Helping People Understand Insurance Can Lower Medical Costs

Patients often do not worry about healthcare costs until there is a bill in their hand. They then begin to scramble and wonder where the cost came from, why they are were charged, and why didn’t their insurance cover it? The next step is to spend hours on the phone with either their insurance or the provider to get an explanation and a play-by-play of what their payment responsibility is.

Insurance coverage is not a simple thing to understand, and people often don’t take the time to learn. Because of this, vendors lose billions in customer service costs. One report shows this cost as high as $4.8 billion just for administration. This literacy is not connected to people’s level of education.

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According to the report, “Roughly half, 48 percent, of those who have low literacy are college-educated, and 97 percent have at least a high school diploma.”

But how can we correct that literacy rate? Making such a change will require help from the medical and insurance industries, but employers and consumers can help, too.

What Employers Can Do

If you’re an employer, help your team become insurance literate:

  • -Offer a yearly in-depth information session to explain what deductibles, co-insurance, and co-pays your team members must pay and what the amount would be for a catastrophic life event (out-of-pocket maximum).
  • -Make sure your team knows how they are billed for medical equipment and elective procedures.
  • -Make it apparent to employees what is in-network versus out of network and how to find providers that are accepted under your offered health plan.
  • -Offer online access to their health benefits where they can learn more and get real-time updates on claims.

What Consumers Can Do

We know insurance and medical terms are confusing. The general idea with health insurance is that you will pay for some things, while your insurance will cover others. Here is what you can do to understand which is which — before you have an unexpected bill.

  • -Inquire about cost before the procedure with either your insurance or the hospital/doctor office.
  • -Make sure your doctor and facility are in-network before your visit.
  • -Know your co-pays for seeing a primary care physician versus a specialist. Know what you will be charged to visit an emergency room doctor.

What Health Insurers Can Do

Health insurance companies have the power to make changes, too. Although the terminology is not likely to transform, insurers can help people use their health insurance wisely. Many health insurance companies have already begun doing things such as:

  • -Making sure those insured know about options for low-cost care so they don’t overuse the ER.
  • -Pushing wellness and prevention by covering related visits and treatments. People who receive annual physicals and interact with health care professionals regularly can be taken care of more cheaply.
  • -Offering tools to help people understand their benefits, whether it’s online or elsewhere.

If you were in charge of everything, what steps would you take to help people become more literate about healthcare?

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