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August 14, 2015 at 02:00 AM
Health plan designers are giving patients more “skin in the game” by increasing deductibles, co-payments and coinsurance amounts.
Narrower provider networks are increasing the risk that the patients will get more out-of-network care, even when they do everything they know how to do to get in-network care.
The new Patient Protection and Affordable Care Act (PPACA) open enrollment calendar system for individual major medical coverage may lock patients into policies even if their primary care providers leave the provider network, or the plan drops coverage for the patient’s medications.
Meanwhile, the new PPACA system is putting pressure on insurers to cut their administrative expenses, and insurers are responding by cutting what they pay agents and brokers. Both insurers and producers are struggling to offer enrollees the kinds of problem-resolution services they offered in the past.
Stand-alone patient advocacy services are trying to fill the void by offering these services. One of the pioneers in the market, Health Advocate Inc., has broadened its offerings to include biometric screening, tobacco cessation help, and other wellness and condition-management services as well as patient advocacy.
