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Guiding Boomers Through The Maze

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Financial professionals may start to play more of a role in helping baby boomers figure out how to use their health insurance and personal health accounts. For some boomers, efforts to shape health coverage to hold down employers’ costs and make individuals better health consumers have turned decisions about whether and when to visit a doctor, get a colonoscopy or ask how much an operation will cost into the intellectual equivalent of solving a Rubik’s Cube puzzle without physically taking the cube apart.

Many health insurance executives, brokers and consultants have admitted when being interviewed for other articles that they have a tough time figuring out in advance how much their own care will cost.

The current situation may be particularly irritating for baby boomers who spent 40 years watching health insurance get simpler for the consumer and, in most cases, are too young to remember a time before major medical insurance was commonplace.

Compared with other generations, “members of the baby boom generation are more used to an entitlement relationship with their health benefits,” says Dr. Abbie Leibowitz, chief medical officer at Health Advocate Inc., Plymouth Meeting, Pa.

When boomers were growing up, parents paid for medical care with inexpensive health benefits from the new, rapidly expanding Blue Cross and Blue Shield companies and other health insurers. Parents had to file claim forms and take care of deductibles themselves, but insurers rarely put limits on which providers patients could see or the treatments patients could receive.

In the mid-1970s, boomers themselves helped promote the rise of “managed care” and the “health maintenance organization.” Since the early 1990s, boomers have been complaining bitterly about evidence suggesting that some HMOs seemed to be holding costs down by restricting patients’ access to much-needed care rather than improving the patients’ health and reducing their actual need for care.

In the past few years, boomers have championed use of mechanisms such as wellness incentive programs, disease management programs, high-deductible health plans designs, consumer health Web guides and personal health accounts to give patients the financial incentives and tools they need to improve their own health and manage their own use of care.

The health account programs do appear to be affecting the way patients think about getting health care.

About 38% of health account plan members say they have delayed or avoided getting needed health care due to cost, compared with just 19% of traditional plan members, according to results of a Web survey conducted by the Employee Benefit Research Institute, Washington, and the Commonwealth Fund, New York.

The health account plan members told researchers they were more likely to ask about the price of medical services before getting care and to ask doctors to recommend less costly prescription drugs.

But the researchers found that only 26% of the health account plan members, 23% of the consumers with high-deductible plans and no health accounts, and 20% of traditional plan members had asked about the price of care before getting care.

The percentage of consumers who said their health coverage was extremely or very easy to understand plummeted to 36%, from 45%, for health account plan members, and crept down to 30%, from 31%, for high-deductible plan holders without health accounts. The percentage of traditional plan members who claim to understand their plans increased to 63%, from 60%, but more than a third of traditional plan members admit that they are confused.

Many health carriers try to offer relief through 24-hour health nurse lines, care coordination programs for employees with health problems and regular customer service lines. And most health insurance brokers do their best to help individual clients and employees of group health customers cut through red tape.

But some carriers, many health insurance brokers and a growing number of the kinds of financial advice firms that focus on retirement planning and estate planning are turning to outside claim resolution services and health care advocacy services.

The Health Advocate service, which may be the best known health advocacy firm, now reaches 6 million U.S. residents through its list of 1,900 clients.

Clients, which include health insurance brokers and non-health financial services firms as well as employers, pay about $1.50 to $4.95 per covered consumer or employee per month.

The boomer callers often ask about “sandwich generation” issues, Leibowitz says. “We have all the issues of our children and all the issues of our parents to deal with.”

Since the company was started in 2001, it has added more geriatric nursing specialists and geriatric social services caseworkers, Leibowitz says.

At this point, because personal health accounts are relatively new, many of the health account calls deal with the mechanics of setting up the accounts.

Health Advocate is calling to try to negotiate discounts for some patients who are about to get medical care, as well as to get discounts on bills for care already received.

Today, “the hardest job in the world is to be a patient,” Leibowitz says, because patients are in such a weak negotiating position. “It’s much better to stay in network and understand your benefits than it is to try to negotiate a price after you’ve already received a service.”


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