Consumer choices affect health plan costs and costs to members
Health care costs in Alaska are among the highest in the nation, but as members of a self-insured organization, we can help control some of the expense. Costs incurred by plan members have a direct impact on the cost of the plan for everyone. With the help of Patient Care, our consumer health advocacy provider, you can easily find the best option locally, or work through Premera for medical travel support to utilize an even better provider outside Alaska, or in another part of the state, including the cost of travel and lodging for you and a caretaker.
Here’s how you can help keep costs down while improving your health at the same time.
Medical travel benefit
As of Jan. 1, 2016, the medical travel benefit expanded to cover most conditions as long as travel is considered safe and a savings potential can be shown. Overall, the 10 medical travel benefit procedures approved between January 2013 and June 2015 saved the plan $301,581 against the lowest cost Alaska providers.
Since joint degeneration is the most prevalent condition for members in our plan, let’s use a hip joint replacement procedure for an example. When you review the graph below you can see the difference the selection of a provider can make. By using the travel benefit and flying to Seattle, the costs could be reduced between $7,215 and $54,940 on that one hip replacement. It’s well worth the savings to the university to cover the price of your tickets and hotel!
In-network vs. out-of-network
No matter what the procedure, it is important to understand the difference between in-network and out-of-network providers. As of December 2015, Premera had 20 hospitals and 2,736 providers in its discount network in Alaska. Premera negotiates discounted contract rates with in-network providers, then the university pays 80 percent of the cost, after the deductible. The provider cannot send any more bills to the plan member beyond the 20 percent coinsurance, up to the member’s out-of-pocket maximum.
With out-of-network providers, the university plan pays only 60 percent of the allowable cost, while you pay the remaining 40 percent. (If there is no in-network provider in the area, the plan pays 80 percent). But in addition to the 40 percent coinsurance, the provider can “balance bill” the member for any charge amount above the allowable cost, and out-of-pocket maximums do not apply. With the plan now paying a lower amount in allowable charges (125 percent of Medicare instead of the 80th percentile of Alaska prices) it is possible for members to receive very high health care charges for which they are personally responsible, and without an out-of-pocket maximum limit.
To put that in perspective, imagine that an out-of-network provider charges $18,000 for a procedure. The allowed amount that the Premera plan will cover is $8,000 based on 125 percent of Medicare charges for that procedure. The University of Alaska, through Premera, contributes 60 percent, (assuming you have already met your deductible), paying $4,800. You pay $3,200 in co-insurance. The provider can then decide to balance bill you for the $10,000 difference between the allowable charge and their price. In the end, you could be left with $13,200 in bills for that procedure. By comparison, imagine an in-network provider who contracted with Premera for $15,000 for that same procedure. The university would pay 80 percent, or $12,000. Your part at 20 percent would be $3,000, and there could not be another bill from the provider for that procedure even if their regular price is higher.
Before you get a procedure, always:
- find out if your procedure needs to be pre-authorized
- contact Patient Care for help finding a recommended provider
- get an estimate of benefits to find out how much the plan will pay and what you’ll be responsible for
A little homework ahead of time could prevent a lot of unexpected expenses later!
If there’s no in-network provider in your area:
- contact Medical Travel Support benefit to help you get the care you need with an in-network provider in another city or state. Just call Premera for help in getting started.
Prevention is key to avoiding expense
Plan redesigns over the last few years have increased preventive care benefits. Screenings help doctors catch health problems earlier and avoid larger medical bills or more serious conditions later. The following screenings are offered at 100 percent of allowable cost, with no deductible or coinsurance expense:
- routine physicals
- dental cleanings
- eye exams
A full list of the preventative benefits offered under the plan can be found here.
Save even more with the wellness rebate
Plan members in the Healthyroads wellness program can earn up to a $600 rebate on annual health plan costs. The rebate is applied on any check that has a health plan deduction. Employees who join the plan mid-year or leave before year end will have their rebate prorated for the time they’re on the plan.
The FY16 wellness program deadline is coming up on April 30. Participants must complete a personal health assessment, get a biometric screening, and earn five points to get the rebate on their FY16 health care contributions. Information on how to earn points is at www.alaska.edu/benefits/wellness/.
Want additional help with your health and wellness goals? Enroll in the Healthyroads health coaching program. The coaching program is free for anyone currently eligible for the wellness program, and you can earn points toward next year’s rebate as well.
Choose to pay less
We can improve our health and lower our costs by:
- choosing less-expensive providers
- participating in preventive screenings and the wellness plan
- selecting in-network providers
Because our plan is self-insured and employees share in the costs of the plan, a savings for any one member can contribute to a savings for all.
Get help with medical billing questions and claims
Medical billing is difficult to understand. One procedure can create multiple claims, for instance separate lab, doctor and pharmacy bills. Balance billing can create a nightmare situation, with large medical bills not covered through the plan. UA Choice plan members have an advocate to help them: Patient Care. They can assist with medical billing questions after the fact in addition to assisting in finding a provider prior to a procedure. Their HIPAA protected service is only a phone call or click away. If you have been affected by changes in allowable cost to your provider, or have other questions about medical bills, you are encouraged to use their advocacy services by calling (866) 253-2273.