InQ
The Fog of Health Care: Is Confusion the Plan?
March 08, 2009 by David DeCheser

The Fog of Health Care

My wife recently gave birth to our son. That spectacular event triggered a flurry of communications from our health plan — namely, plan statements. Plan statements get mailed following a provider visit. They explain what procedures were performed, what the provider billed the plan, and what the consumer’s cost is (if any).

Up until recently we really didn’t pay much attention to our statements, as we rarely visit the doctor. But after the birth, larger bills started to float in — it was time we looked closer.

For 10 minutes I stared at one such statement and couldn’t make heads or tails of it. My plan’s statements are filled with so much jargon and cryptic codes that each one comes with a whole extra page of definitions. Even with this glossary, I still needed to call customer support to get help understanding the statement in question. After 20 minutes of going through my statement line-by-line, I found that at least half of the information I had questions about wasn’t even relevant to me. One is left with the cynical feeling that these statements are made intentionally complex in order to deter members from questioning their content and accuracy. Customer loyalty is based on trust. Mine was shaken.

I found myself asking, “Who do these companies think their customers really are?”

Today it’s not cost effective for me to express my displeasure by walking my business elsewhere to a plan that not only sends statements I can understand, but maybe has better coverage, too. Shopping for health insurance is a luxury that most individuals can’t afford. A large majority of us go through our employers — with the cost of health care rising, it’s really the most affordable option.

In this type of environment, where companies don’t have to compete as fiercely for consumer loyalty, it’s the consumer who loses.

As bad a rap as the health industry gets, apparently 70% of us are happy with our plans. Not surprisingly though, studies show that we want more control. According to a Deloitte report, consumers have indicated that if the pricing were comparable, 46% would prefer to shop for their own insurance rather than go with their employer’s. And while happy, 52% of us admit to not understanding our coverage.

For the moment, with the health care system set up the way that it is, the power primarily rests with the insurance companies. Let’s assume that one day that changes. Websites would surface that would let consumers rate, review, and compare plans and their related providers. Insurers would have to step up and provide better services and communications. Plan statements might actually start to get written in plain English; maybe they’d even have useful information like a running total of your deductible.

Most of the conversation around health care reform rightfully revolves around cost. If and when this future state is ever achieved, we might also finally find ourselves in the position of buying a product that we can actually understand.

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