Is health insurance the only option to pay for care? Can a good health plan include paying directly for services?
Healthcare costs are too high. Every year we face rising premiums, as our coverage options become more limited. Having good insurance no longer protects you from significant out of pocket expenses, in the form of copays and deductibles. For employers, health insurance is second only to payroll in line item expenses and many employees stay in their jobs just for the benefit.
But the reality is employers can no longer afford to pay all of their employees’ health expenses and there needs to be an alternative. Why should going to see a specialist for an opinion on your knee pain or getting a prescription for a generic pill for blood pressure require insurance? The answer is because we are trained to use insurance for all of our care, even if the price we end up paying out of pocket is higher than if we paid directly. In fact because of new laws requiring price transparency in healthcare, there are more affordable choices than just those dictated by insurance plans, and as employers expand the use of HSAs and FSAs, these choices are easily available.
Health insurance is important for the big things in life, having a baby, major surgery, or cancer care. But the vast majority of care, the costs are predictable and exist far below a deductible. In fact, over two thirds of people never reach their deductible even when they have seen a specialist twice in a calendar year. Technology has created new avenues for patients to connect to their doctors but having the right insurance shouldn’t stand in the way. Just like energy, we can’t depend on just one source for our power, and direct pay is a good alternative.
Three tips:
- Know your insurance plan. Even though it is confusing, look at the back of your card and read the fine print. Add up the copays, deductibles, and the out-of-pocket costs for office visit, urgent care, imaging and emergency room. This is the cash you will need in your HSA or on hand.
- When you need to see a doctor, ask what the price is out of pocket. Its most likely less than a deductible.
- Be smart. It’s about your health, not about your insurance. Good doctors work for you.
Paula Muto is a practicing surgeon in Massachusetts and CEO of Uberdoc.
