everything is more expensive than with other providers in your network? And how do you know what services you’ll need anyway?

With the increasing popularity of consumer driven health and high deductible health plans, employers and consumers are looking to save on costs. Consumers are increasingly turning towards HSA eligible plans and are enrolling in more HDHPs at a growth rate of 15% per year. They are doing this because their employer is offering a contribution or because they think it makes good sense to set money aside that can be used for health care and retirement. Having HDHPs is encouraging people to be more cost conscientious because they may have to pay a lot out-of-pocket before they hit their (high) deductible and the insurance company starts paying the bills. Consumers are looking for deals in a landscape where prices for in-network services vary by 300%. Also, they want to make sure they understand if out-of-network doctor visits apply towards their HDHP deductible.

Know when to hold them and when to fold them

There are some good cost transparency tool like Healthcare Bluebook that can help people figure out what standard procedures may cost. Studies show consumers won’t stick to their doctor at any cost; there is a limit. Calculating that limit used to only happen at the premium level, but now it’s become more complicated. Taking future health care utilization into consideration can help to truly find out if a doctor or facility is worth the price. You may have to let go of the idea of keeping your doctor in order to participate in the savings that HHS is touting and/or the benefits of an HSA eligible plan.

How are your tools?

With all these tools already out there and new ones coming, consumers will certainly feel overwhelmed. By the way, what is your website tool utilization rate, and how effective is it? One of the more successful modern website tools is an Interactive Virtual Assistant that helps consumers understand their health care options, how to use their plans, and how to pick the best plan for themselves. They even help enhance the utilization of tools built into your website. 

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About the Author

Ray Catudal

As Director of Healthcare Consulting, Ray is focused on CodeBaby’s healthcare specific customers and delivering on CodeBaby’s mission of customer centricity. With over 20 years of experience in medical devices, healthcare and technology, specifically: ehealth, health insurance, and software, Ray is a subject matter expert who contributes to industry articles, and speaks at trade shows and events.

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