I have a high deductible health plan—now what?
We are all used to shopping locally and online. We check out the product, check out the reviews and price compare to make our decision. But when it comes to health care, being a consumer is very difficult. How do we compare price and quality? What tools are available to help? How do we even begin the process?
Let’s start at the beginning…
- Do you have a primary care physician? These can be family doctors or internists. They can also be pediatricians for children from birth and up to age 18.
- If you do not have a primary care physician, then you need to establish a relationship with one. Get a referral from a friend or co-worker. Call and make an appointment when you are not sick. You want to be sure that you and your doctor have rapport. Think about looking at a practice that has many providers, so there will be availability to get in quickly when you are sick.
- Why do you need a primary care physician? Primary care physicians should be your main point of contact and will help to coordinate your overall care. They perform your preventive screening which is covered at 100% by the Alliance Health Plan. They will refer you to a specialist, if needed. and are the most cost-effective way to receive treatment. They help you avoid costly urgent care and emergency room charges.
- So you have your PCP and they have recommended that you have imaging done (i.e. MRI, mammogram, bone density test, etc.). How do you shop for an in-network imaging center? First, the hospital is the most expensive place for any procedure. Sometimes, when a doctor’s practice is owned by a hospital system, they will refer you to the hospital. But you don’t have to go there. Check on the Anthem website for stand alone imaging centers. Call them and ask for the Anthem price. Prices can vary dramatically between locations.
- What happens if the doctor suggests surgery? Ask your doctor about other alternatives to surgery that might be attempted first. You can also get a second opinion with another provider.
- After researching all the options, if surgery is still required, what then? Ask your provider if it is safe to be performed at an ambulatory surgery center. If so, be sure to check that the center is in-network. Also, beforehand check with the surgery center to make sure that the anesthesiologist or any billable assistants involved in the procedure are in-network. You can certainly call the surgery center before your procedure to ensure that they use in-network providers.
- Should you bring a loved one to your doctor’s appointment? If you can, it is always advisable to bring someone with you to your appointment. They can listen and take notes while the doctor is talking to you. Many providers now give you access to a portal to communicate, get test results, and set up appointments. This is a great way to keep track of your ongoing health care.
- Maybe your procedure requires a hospital surgery or inpatient stay. Your provider will have privileges at certain hospitals. Make sure the hospital your provider wants you to go to is in-network.
- How can you check hospital quality? One option is to visit Leapfroggroup.org. They rate hospitals based on safety and quality. If your hospital is not on the list, then the hospital refused to share their information.
- How can you check out the surgeon’s success rates? Visit ProPublica and enter the provider’s information. This is based on both ProPublica and Medicare Data. Healthgrades is another website where you can read reviews about providers.
One of the best ways to be an active consumer is to participate in your health care the way you participate in other areas of your life. Ask questions, get referrals, and research your options. These things will help you better navigate a very complex system.
Allison Johnson is the President of Benefit Dynamics Company and has enjoyed her career spanning many different areas of the insurance world. Benefit Dynamics Company has been in existence for over 20 years and partners with Alliance Benefits to find alternative strategic solutions that focus on cost strategies while also striving to provide an employee/participant-centered benefit program.
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