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Why Consumers Often Err in Choosing Health Plans


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In many cases, consumers' choice of the lowest-cost health care that meets their needs from an array of choices is NO BETTER THAN CHANCE. Considering this is one of the biggest financial choices every American needs to make, truly appalling information from an array of studies.

It's understandable that Americans are confused.

Most things in the health care industry are obfuscated, from the actual price of things, to what my actual coverage is in any given situation. 

I don't blame Americans. I blame bad public policy that lets companies get away with obfuscation. 

Well why don't the smarty-pants of Silicon Valley make tools that solve this problem?

Because they'd be in that 21% sector, too.  Have you seen Covered California? This is a huge issue.  I've done a lot of research for plans in several states, and they are complex.  There are several at all 4 tiers, bronze, silver, gold, platinum, and it often seems like it's better to go up the chain but it isn't.  Then, if you add the networks, HSA/FSAs into the mix, even someone who knows insurance (it was my first career) can go postal.  I have a state plan, so something you'd consider good. I have watched it erode contract by contract with no explanation.  I asked people, "Do you understand these changes?"  Nope. Only one or two did.  And they were big, big changes--the next one coming down the pike is even bigger.  

Deductibles and copays are really confusing the way they are structured, and you have to be a master of the code and test to not avoid things being denied.  A slip of the elective vs doctor ordered codes can mean the difference between covered labs and labs that cost thousands. 

Wow... that is nice. 

A couple years ago I had a gold-level plan that stopped covering my doctors without anyone bothering to inform me! So for a WHOLE YEAR PandaWhale was paying like $8000+ for my insurance but Anthem wouldn't pay for anything unless I changed medical practices to one in another city, which I hesitated to do. Oh and on top of that, they were sued by the state for fraud and had not one but TWO major security breaches in the course of one year! Way to make your customers trust you.

Adam had a similar situation with a different gold plan that one day just stopped paying for something that they had previously covered without question -- and in fact the only doctor he visited that year. That's how I learned that you need to check EVERY YEAR during open enrollment that your health insurance will actually cover each and every one of the doctors you might want to go to... but they make it RIDICULOUSLY hard to do that.

What I'm envisioning is an app that any consumer could use for themselves, where they can input different scenarios and the app will tell them "If you switch to this other health insurance this year and put $40/pay period in an HSA, you will save the most money for the kind of care you typically use and still be covered for common catastrophes". Actionable advice!!!

Jared I like Collective Health a lot! But so far they only work with self-insuring companies, and they also have a lot of HIPAA issues that might make it harder for them to give advice.

i know but they seem to have a really good start...and you have to start somewhere

I agree! We were just over there for their weekly happy hour the other week, they're definitely our homies.

So, I don't understand why this isn't simply a data input situation... I, too, have seen doctors come and go from one day to the next as far as coverage on my plan and plans of friends.  

My plan got a deductible overnight, a network, and a bunch of co-pay increases.  In addition, nothing I do for supplements is covered on the FSA--I can get band aids covered w your flex plan but not OTC supplements, all of which cost a ton.  

I've done research on Anthem specifically, Joyce--here's the catch... There is a list of covered doctors so you'll think your doctor is covered, then when you call they'll say "Are you in the Marketplace?  Oh, no... we don't take that."  So, there are actually two lists for companies--doctors that accept XX insurance plan but not XX plan through the Marketplace.  In today's day and age there should be no reason people should have to call down lists of doctors.  Many doctors are changing which plans they deal with...

It should be an input field and suggestions.  Several of them do have decent websites, but not where they need to be. 

I'm almost wishing for a bunch of concierge physicians to hand out price lists and forgo insurance.  With a high-deductible plan it's not like you're getting much benefit anyway--maybe a preventative screening and a round of labwork...  I'm trying to leave going to the doctors behind as much as possible... 

However, as more and more of the nation does that, you'll see that cost of care rise as we get ourselves seriously ill...

Have you seen One Medical?

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