How to Be a Smart Consumer When It Comes to Your Healthcare

How to Be a Smart Consumer When It Comes to Your Healthcare

For businesses, shopping for healthcare can be frustrating and complicated. It’s often difficult to know what questions to ask. In addition to the normal questions about premiums and coverage, there are additional areas to know about that can help get the most out of your plan. Here’s a few topics of conversation you may not have considered: 

Understand the real cost of healthcare

You undoubtedly want your employees to have the best healthcare possible. And we’re conditioned to think that, when selecting between providers, the higher priced option is the better one. That’s what you might first think…like the difference between a Ferrari and a Ford. But it’s important to know that there isn’t a standard pricing model in healthcare. It’s possible for two hospitals, for example, to charge very different prices for the same procedure. Just because one provider is more expensive than another doesn’t automatically mean that it’s better. It could just mean that you’re paying more when you may not need to. As an example, Mayo Clinic – a nationally recognized leader in healthcare - often charges less than smaller hospitals with far less expertise

Use price comparison tools

In early 2021 the new Price Transparency Rule requires hospitals to publish a list of their standard charges via the internet in a readable format. Your employee benefits manager will want to become familiar with these charges for the hospitals your employees and their dependents are most likely to use. And you may want to subscribe to the Healthcare Bluebook for your employees and empower them to do their homework and shop around for the best provider of services. 

Take advantage of virtual visit services

Save costs by not going to urgent care. Sparked in popularity by COVID, where people are afraid to leave the house, much less go to the doctor, virtual visit services have risen dramatically in popularity. It’s a quick, easy and cost-effective way of receiving treatment versus going to urgent care for needed medications. 


Know The Real Cost of Prescriptions

Your employees need to understand that the copay isn’t the actual cost of the drug. For example, you may need a $100 drug, and if your copay is $10…the insurance company pays the remaining $90. When those prescription costs are consistently high, it can affect your plan around renewal time. The good news is that there are decisions you can make about your drug choices that save money but don’t impact the efficacy of the prescriptions you need.

Use mail order when available.

Most insurance plans offer a mail order option where your prescriptions can be filled in larger quantities, often 90 days, from the ease of your phone or computer and shipped to you…often for less money than if the prescription were filled at a pharmacy. Be aware though, that for emergency prescriptions like antibiotics where you need to get the drug and take them quickly, mail order won’t work. There is a natural time delay, so you’ll need to plan in advance of when your prescriptions will run out.

Use generics when available.

Generic prescriptions are available for a large number of drugs, and cost less because you aren’t paying for a brand label. The drugs, however, are equally effective as their brand-name counterparts…and significantly less expensive. Over-utilization of higher-priced drugs leads to higher copays for your employees and higher drug expense for your company.

Do comparison shopping.

Encourage employees to be smart shoppers and to use prescription cost comparison services like GoodRX. Most doctors will ask you where you want your prescriptions filled, and if you’ve done your homework, you can choose a pharmacy that charges less to fill the same order.

Take all maintenance meds as prescribed.

Encourage people to take any maintenance meds as they are prescribed and not skip doses, cut pills in half or anything else that would dilute the effectiveness of the drug. It can likely result in the development of more health complications down the road and end up costing you money in the long run. 


Working with a Pharmacy Benefits Manager (PBM)

When a pharmacy dispenses a medication to someone covered by your company's plan, a good Prescription Benefits Manager (PBM) can make a huge difference. Your company pays the pharmacy amounts determined by a PBM through your insurance plan. Our experience has been that companies can sometimes save more money by having a good PBM than by shopping around for a new insurance carrier.

What does your PBM do for you?

You pay prescription drug claims (for amounts over any copay or coinsurance). At the end of every fiscal period specified in your contract, your PBM sends you manufacturer's rebates for expensive brand-name drugs.

Your PBM makes sure you receive the correct amounts of manufacturer rebates specified in your contract, and sometimes can help you get additional savings over list prices for the drugs prescribed to your employees. You don't pay your PBM for their services. They are paid from a proportion of the manufacturer rebates and service fees paid by the drug companies 

Be A Smart Healthcare Consumer

People are so used to not questioning a doctor or clinic/service provider, and only go where a doctor sends you. If you have an HSA or high deductible plan, that money is coming out of your employee's pockets. You want your employees to have choices, and you want them to know they have the right to ask questions. By educating yourself and your employees, you overcome your fear of asking questions and make better decisions. The smarter you can be as a consumer, the better your healthcare plan will work for you…both when you need it now and in the long run.

Winter-Dent can help you find the right plan for your employees and your company. Working with your experts at Winter-Dent, everyone wins. 


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