Health Insurance

Counseling Your Clients in the Current Economy
by Gina Stassi

While the current economy has stripped jobs and therefore health insurance benefits, there are still 30 million insured Californians. And more than ever, they need your advice on how to use their benefits cost-effectively. One of the ways you can help is by advising them that this is not the time to start curtailing doctor visits in hopes of saving the immediate cost. That’s because delaying care now often results in more intense future treatment and an even greater financial, health and emotional impact. We’ve all heard horror stories like the one about someone with a nagging cough who ignores symptoms and eventually winds up in the hospital with a long bout with pneumonia.

The overall point is that health insurance protects individuals from many of the financial consequences of care and hospitalizations and it is possible -- even simple – to use health benefits while keeping a lid on out-of-pocket expenditures.

With that in mind, below are a few more tips worth sharing and discussing with your clients:
• Switch to an HMO plan for greater cost predictability. For the past several years, people have been willing to pay more for PPOs to have access to bigger networks than what HMOs typically provide. But for greater cost predictability, switching to an HMO usually provides fixed-dollar co-payments instead of percentage-based coinsurance, making it easier to know, in advance, how much medical services will cost. And most HMOs have no annual deductibles.

• Look for an HMO that provides a narrow-network option. Some health plans offer smaller networks of cost-effective, quality providers in exchange for significant premium breaks.

• Use medical professionals within your health plan’s network, where co-payments are lowest. Co-payments are lowest when you use healthcare providers within your health plan’s network. Using out-of-network providers typically results in higher co-payments or sometimes no coverage at all.

• Use preventive care benefits to stay healthy. Blood pressure and cholesterol checks, mammograms, Pap smears, PSA tests, diabetes and cancer screenings, physicals and similar services can keep you from developing preventable conditions, or keep previously undetected conditions from getting worse.

• Call your doctor first instead of heading to the emergency room. Using a hospital emergency room for non-urgent care usually comes with a higher co-payment than a doctor’s office visit. So when you need medical treatment for a non-emergency, call your doctor first so the doctor can decide if you should go to the office, visit an urgent care center, or go to the emergency room. When their office is closed, most doctors leave instructions on voicemail or with their answering services.

• Use a mail-order pharmacy program. Many health plans offer cost savings and convenience through mail-order delivery of maintenance medications. Some plans provide up to 90 days of mail-order medications for the same co-payment as a 60-day supply from a retail pharmacy.

• Go generic and save. Generic drugs most often are a lower-cost alternative to their brand-name counterparts – and they work the same way, according to the Food and Drug Administration.

• Take advantage of health coaching, health education, wellness benefits and other free tools and resources offered by your health plan. Health plans want to help their members be healthy. That’s why many offer free health coaching programs, health education materials, and wellness benefits. Professionally trained health coaches who are available 24/7, online health assessments, print and video educational materials, gym memberships, treatment cost estimators, medical group quality comparisons and smoking cessation and weight management programs are a few of the many resources available.

• Use discounts for health-related expenditures. Many health plans offer discounts on purchases of health-related products and services, such as athletic footwear and apparel; child safety products; eye exams, eyewear, contact lenses and vision correction surgery; fitness clubs; healthy living books, magazines and videos; hearing aids and screenings; massage therapy; vitamins, herbal supplements and other natural products; and weight-loss programs. Log on to your health plan’s Web site to see if discount programs are available.

The bottom line is it can be easy to take care of your health while managing out-of-pocket costs and each health plan has tools and strategies for helping their members be cost-conscious consumers of health care services.
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Gina Stassi is commercial officer for both Health Net of California and its parent, Health Net, Inc. She is responsible for supporting overall strategies to grow membership across all commercial product lines, including the individual and small-group, mid-market and large-group lines of business. She also is accountable for Product Development and Sales Operations for all commercial business and she manages the individual business across commercial lines.