Most of you don't understand your health care plan.

J.D. Power and Associates is a name you are probably familiar with from automobile ads, touting their consumer satisfaction and reliability. But, J.D. Power has also undertaken the second of its surveys on consumer satisfaction in the health care industry. Factors studied are: "coverage and benefits; choice of doctors, hospitals and pharmacies; information and communication; approval processes; claims processing; insurance statements; and customer service."

The take-home message from the study was that satisfaction with health care plans varies widely depending on who the provider is. BCBSNC doesn't do too badly, considering I think they provide horrible service with more hurdles than Beijing's Track and Field stadium. Overall, the study found that most unhappiness with the health care system stems from a lack of communication between the company and you, the consumer.

The study finds that the majority of health plan members rate their insurer lowest for the communications and information that are provided to help them understand their plan. Only 45 percent of members reported they fully understand how to use their health insurance coverage and member services. Enhancing member understanding with critical plan details—such as prescription coverage, co-pays, how to locate physicians and how to appeal coverage denials—can lead to higher satisfaction ratings for insurers.

Let me tell you a quick story. When I was about nine, I rode my bike out from behind a white suburban and promptly got smacked by a car doing about 25 mph. I went flying sideways off my bike, landed halfway down the hill and rolled to the bottom of the hill. All I remember about the incident is my mom coming running down the hill screaming my name. As a parent now, woooh! she must've been freaked out. Anyway, my parents took me to the hospital and nothing was wrong, not even a scrape. I asked my Dad about this recently, I asked how the payment procedure went. He said that he signed the paper saying I could leave and that was it. No copays, no coinsurance, no money up front. So, I asked him what he paid in premiums each month. Nothing. That was BCBS back in the 1970s. Now, what percentage of people would say they understood that system?

100%. That's right.

Why is it so confusing? Because the health insurance companies are there to make it confusing so that you don't take advantage of your benefits. Every dollar you leave on the table is one more dollar for them. That is why when BCBS went from non-profit to for-profit we lost out on a good insurer. Now, everything is about the bottom line and not about quality health care. The people over at PNHP point out that many of those who say they understand their health care plans are those who do not use them. Think about it, if you are a healthy, single state employee that pays $0/month for your health care plan (YOU the taxpayer pay BCBS about $300/month for their health insurance), you probably never use your insurance. So, what is there to understand? On the other hand, show up with a non-standard mental health condition and see how quickly it gets confusing.

J.D. Power ends with this, and I will too:

“With increasing healthcare costs and an aging workforce that needs additional services, businesses have less and less tolerance for insurers that aren’t consistently engaging members and helping them manage their own health care and the associated costs. However, we find that those plan members who are most engaged by their insurer through effective communication better understand how to use their plans and have particularly high satisfaction levels. Those higher satisfaction scores translate into better retention rates and more positive recommendations for the plan.”


Do you understand your health care plan?

If you think you do, how often do you use it?

How about those of you who deliver services, how often do people come to you confused?

Jesus Swept ticked me off. Too short. I loved the characters and then POOF it was over.


Basic things like doctor visits, dental cleanings, and prescriptions, yep. Anything more complicated, and I'm turning to the website or benefits booklet.

Now, in pharmacy school, we had a primer on how health insurance works, including Medicare and stuff. That was 2001, so god knows it's all changed by now. But I'm pretty savvy about coverage and plans and I speak med-speak, so I can definitely understand people without the background knowledge being confused as all hell.

Fortunately for me, we don't bill insurance here. At least not in my department.

I try to stay away from my healthcare plan

it gives me a headache. And the truth is, it's impossible to understand it anyway. No one really understands this stuff. The whole industry is built on obfuscation and complexity. Just like the tax industry.

Heh ;)

Like I say, I only get the basic stuff. Though I did spend 6 weeks working at an insurance company (split between prior auth and making a report on why they should reduce copays on chronic meds for diabetes and blood pressure.)

I may not understand everything, but

I do understand that BCBSNC paid out six figures on our policy last year without hassle and denied nothing but duplicate claims sent by providers. I'll do a commercial for them if they want.

It's a monster

the only thing more frightening than confronting the minutiae of one's health plan is the prospect of being without it.

I understand this much

I pay $400.00 a month for my employer provided coverage for my Wife and I, I have a deductible of $1500.00 per person, if I go to the hospital they only pick up 80% and I definately put off needed visits to any Specialists, because the insurer only pays up to a set amount per visit (wheather it is a GP or a Specialist) which ends up costing me so much that I just go with whatever the GP says or I do without.

I understand that I would like to have health care for everyone that was simple like I had back in the early 80's. Just like Robert's parents.

North Carolina. Turning the South Blue!

North Carolina. Turning the South Blue!

I can tell you about being without it.

Since I started freelancing 15 years ago. I have been without health insurance more than with it.

It was a terrifying prospect leaving the safety of a full time job with benefits but sometimes you've gotta do what you've gotta do. At first I purchased my way into a group plan. The salesperson had told me "If you don't need to use this insurance, the premiums will decrease" Well, happily I never needed to use the plan over the course of three and half years but... you guessed it, the premiums only went up.

After struggling to keep paying for this plan with a high deductible for so long, I decided that I would rather be paying for health care than for insurance and dropped it.

I have been very fortunate to have found a good doctor who only charges her patients without insurance a "co-pay" of $35.00 for office visits.

I don't know what I will do if ever faced with serious trouble.

Progressive Democrats of North Carolina

I realize that you are not a small dog

But when I read your posts I see this picture of the cute, small dog, and in my mind, I see this cute little dog saying the things you post.

It was impossible for me to avoid thinking, "no one would let that adorable little creature go untended in the event of illness or accident."

But of course, we let this happen to human beings (and dogs) every day.

My employer pays

100% of my health insurance premium, and I purchase care for my son and my spouse through the plan. We just switch to a pre-tax plan so that it's only costing us about $300 out of pocket (not including what my employer pays) instead of close to $600. I couldn't believe that difference.

Our deductible is $6000 for the family, or $2000 per member. I have a chronic condition that keeps me visiting my health care provider about once every 6 weeks and that's $35, and even with insurance, my prescriptions cost a little over $200 a month.

All in all, it's not as bad as it sounds. What bugs the crap out of me is that my doctor wants me to have a certain number of migraine pills per month. The insurance company says "No, you don't need that many." So - ta da, instead of only paying a $35 copay for that particular prescription, I wind up paying about 80 to 120 a month for that drug, depending on how bad the migraines are.

I don't know why they think they know better than the doctors!

Oh - and get this - they charge our group higher because we have smokers. But they won't cover any drug to help people quit smoking. Fucking hypocrites.

Be the change you wish to see in the world. --Gandhi
Pointing at Naked Emperors

This is a good post for this site...

Judging from my readings, probably most on this site are in the age group that really has not had to get into any hassles with their health care provider.(unless your kids require it) I, on the other hand, am in the age group that does deal with BCBS and Medicare at some time each year. I hardly remember having to deal with my plan during my working years, but now I do regular readings on my med bills. I could relate to a few horror stories with my plan, or go into the phony way they make up the amounts for services rendered in a "fair and reasonable" way. But I would rather point to that very terrific movie by Michael Moore, "Sicko". After seeing that movie, you have to wonder if the gangsters have complete control of this country. When he interviews these people in other 'civilized' countries, who don't spend all the time and aggravation like us, and none respond that they wish they could be like the USA. It really has irked me that my whole life, this country has been fed the 'socialist' bullshit by our corporation execs and their puppet politicians. And now it looks like the Congress is going to get around to doing something in the next few years. But wait, they're still going to have a 'premium' based system, so they can keep their hands in your pocket, and maybe still seize your property before you die. Anyway, back to the point. Everyone really needs to understand their deductibles and the way the 'system' works, if possible.

Thanks....I think?

Talk about a back-handed compliment!

When he interviews these people in other 'civilized' countries, who don't spend all the time and aggravation like us, and none respond that they wish they could be like the USA. It really has irked me that my whole life, this country has been fed the 'socialist' bullshit by our corporation execs and their puppet politicians.

There was one party that spent twenty years hiring pscyhologists and linguists to come up with the perfect "framing" for that socialist bullshit. And, we fell for it hook, line, and sinker.

There are many first-world countries that have truly universal health care with similar wait times, better health outcomes, and half our per capita output. It's not a hypothesis, it's been done. We've been had.

Jesus Swept ticked me off. Too short. I loved the characters and then POOF it was over.

BCBS used to cover 30.....

OT, PT, or ST visits per year. not one per week or every other week.30. luckily they changed to unlimited.

----insert witty remark here----coming soon----

Jesus Swept ticked me off. Too short. I loved the characters and then POOF it was over.

Yeah, sorry Robert...

I did mean it as a compliment that you posted this. Our medical system is one of those subjects that gets me going into rants, so maybe lose track of the objective. My mind is still part of that nutty bunch who tried to change things in the 50s and sixties, but when so many became part of the well off Repuke party, the ball was dropped.