Patients on health care costs: we don't care and screw the insurance company

[MillCreek]

http://www.npr.org/blogs/health/2013/03/12/174106660/when-it-comes-to-health-care-patients-don-t-want-to-be-swayed-by-cost?ft=1&f=1001

Well, this is somewhat depressing, but not surprising.  So it makes me wonder how we are going to meet the governmental and insurance company requirements for reducing health costs, when the patients have little skin in the game.

[dogmush]

They were also unlikely to accept a less expensive treatment option, even if it was nearly as effective as a more expensive choice. Moreover, they were antagonistic toward insurers and seemed to be motivated to choose expensive care out of spite.
"There was an almost vengeful attitude toward insurance companies," says Goold.

I see this in almost all of my liberal friends.  Then they wonder why insurance rates go up, and insurers try to deny things.

[Balog]

Still, Goold says she's somewhat optimistic about the possibility that people can be encouraged to change their attitudes about weighing medical costs. She pointed to changes in end-of-life care over the past 30 years as an example. As hospice and palliative care have become widely accepted, the focus of patients, their families and providers has shifted toward improving quality of life through pain and symptom management rather than necessarily extending life.

The most encouraging thing about reducing costs is that people are letting the old folks die instead of trying to save them huh? Says a lot about the folks who want to control your healthcare...

[AZRedhawk44]

File this under "duh!"

I think HSA-based plans are going to be the saving grace of insurance companies.  When the insured is contributing towards his health costs and responsible for the first $xxxx dollars each year in costs, he tends to shop around a bit and be more frugal with his expenses, treating health insurance as disaster-coverage rather than just another free-bucket-o-stuff to plunder from yet another common trough.

[RevDisk]

They were also unlikely to accept a less expensive treatment option, even if it was nearly as effective as a more expensive choice. Moreover, they were antagonistic toward insurers and seemed to be motivated to choose expensive care out of spite.

"There was an almost vengeful attitude toward insurance companies," says Goold.

Health insurance folks are not exactly viewed as the nicest of organizations. I imagine they'd rank as being less well liked than say, the mafia. Or even Congress. Hostility has a price.

The most encouraging thing about reducing costs is that people are letting the old folks die instead of trying to save them huh? Says a lot about the folks who want to control your healthcare...

Tis because it's very very expensive for folks in their last six months. And I've been told by many doctors that they've been "shopped" by folks not wanting to hear bad news. Doctor X says "He or she is brain dead. There's nothing we can do...", so take to Doctor Y who says same, so take to Doctor Z who says same thing, etc. Don't get me wrong, medical mistakes happen all the time. But some folks have trouble letting go.

If give the choice between a hospice and megatons of GOOD narcotics, and an extra few days or weeks of life strapped to life support, gimme the good stuff. Dirt cheap and I prefer dying with some dignity. It should be a choice, but preferably an informed choice. We're talking a couple hundred bucks versus hundreds of thousands. Multiply by thousands or millions, it adds up. Before we can discuss this subject, the DEA needs to be politically kneecapped and dumped in an alley behind a Mexican clinic. Chasing doctors writing prescriptions is a LOT easier than trying to bust MS-13 for a couple hundred grams of coke.

[HankB]

. . . If give the choice between a hospice and megatons of GOOD narcotics, and an extra few days or weeks of life strapped to life support, gimme the good stuff. Dirt cheap and I prefer dying with some dignity . . .

But . . . but . . . narcotics are habit forming and addictive! That just won't do!

[MillCreek]

Back when I was with the multistate healthcare organization, I did most of the risk management for their hospice service lines.  After seeing hospice up close and personal, when the time comes, I am going that route if I can. I would much prefer that than the ICU.  The most common diagnoses of people on hospice are cancer, dementia, respiratory disease and heart disease.  By federal law, if you have a terminal condition and are expected to live six months or less, you are eligible for hospice.  Medicare pays for it.  Only about 30% of the patients who are eligible for hospice avail themselves of it.

[Fitz]

File this under "duh!"

I think HSA-based plans are going to be the saving grace of insurance companies.  When the insured is contributing towards his health costs and responsible for the first $xxxx dollars each year in costs, he tends to shop around a bit and be more frugal with his expenses, treating health insurance as disaster-coverage rather than just another free-bucket-o-stuff to plunder from yet another common trough.

This. Since I don't have a simple "co-pay" on my plan, but an actual cost share, i'm much more motivated to shop around. My sinus surgery, I agonized over because I knew that regardless, I was paying a percentage based chunk of it.

I'm thinking of going to an HSA with a certain amount of "catastrophic" coverage, because under that scenario i'd spend even less. Plus, unused money stays with me.

[Hawkmoon]

By federal law, if you have a terminal condition and are expected to live six months or less, you are eligible for hospice.  Medicare pays for it.  Only about 30% of the patients who are eligible for hospice avail themselves of it.

Being alive is a terminal condition. Does that make us all eligible for hospice, right now?

[AZRedhawk44]

Being alive is a terminal condition. Does that make us all eligible for hospice, right now?

Boolean logic fail.

IF ((@terminal_condition = true) AND (@expectancy < 6 months))
THEN (free hospice)
ELSE (NULL)
END

[MillCreek]

^^^ I wish we had that HSA option at work so that I could bank the savings. For me, my employer pays approximately $ 4000 per year to provide me with health and dental insurance. In a typical year, I incur less than $ 500 in medical costs that insurance pays for (1 annual visit to the internist with labs, for which I pay $ 200 deductible and non-covered and $ 50 per year for my statins that I pay out of pocket).  I go to the dentist three times per year at about $ 250 per visit, and insurance covers about $ 500 of that.

I understand the concept of insurance very well, having worked in the field for 30 years, and I also understand that I will no doubt incur more medical costs as I get older, and I have been blessed with good health all my life, but for my entire life, I have been more of a revenue center than a cost center to my insurance company.

[Stetson]

My mother is a home-care/hospice nurse.  Her coworkers took care of me when I got out of the hospital.  I'd have rather gone home earlier and had home care vs. being in the hospital for 8 weeks.  I will go the hospice route if it comes to that.  I do not want to be hooked to any machines to prolong my life, if I am advanced into an illness I will not recover from.

[Fitz]

My current insurance premiums are VERY reasonable, although they're going up. (Bummercare)

I have tricare reserve. It basically gives me a cost share (I paid, I think, 20 percent of my surgery, which wasn't a TON, but still made me think about it, and shop around a bit)

However, I think i'd prefer an HSA. I may switch to my company's HSA option at some point. It's pretty nice, and i believe it has a "catastrophic" coverage to cover against non-routine, unexpected stuff.

[mtnbkr]

Health insurance folks are not exactly viewed as the nicest of organizations. I imagine they'd rank as being less well liked than say, the mafia. Or even Congress. Hostility has a price.

Yup.  Insurance companies don't even try to deliver good service.  As much as people don't worry about saving money, the insurance companies go out of their way NOT to pay, using as many loopholes as possible. 

Also, how can a person price shop for services when they may not fully understand the service and the billing minutia.  There are a lot of factors involved and costs aren't always transparent. 

My company is pushing the HSA plan hard this year, even stating the traditional plan may not be available next year.  Most of us are getting the HSA plan, but contributing an amount to our HSA equal to the price difference of the two plans plus what you'd normally put into Flex Spending.  The end result is no money saved this year for the lower cost plan, but if you don't spend it, you can carry it over to the next year, starting you off with even more money and the potential ability to reduce your HSA contribution.

I happened to stumble upon my benefits numbers for 2009.  My Med insurance contribution was a third of what it is this year and it had gone up quite a bit for 2009 compared to 2008.

Chris

[Lee]

There's a really good (and eye opening) article in TIME magazine this month. The most surprising thing to me was that close to 70% of personal bankruptcies are due to medical costs, and that 70% of those people have insurance, albeit not so great insurance maybe.  It's a really good (and long) read.  I can't say that I agree with the author's proposals to remedy the situation, but much of the information presented if pretty shocking.
The article is called "The Bitter Pill".
A link to some comments  http://healthland.time.com/2013/03/07/letters-to-the-editor-read-reactions-to-bitter-pill/

[MillCreek]

As someone who has worked for many decades in healthcare, I can attest to the accuracy of much of that article in Time.

[Cliffh]

If give the choice between a hospice and megatons of GOOD narcotics, and an extra few days or weeks of life strapped to life support, gimme the good stuff. Dirt cheap and I prefer dying with some dignity. It should be a choice, but preferably an informed choice. We're talking a couple hundred bucks versus hundreds of thousands. Multiply by thousands or millions, it adds up. Before we can discuss this subject, the DEA needs to be politically kneecapped and dumped in an alley behind a Mexican clinic. Chasing doctors writing prescriptions is a LOT easier than trying to bust MS-13 for a couple hundred grams of coke.

QFT, all the above. 

But most of all the DEA needs to butt the *expletive deleted*ck out!  My wife and I both have conditions requiring pain meds.  We have experienced extreme difficulties finding doc's who'll write the prescriptions.  Our primary care physicians can write the 'scripts, they're just so damned afraid of the DEA that they won't write 'em.  So, instead of seeing our doc's who're 10 miles away, we drive west (160 miles RT) to her "pain management specialist" and east (150 miles RT) to mine.

[Nick1911]

I see this in almost all of my liberal friends.  Then they wonder why insurance rates go up, and insurers try to deny things.

I worked IT for a TPA for years, at a self-insured company.

And I completely agree with you about my own liberal friends.  They are annoyed when they can't continually draw more in expenses then they pay in premiums from health insurance.  If they don't, it's "crappy insurance".

It seems many people have forgotten what "insurance" is/means - insuring against fiscal risks you're not willing to bare by selling that risk at somewhat more then it's actual statistical annualized cost.  If most people draw more then they put in every year, the company fails.

[dm1333]

There's a really good (and eye opening) article in TIME magazine this month. The most surprising thing to me was that close to 70% of personal bankruptcies are due to medical costs, and that 70% of those people have insurance, albeit not so great insurance maybe.  It's a really good (and long) read.  I can't say that I agree with the author's proposals to remedy the situation, but much of the information presented if pretty shocking.
The article is called "The Bitter Pill".
A link to some comments  http://healthland.time.com/2013/03/07/letters-to-the-editor-read-reactions-to-bitter-pill/

I have not read the article but if you know anybody who had any form of dementia, cancer or a long term illness the personal bankruptcy statistic is probably not a surprise.

[just Warren]

On the other hand there's this trend of doctors telling insurance companies to get lost and doing only cash business. Marvel at the much lower prices! 

If more and more care providers go this way than people will have to be aware of prices. They'll have no choice.

[Azrael256]

On the other hand there's this trend of doctors telling insurance companies to get lost and doing only cash business. Marvel at the much lower prices!  

If more and more care providers go this way than people will have to be aware of prices. They'll have no choice.

I'm in that .0002% that actually reads my EOBs.  We went to a high-deductible with HSA plan here (amid much wailing and teeth gnashing), so it's actually suddenly important to check the billing codes.  The billed vs negotiated rate difference is STAGGERING, and that was for a well-child visit.  My daughter had a well checkup and a round of shots that billed at well over a grand, but the insurer rate paid at less than half that.  Preventative care is covered, but I still know that negotiated rate is too high, and I have no power to pull it down.  My insurance company won't allow it.  But I still need insurance to cover us if something serious happens.

The HSA plan is a good step, but I'm still constrained by the insurer's system.  I have the freedom to buy you a new fender if I bump your car without involving insurance.  I can't do that at the doctor's office.

[Scout26]

I'll ask again.

Why is my healthcare tied to my employer when I can get Life, Home, and Auto insurance on my own?   And in fact the insurance companies spend lavishly on advertising and marketing to get my business.

[mtnbkr]

Scout, you can buy your own health insurance, but it's going to be staggeringly expensive. 

Employer provided/funded health insurance was a benefit to offset lower wages decades ago. 

Chris

[Fitz]

What they need to do, is allow you to opt out of employee coverage, then give you the cash they spend monthly for your insurance. as part of your compensation. COmbine that with a good HSA plan that you find elsewhere, and you're in good shape.

[Cliffh]

Being self employed, BIL & sis bought their own health insurance.  Their monthly premiums were close to what I pay for a year.

As for checking prices prior to getting care, that's been practically impossible for us.  We'll call the hospital, they say it depends on what the insurance covers and which billing code the doc uses.  Call the insurance company and they can't answer until they're billed by the doc and/or hospital.  Call the doc and they can't tell exactly how it'll be billed.  Round and round we go, where we stop.....  is when the bill finally comes in, after the procedure.

I keep a keen eye on our EOB's.  I've found more than one error.  And the difference between the billed & negotiated amounts is usually 45% or more.  I've often wondered who actually pays the entire amount billed.