With open enrollment season upon us it is officially health insurance season. This time every year I am reminded just how expensive healthcare is, and just how confusing the payment process is on top of that. Fortunately, one of the most empowering things you can do to lower your healthcare costs is not that confusing at all. It’s all about preplanning and knowing, in advance, what the right level of care is for your needs.
Ever play a game of Mad Libs? They are those word games where a pal asks you to substitute words for blank spaces in order to create a nonsensical story. Well, the Healthcare Mad Libs is not nearly as fun, but it definitely makes a lot of sense. In fact, it’s also a great way to compare insurance options available to you during open enrollment season. Just make a Healthcare Triage Memo in your phone or a Word doc. You can simply copy and paste the italicized potions of the narrative below, fill in the blanks with the information from your open enrollment guide, and you will have it ready the next time you need to make healthcare decisions quickly.
Nurse Advice Line
First things first, find out if your health insurance company or healthcare provider offer a nurse advice line. Most do, and this service is both awesome and heavily under utilized. When you become ill this should be your first line of defense. Here is what you should put in your memo:
For Nurse Advice Line: Call [enter nurse advice line number] for the following issues:
- First aid advice for minor injuries
- First line of defense for common illnesses such as the cold, flu, or a urinary tract infection
- Question about a medical condition
- Question about a medication
- Question about how to take a medication safely
- Self-care tips and treatment options
- Questions to ask your doctor
- Illness prevention
- Nutrition and fitness
- Choosing appropriate medical care
This option is free of charge.
Telemedicine services are becoming more widely available. This is the first year that my health insurance company offers them, but, being in the healthcare industry, I’ve been hearing more about them over the past five years or so.
So what is telemedicine? Telemedicine is receiving care from a doctor via HIPAA secured teleconferencing (hence the name telemedicine). This typically takes place using a mobile app or a webcam. These services provide immediate access to doctors 24/7. In some states the doctor can even provide you with a prescription after a telemedicine visit. Here is what you should put in your memo:
For Telemedicine: Call [enter telemedicine number] or log in to [web address] with the username [enter username] and password [password] for the following issues:
- Common health concerns such as colds, flu, fevers, infections, and allergies
- Mental health questions or concerns
This option will cost [enter the cost] per visit.
If you have a PPO plan, then these visits have a lower copay than what you would pay for a doctor visit. If you have an HSA plan, and haven’t reached your deductible, then your telemedicine service will have a capped fee per online visit. Mine is $49, for example.
A note about mental health visits. Telemedicine is a wonderful option for mental health. Some health insurance plans make mental health services much more expensive to utilize. For example, some factor mental health visits as an inpatient visit where you have to cover your deductible before coverage kicks in. That’s a major hurdle to get this very important care. Telemedicine has proven to be very effective at offering lower cost care with the added benefit of helping alleviate concerns of social stigma.
This is usually a healthcare consumer’s first line of defense for healthcare. You feel sick, and then you pick up the phone to schedule an appointment. You can see above, though, that there are much lower cost choices available. For me, the doctor’s office is only my first call when it comes to preventative medicine (yearly physical, pap smear, etc.). That is because preventative medicine is always covered 100% by health insurance. Do make sure that the provider you select is in network because insurance companies will charge you for preventative wellness if you select an out of network provider. For this reason, and many others, choosing an in network provider is a top tip for saving major healthcare money. Enter the following into your memo:
For the Doctor’s Office: Call [enter appointment line] for the following issues:
- Preventative wellness checkups
- Mental health services
- If the nurse line or telemedicine line recommends I go in to see a doctor
The doctor’s office hours are: [enter hours]
For preventative medicine check ups, health insurance will cover 100%. For services other than preventative wellness, I will pay [enter copay] to see my primary care physician or [enter copay] to see a specialist. I will also have to pay up to [deductible amount] for any inpatient our outpatient services.
For HSA plans: For preventative wellness check ups, health insurance will cover 100%. For services other than preventative wellness, I will need to pay my full deductible of [enter deductible] before my insurance kicks in. After I paid the deductible within a coverage year, then I will pay [%] of the total cost of service until I have paid a total of [enter out of pocket maximum] within a year. Then my insurance will pay 100% of my healthcare costs.
As for deductibles, as noted above, they typically only come into play for inpatient and outpatient services, but each insurance policy has different definitions around what qualifies as an “inpatient service” versus a primary care or specialist visit. This is most commonly an issue with mental health services as described above under telemedicine.
Convenience Care Clinic
I like to consider “convenience care clinics” like the Minute Clinic at CVS as a healthcare bridge. Typically one either goes to a doctor’s visit or to urgent care. However, the benefit to these clinics is they are usually close in proximity (almost always tied to a major pharmacy like CVS or Walgreens), they have better hours than a typical doctor’s office, and they are cheaper than urgent care. My doctor’s office rules still apply here. Always check with the nurse line or telemedicine first. Here is what you put in your memo:
For the Convenience Clinic: Call [enter number to a local convenience care clinic] or go to [convenience care clinic address] for the following issues:
- If the nurse line or telemedicine line recommends I see a doctor, but my doctor’s office is not open and the convenience clinic is.
The convenience clinic hours are: [enter hours]
I will pay [enter copay] for a convenience care visit. I will also have to pay up to [deductible amount] for any inpatient services
For HSA plans: I will need to pay my full deductible of [enter deductible] before my insurance kicks in. After I paid the deductible within a coverage year, then I will pay [%] of the total cost of service until I have paid a total of [enter out of pocket maximum] within a year. Then my insurance will pay 100% of my healthcare costs.
One of the main reasons that an urgent care location is selected over the options above has to do with the time of day, or the day of the week, you need care. Typically if your doctor’s office is closed, then this will be your next resort. I have, however, outlined other options above, which is why you should enter the following in your memo:
For Urgent Care: Call [enter appointment line] or go to [urgent care address] for the following issues:
- If the nurse line or telemedicine line recommends I see a doctor and the doctor’s office and convenience clinics are closed.
The urgent care hours are: [enter hours]
I will pay [enter copay] for an urgent care visit. I will also have to pay up to [deductible amount] for any inpatient and outpatient services.
For HSA plans: I will need to pay my full deductible of [enter deductible] before my insurance kicks in. After I paid the deductible within a coverage year, then I will pay [%] of the total cost of the urgent care visit until I have paid a total of [enter out of pocket maximum] within a year.
This is your most expensive healthcare option. As a result, you should always remember that the word “emergency” is in emergency room. Use this only for serious, life-threatening conditions. Let me explain why. According to Kiplinger, the average in-network emergency room visit costs $933. Let’s compare that to an urgent care visit with an average cost of $71 or a “convenience care clinic” (like the Minute Clinic at CVS) of $33 on average. Your copay will be higher and you will almost always get another bill in the mail to pay for tests provided in the ER. This is why I recommend that, whenever possible, the nurse line should be your first line of healthcare defense. These are trained professionals that can help you triage your care options. Here is what you add to your memo:
For the Emergency Room: Call 911 or go to [ER address] for serious, life threatening issues.
I will pay [enter copay] for a visit to the ER. I will also have to pay up to [deductible amount] for any inpatient or outpatient services tied to this visit.
For HSA plans: I will need to pay my full deductible of [enter deductible] before my insurance kicks in. After I paid the deductible within a coverage year, then I will pay [%] of the total cost of the emergency room visit until I have paid a total of [enter out of pocket maximum] within a year.