Today's Health Care Price Tools Are a Good First Step

magnifying glass next to price tag

The most difficult thing for employees to understand about their health insurance is how much they have to pay when they go to the doctor’s office. The Summary of Coverage outlines what the deductible, coinsurance and copay amounts are for most services. It indicates that out-of-pocket costs are less if received from an in-network medical professional. It states the maximum amount participants pay out-of-pocket in a plan year.

However, it does not inform employees about the many situations that can arise that increase their out-of-pocket costs. For example, doctors who require an office visit and copay to renew a prescription. Or that even though Dr. X and Dr. Y are both in-network, Dr. X charges more for his service which means greater out-of-pocket costs for patients. It also does not remind employees to use health care price transparency tools before receiving care, but employee benefit pros can.

Health Care Price Transparency Tools

Nearly everyone agrees that consumers cannot take control of their health care buying decisions without basic price data. So insurers, non-profits, and private organizations are creating and enhancing health care price transparency tools to help consumers access this data. In fact, before the recent release of Medicare price data, all major U.S. healthcare insurers provided a price transparency tool to its members. And just last week UnitedHealthcare announced it was making its free health care price app, Health4Me, available to the public. The app contains average local prices of hundreds of medical services.

More Free Price Transparency Tools)

Challenges of Using Health Care Price Transparency Tools

There are many challenges to using health care price transparency tools. But for employees the biggest challenge is changing the way they interact and communicate with doctors and their staff. People are afraid to engage their medical care provider about costs because they fear the reaction. They do not want to appear ungrateful. They also do not want to appear as if they are questioning the doctor’s recommendations for care. And doctors are aware of this fear and loyalty.

Also, too many doctors think that price transparency is not an important issue and that the problem lies with employees not understanding their plan. This and other stupid attitudes of doctors and their staff make it difficult for employees to talk to them about the costs of procedures. Other challenges to using health care price transparency tools include:
  • Lack of access or training in using these online tools
  • Lack of continuous communication by insurers and employers about the availability of these tools

I see the employee benefit function changing from behind the scenes administration and compliance, to being a true advocate for employees. Employers, that’s you employee benefit pro, should remind employees often about available health care price transparency tools. They should also honestly talk to them about the resistance they may encounter from doctors and encourage them to face it head on by offering support.

When was the last time you discussed health care price transparency tools with your employees? Have you provided them with a list of tools they can access?
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