Podcast Center
Video Center
Webcasts
Resource Center
Events
October 21, 2007 at 04:00 PM
Consumer-driven health plans continue to increase in popularity, representing a growing share of the commercial health insurance market.
Among other things, these plans can create greater price awareness of treatment options and reduce use of unnecessary services, bringing down overall health care costs.
CDHPs are designed to help consumers approach health care expenses prudently and maximize health benefits by making better choices about how they spend their health care dollars.
One way benefit plan advisors can help employers and consumers get the most out of CDHPs is to make sure they know how to get care at in-network rates.
CDHPs and in-network rates
Consumer-driven health plans typically require the consumer to pay a deductible before the health plan pays for services. Some critics of these plans mistakenly believe that the consumer does not get the benefit of the health plan discount during the period where the deductible has not been “satisfied.”
If the plan is underwritten by a health insurer that offers a network, or the self-funded employer has contracted with a network, make no mistake–the plan discounts do apply during this period. It is important that individuals take advantage of the network discounts that insurers offer as the discounts can provide substantial savings.
To ensure that they are getting the full benefit of the discount, consumers should ask the provider to submit the claim to the health plan before paying for the service. Once the health plan has processed the claim and the consumer has received the explanation of benefits, she can then pay the appropriate amount.
“Up front” payment requirements
On rare occasions, providers will require payment at the time of service. When this happens, the consumer should ask the provider to factor in the health plan discount.
Most providers have a pretty good idea of what the health plan’s allowable charge is for routine services. If the amount the provider charges is greater than the amount the consumer owes, the consumer can ask that the provider issue a refund after the claim has been processed.
Some providers do ask for these payments “up front” as they are concerned about getting paid. Many providers are aware of the use of health care debit cards tied to flexible spending, health reimbursement or health savings accounts.
When a consumer has such an account, some providers are willing to have the consumer sign an authorization form that allows the provider to debit the consumer’s credit card after the claim has been adjudicated.
These types of arrangements are usually win/win for both the consumer (who does not tie up funds unnecessarily) and the provider, who has an increased comfort level in receiving payment.
