Consumerism Education for High Deductable Health Care Plans

Monday, November 22, 2010

Previously we pointed out that one component of a High Deductible Health Care Plans is education. Education of health care consumers, employees, their dependents, and others is needed since for the better part of several decades, health acre consumers have had little knowledge of the health care industry. Consumers paid their premiums, co-payments, deductible, co-insurance payments, and out-of-pocket expensive with little knowledge of the true cost of care. For the majority of us who receive health care through their employers, we never the cost of an office visit, immunization or more complex procedures such as debridement of skin and subcutaneous tissue. We made our appointments, paid our co-pay, deductible, co-insurance payment or our out-of-pocket expenses and went on our way. One role of Consumerism Education is to help individuals with HDHP’s to understand the true and total costs of their health care choices.

To assist employees and their dependents gain information and even assistance with their HDHP issues, many organizations employ a “health advocate”. This is usually an organization other than an insurance company who works with the consumer in helping them navigate through the health care system. Carolyn M. Clancy, M.D., Director Agency for Healthcare Research and Quality (AHRQ) writing for AARP defines a

“health advocate” as “can be a family member, friend, trusted coworker, or a hired professional who accompanies you to your appointments and asks questions, writes down information, and speaks up for you so you can better understand your illness and get the care you need.”

For our purposes, we will focus on professional organizations hired by an employer to assistance their employee’s and their covered family members.

Health Advocate, Inc., headquartered in Plymouth Meeting, PA utilizes “Personal Health Advocates, typically registered nurses, supported by medical directors and benefits and claims specialists.” Their services include Wellness/Enrollment; “FMLA Support; Benefits Gateway; Medical Bill Saver; EAP+Work/Life; NurseLine; MedChoice Support; Chronic Care Management; Tobacco Cessation; Health Information Dashboard; External Appeals Administration and Independent Appeals Administration”.

Employees of organizations, which employ health advocate services generally, may contact the services for questions dealing with questions about what a typical medical procedure entails costs, recovery times, side effects, alternatives, screening/testing outcomes and readings. Often the health advocate service may suggest a second opinion, availability of generic or Over-The-Counter (OTC) drugs. They may even speak directly to the individual’s doctor or provider. Should the individual wish for a second opinion, the health advocate service may assist ion locating a suitable provider, make arrangements for appointments, review the individual’s health care plan to confirm how second opinions are paid.

Often individuals contact health advocate services to obtain a better understanding of what the doctor has told them. In cases where the doctor has developed very negative news, the individual has not been able to focus through the shock of the news. Health advocate services will review the indidvual’s case and help them to work through the medical, financial, and emotional issues of their specific situation.

In situations that are more mundane health, advocates can help the individual understand the coverage options available during open enrollment, changes in life stages such as marriage or birth of a child. They help individuals understand how to make the best use of HDHP’s, FSA, HSA, and HRA’s and when one might be more appropriate than another. Health advocates can assists with mis-billing and over-billing issues, they may be able to negotiate reductions in bills or arrange for time payment of very large bills.