The Importance of Being an Educated Healthcare Consumer

While most people research the different options and shop around when making large purchases, fewer people do the same when it comes to healthcare. However, the cost of healthcare can vary greatly from one provider or facility to another, so shopping around can save patients a lot of money. Prescriptions, for example, vary in price from one pharmacy to another. In-network providers offer discounted rates (and, generally, more significant insurance adjustments) than out-of-network providers. Because of this, it’s important to  research providers, facilities and pharmacy costs before seeking medical care to ensure you are selecting the best option based on your plan.

This blog details why it is important for you to be an educated healthcare consumer.

Self-Funded vs. Fully-Insured

Many employers are choosing self-funded healthcare plans, rather than fully-insured. With self-funded plans, it is especially important for employees and their dependents to make educated healthcare decisions.

In a self-funded—or self-insured—healthcare plan, the employer takes on the full financial risk of providing healthcare benefits to employees. This means that the employer is responsible for paying for claims out-of-pocket (the portion of a claim that is covered by insurance is actually paid by the employer). This differs from fully-insured plans where the employer pays a set premium to an insurance carrier, regardless of the cost of claims.

With self-funded plans, employers have the flexibility to design plans that are best for their employee population, rather than selecting from a list of pre-designed plan options.

Control Future Plan Costs

When claims costs are particularly high, the employer may need to increase the amount that employees contribute to the plan in future years. Because of this, when employees are educated healthcare consumers (i.e. make smart decisions regarding when to utilize Urgent Care rather than the Emergency Room, choose lower-cost pharmacies and prescriptions when possible, etc.), they can help control the cost of their plan in future years. If claims costs are low, the employer may be able to offer lower-cost plans and vice versa.

Employee healthcare decisions are especially useful in controlling future plan costs when plans are self-funded, however, they are still important even with fully-funded plans, as the employer may be offered lower-cost plans in the future if plan costs for previous years were low.

Save Money

Here are a few different ways to be an educated healthcare consumer and save money at the same time:

• Determine which providers are in-network prior to receiving care and utilize those providers whenever possible
• Research prescription prices at different pharmacies and select the pharmacy from which to purchase each prescription based upon price
• Know when to visit urgent care rather than the emergency room, as emergency room visits are more expensive—an ambulance ride to the emergency room alone can cost $1,200 or more! (GoHealth Urgent Care)
• On average, urgent care visits cost between $100 and $200, while emergency room visits are more than twice this, usually costing over $500 (SolvHealth)
• Choose urgent care for minor medical issues (e.g. minor headaches, bumps, cuts and scrapes, vaccinations, lab services, etc.) that require care within 24 hours but are not life- or limb-threatening—for this type of condition, you will often get in and out more quickly in urgent care since the emergency room prioritizes life-threatening conditions
• Visit the emergency room for true emergencies (situations and/or conditions that are potentially life- or limb-threatening), such as having a hard time breathing, severe chest pain on the left side, sudden paralysis, etc.
• Utilize telemedicine services rather than office visits for minor issues—telemedicine refers to a HIPAA-compliant video conference consultation with a doctor, and can be appropriate for situations in which you would normally schedule an office visit and/or go to urgent care

Being a smart healthcare consumer is important, and it is the employee’s (or member’s) responsibility. Making educated healthcare decisions can save you money now and by allowing lower-cost plans to be offered in the future.