When I was 23, jobless, and living at home, on a whim, a couple of friends and I decided to go to Mohegan Sun Casino in Connecticut. It’s never a good sign when there’s a convergence of 23 year old dudes, without jobs, who decide to go to a casino on a random Wednesday, and the croupier at the roulette table looks like the Black Widow.
Within 20 minutes of walking through the doors, the $100 I had in my pocket turned into $0. I had to beg my friends for food money. Sad.
When you are poor, as I was, losing $10 is catastrophic, and I had just blown $100. Remorse is not even close to the emotion I was feeling, not helped by my fiancé, who was employed at the time, who just used one word….idiot. The memory still pains me to this day.
I was reminded of that feeling when an employee at an employer client of mine had to take his child to an orthopedist because of foot pain. She needed an x-ray and an injection. The gross charge for the office visit, x-ray, and injection at the Greenville, SC based hospital system was going to be $23,656.
Upon engaging with a Care Advocate, it was found that we have a gem of an orthopedic facility in South Carolina. Midlands Orthopedics was able to perform the exact same procedure for $450.
Naturally, upon being informed of this, the employee chose (yes, we give employees the choice) to drive the 90 minutes to Columbia for the visit to save the money.
As Americans, we have been trained to simply put an insurance card down before all encounters with physicians, facilities, and at the pharmacy. After all, your friendly local health insurance broker promised that the health insurance company would pay. If that happened in this case, both the employer and employee would have had to pay thousands of dollars.
When it’s so easy just to put your card down as we are all trained to do, why would an employer listen to a crazy person like me and request that employees ask questions about the cost of care and engage with an advocate? Because who ultimately pays that $23,656? While the carrier might pay in the short run, ultimately, that cost comes back to your business and employees in the form of higher premiums. In the world of health insurance, the payers are not the health insurance companies. It’s ultimately you, the individuals and businesses, who pay the premiums.
What else did this employee gain? The non-monetary benefit was the message that the employer gave a shit about them. For only the time it took to place a phone call and be given the option of a lower cost location, which the employee ultimately chose, the employee was given the sense that someone was looking out for them and their best interest in the design of the program.
What we propose is a trade. Let’s trade shopping insurance premiums for the correct level of catastrophic protection and spend the savings on actual healthcare. While insurance brokers survey the market to present a choice of mediocre to bad options, what we do is advise employers on how to build their own plan while improving access and cost for employees and their families.
When you are playing the health insurance game, and you put your insurance card down, you are placing a bet. You’re betting that you are getting the best possible price for the highest quality of care. Much like the casino, insurance carriers don’t care about your ability to afford the care at the rates they negotiate, they just want the money your place on the table in the form of premium payment.
Don’t live with the remorse that the hundreds paid in the form of premiums result in the loss of thousands when you lose the game.
The house always wins.