select your privacy, cost and experience
With how much we all pay for insurance, today’s consumers want maximum value from their healthcare dollars. According to eHealth, America’s largest online provider of health insurance, premiums took a significant leap in 2017 and are expected to continue to rise with some estimates as high as 50% in 2018. On average, monthly family premiums in 2016 were over $1,000 with annual deductibles over $8,300. Now more than ever, it’s important for consumers to be knowledgeable about their healthcare choices.
Informed consumers are selective consumers
In the past a convenient location like close to work or home was a major factor in choosing healthcare providers. But no more—consumers are becoming more selective. They want to go to the right person the first time, and they are doing their research. As one client put it, “I need this care and I’m not going to waste my time on the wrong person with the wrong skill set. I want to see someone who is smart, dialed in and totally gets me and my goals. I’ll drive 30 minutes to find that person because great healthcare is worth it to me.”
There is no such thing as a typical client: different clients have different priorities and make different choices in different situations. Similarly, all clinics are not alike. They vary in personality, values, organization, environment, efficiency and approach to care. Good healthcare means finding the skill set, price point and convenience that works for your personal preferences. It’s ok to be picky!
It is not unusual for our clients to visit different clinics, dig into websites, and study Google reviews. Some clients arrange to talk with a clinician first to make sure it’s a good fit. We love proactive, engaged clients who do their research! When they care that much about the decision on where to go, we know they are committed to their rehab.
Why won’t they tell me the cost?
Before buying anything, a key question is, “how much does it cost?” This is a frustrating arena for healthcare consumers who may feel like they get the run around when asking this fundamental question. In truth, the answer is more complex than it appears.
Your out of pocket costs depend on the terms of your specific plan, your deductible amount, what services your plan has covered so far this year, as well as any secondary insurance you may have.
Health Insurance companies prevent providers from freely sharing costs of care because of anti-trust and contractual statutes. This adds to the complexity and frustration for consumers and providers alike, both of whom would like transparency in pricing. Each insurance company holds individual contracts with providers, each potentially at different rates. Care may be priced based on time and type of treatment at each visit versus a flat rate, so it’s not easy to get the bottom line until the service has been delivered, billed and the insurance company has determined what they will pay. Physical therapy care for a client with complex pelvic pain may be more lengthy and multifaceted than rehabilitating a client with turf toe. (No offense to those with turf toe, that hurts too!) A client with a lengthy, detailed medical history or specific and multiple rehab goals can mean greater complexity and duration of the intervention and therefore the cost. Taken together, these variables create difficulty for those who like clear numbers.
Providers find it frustrating too.
The one who pays controls the information
HIPAA, or the Health Insurance Portability and Accountability Act, is a US law designed to provide privacy standards to protect clients’ medical records and other health information provided to health plans, doctors, hospitals and other providers. Everyone involved in healthcare treats privacy with the utmost seriousness and access must always be an as-needed basis only. That being said, when insurance companies outsource decision making for treatment authorization to a third party, it does mean more eyes on your records and more opinions on your care. When insurance pays for your care they set the rules on what is allowed, how often you may receive it, and who can deliver it (and where). As the payer they also have the right to view the records for that care.
Based on a 2013 ruling, consumers may request to pay privately for healthcare services and in doing so, restrict disclosure of information to their health plan. Paying your premiums and then for healthcare as well can be expensive, but some clients are making that choice for two primary reasons: to protect their personal information; and to choose the timing and type of care that is right for them outside of the rules and regulations of their insurance company. (An exception to this is Medicare, which as a federally funded program, tightly controls what providers and participants may do.)
Great care provided by a company whose values align with yours
We encourage clients to ask questions about things that matter to them, and vote with their feet to support organizations that align with their needs and personal values.
Does the clinic offer expansive hours 6-days per week for client scheduling convenience? Do they offer advanced scheduling convenience for all clients, regardless of how much their insurance reimburses for care? Will you work consistently with a licensed clinician during each of your visits? Can you see a different clinician if it isn’t a good fit? Are they locally owned? Do they take good care of their employees with benefits, education and retirement? Do they offer flexible work arrangements for families? Do they share financial success with their employees? Do they invest in equipment and space that reflect value, aesthetics and the most current treatment progressions? These are unusual questions for healthcare consumers but factors that we know are important to many. When it comes to CorePhysio, the answers are all a resounding “Yes”. Despite the challenges in healthcare, our client-centered values drive us to create a win:win:win for clients, staff, and the organization.
Three Proactive Client choices to find the right care for you
- Decide if you want your insurance to pay for your care. The bottom line—control of information rests with the payer. Unless you have Medicare, you do not have to share your health insurance information with a healthcare provider and you have the option to pay cash for services.
- Become an informed consumer Do you know the difference between coinsurance and a co-pay? What’s your deductible?. What is your personal financial responsibility for your care? Talk to your provider’s billing staff. They should be able to answer your questions or direct you to the right person. Does the provider have policies that can accommodate a range of financial realities?
- Do your homework with 5 different types of references to choose the right match for you.
- Ask friends and family. They know what you like, and you know what they like. That kind of insight is golden!
- Ask multiple people in the industry. Whose name keeps coming up?
- Look at online reviews (but take them with a grain of salt.)
- Visit the provider’s website and office. What’s the vibe? Your experience includes front office staff, other clients in the waiting room, and location convenience as well as your clinical team. Any one of those things could be an enhancer or a detractor to your satisfaction and willingness to stick with your program.
- Know out who your clinician is. Read their bio and, if it would be meaningful to you, call to talk with them before scheduling.
Elizabeth Hampton PT DPT WCS BCB-PMD is the owner of CorePhysio and a highly selective healthcare consumer. Her requirements for her personal healthcare providers is that they are great diagnosticians, smart strategic thinkers, charismatic, funny and love what they do.