First Paycheck of the New Year

[Surfah]

My Fortune 50 company has built an intranet (internal) web site so its employees can better calculate and understand the true value of their compensation...because the rank and file's bottom line on their paycheck has gotten smaller every year even with temporary tax cuts, etc.

I haven't taken the time to view it yet. It's bound to be interesting since the company recently ditched their limited pension for new hires. Perhaps this internal web site is a sign of economic recovery since the company seems a little worried about losing staff.

Mine does the same. I don't think it's because they're worried about losing staff though. I think it's to show us exactly how much they're paying for insurance.

[Clark Addison]

Bi-monthly paycheck. Net pay down $336.37. But about $175 was due to an increase in my HSA contribution, because we went to a high deductible insurance plan (not by choice). Plus, raises don't hit until February. Of course, my raise last year totaled $0, so who knows if I will see any relief there.

[MarkGrace]

Can't remember the last time I looked at details of a paycheck. No idea how much mine has changed.

Got paid today and checked the amount to see if it had changed. When I first looked at it, I thought "woah, it went up, weird!" Then I looked at my last paycheck and it had actually gone down. lol...yeah, i don't pay much attention.

[pellegrino]

came in at about $40 less on the biweekly, so $80 per month. I guess we won't be going out for birthdays anymore.

[Uncle Ted]

Bi-monthly paycheck. Net pay down $336.37. But about $175 was due to an increase in my HSA contribution, because we went to a high deductible insurance plan (not by choice). Plus, raises don't hit until February. Of course, my raise last year totaled $0, so who knows if I will see any relief there.

I read that about 20% of companies only offer high-deductible plans this year and that may jump as high as 45% in 2014. The move from traditional healthcare plans to high-deductible plans has some interesting implications for both the consumer and the healthcare provider such as...

[...]

Studies show people on these plans are three times more likely to delay or skip care than people on traditional plans, where doctor or emergency room visits are covered by a relatively low co-payment.

[...]

These plans have been around for years, pushed by employers, insurers and industry experts who believe that consumers with "skin in the game" will drive demand for better quality care at a lower cost. It is a rationale also backed by President Barack Obama's Republican challenger Mitt Romney. [It may also drive the consumers to live healthier life styles as well.]

[...]

The shift means consumers will have to spend many more hours researching their treatment options and managing costs on websites like Healthcarebluebook.com, which helped budget the cost of examining the shoulder pain mentioned above.

It could also spur lawsuits against doctors whom patients may blame for not making clear whether a test or procedure would spare them future harm, legal experts say.

[...]

Critics of this shift say it leaves consumers at the mercy of providers when it comes to medical costs. While insurers have been able to leverage their scale to negotiate rates down, ordinary individuals do not have that clout.

That gap may prove fertile ground to patients waging legal challenges against doctor bills.

[...]

Laws dealing with "informed consent" may also play a role in putting the onus on doctors to clearly disclose costs when explaining treatment options. Doctors may be liable for a breach of fiduciary duty if their healthcare recommendations turn out to be too aligned with their financial interest, Morreim said.

I am guessing that we will see more and more healthcare providers publishing prices in the near future.

[doctorcoug]

I read that about 20% of companies only offer high-deductible plans this year and that may jump as high as 45% in 2014. The move from traditional healthcare plans to high-deductible plans has some interesting implications for both the consumer and the healthcare provider such as...



I am guessing that we will see more and more healthcare providers publishing prices in the near future.

Very few Americans should not be on an HSA.

Liability to the physicians? I have no knowledge of what the lab is going to charge. That isn't my responsibility. The consumer should call and ask. Why isn't always the physician's fault? Let the patient do the legwork and find out how much it is going to cost. Their the consumer, not me. In only provide recommendations and it is their choice to follow my recommendations. If they follow them or not, that is their decision that they have made as a consumer, not because I forced them to do anything against their will.

My test found an abnormality and now I'm liable because you didn't want to know and now can't afford it? Take some responsibility.

Also, the author knows squat about insurance. The statement that insurance companies are able to negotiate prices for their clients and HSA users will be left high and dry is pure ignorance. People that have an HSA that they currently deposit into also have a high deductible health plan. Who provides that plan? Big insurance company that is able to negotiate prices. The insurance company wants prices to be low because once then out of pocket max is met...they are on the hook up to the limits. Pure ignorance.

We really need to get back to a model of insurance, not our current prepaid medical system. For instance, doctor visits should be a cash only thing. The insurance should be used for catastrophic events.

Over 25 percent of my patients are on HSAs and it has completely changed my management. I order significantly less tests, but I have longer talks about risks and I document very well.




via a galaxy s3 far far away

[Uncle Ted]

Very few Americans should not be on an HSA.

Liability to the physicians? I have no knowledge of what the lab is going to charge. That isn't my responsibility. The consumer should call and ask. Why isn't always the physician's fault? Let the patient do the legwork and find out how much it is going to cost. Their the consumer, not me. In only provide recommendations and it is their choice to follow my recommendations. If they follow them or not, that is their decision that they have made as a consumer, not because I forced them to do anything against their will.

My test found an abnormality and now I'm liable because you didn't want to know and now can't afford it? Take some responsibility.

Also, the author knows squat about insurance. The statement that insurance companies are able to negotiate prices for their clients and HSA users will be left high and dry is pure ignorance. People that have an HSA that they currently deposit into also have a high deductible health plan. Who provides that plan? Big insurance company that is able to negotiate prices. The insurance company wants prices to be low because once then out of pocket max is met...they are on the hook up to the limits. Pure ignorance.

We really need to get back to a model of insurance, not our current prepaid medical system. For instance, doctor visits should be a cash only thing. The insurance should be used for catastrophic events.

Over 25 percent of my patients are on HSAs and it has completely changed my management. I order significantly less tests, but I have longer talks about risks and I document very well.

And having a HDP and HSA has made me care a lot more about what I eat and exercise more.

I can see more and more consumers with HDP/HSA using resources like healthcarebluebook.com and healthcare providers being pressured to disclose more information about what they charge openly. BTW, is your price list published on your website?

[lambdacoug]

Very few Americans should not be on an HSA.

Liability to the physicians? I have no knowledge of what the lab is going to charge. That isn't my responsibility. The consumer should call and ask. Why isn't always the physician's fault? Let the patient do the legwork and find out how much it is going to cost. Their the consumer, not me. In only provide recommendations and it is their choice to follow my recommendations. If they follow them or not, that is their decision that they have made as a consumer, not because I forced them to do anything against their will.

My test found an abnormality and now I'm liable because you didn't want to know and now can't afford it? Take some responsibility.

Also, the author knows squat about insurance. The statement that insurance companies are able to negotiate prices for their clients and HSA users will be left high and dry is pure ignorance. People that have an HSA that they currently deposit into also have a high deductible health plan. Who provides that plan? Big insurance company that is able to negotiate prices. The insurance company wants prices to be low because once then out of pocket max is met...they are on the hook up to the limits. Pure ignorance.

We really need to get back to a model of insurance, not our current prepaid medical system. For instance, doctor visits should be a cash only thing. The insurance should be used for catastrophic events.

Over 25 percent of my patients are on HSAs and it has completely changed my management. I order significantly less tests, but I have longer talks about risks and I document very well.




via a galaxy s3 far far away

It is very hard to be a smart consumer when prices are not published. I cannot make a determination of which doctor to see based on cost. You say you have no idea what the labs will charge. When I ask how much a test/procedure will cost I get a lot of hemming 'n hawing and not much that helps me be a smart consumer. I'm no expert on the system, but I know that as a consumer it is very difficult to be an informed consumer and make my health decisions based on how.much services cost vs the quality of care.

[doctorcoug]

It is very hard to be a smart consumer when prices are not published. I cannot make a determination of which doctor to see based on cost. You say you have no idea what the labs will charge. When I ask how much a test/procedure will cost I get a lot of hemming 'n hawing and not much that helps me be a smart consumer. I'm no expert on the system, but I know that as a consumer it is very difficult to be an informed consumer and make my health decisions based on how.much services cost vs the quality of care.

That isn't my fault. The person that should be publishing costs is the insurance company, not me. If I charge a level four visit, each insurer pays differently.

I tell my self pay patients up front how much it is going to cost. I can't do that for insured patients because it is the insurance company that ultimately tells me how much it is going to cost and I can't balance bill.

So, don't blame the physician, blame the insurance company for not disclosing prices.

Also, I had a lady today who had a cough and sinus congestion. I noted a heart abnormality on exam today and that led to an EKG and the diagnosis of atrial fibrillation was confirmed. This led to a ct, which led to an echo. If I had said, your visit will cost you 80 dollars, that would have been wrong. I did a good job and then ended up costing her thousands of dollars today. But, I have significantly reduced her liklihood of having a stroke.

via a galaxy s3 far far away

[statman]

Over 25 percent of my patients are on HSAs and it has completely changed my management. I order significantly less tests, but I have longer talks about risks and I document very well.

Another fairly recent thing that has changed behaviors - the donut hole in Bush's Medicare drug benefit. When the government paid all the drug bills, seniors had no problem in taking only the newest brand-name maintenance drugs - often to the tune of several hundred a month in maintenance drugs. When the government paid the first couple hundred a year, and seniors were mostly responsible for the next thousand or so, seniors were suddenly fine with taking alternate generic medications - in fact, they started asking their doctors for the drugs on the Walmart $4 formulary, and could keep the price of all their day-to-day drugs under the threshold where the government stops paying. Market forces like big deductibles and donut holes are what will ultimately reign in medical costs...

(Walmart estimates that it's switch to $4 scripts (and everyone else following suit) have saved the US government about $100 billion in the last five years. And somehow they're the enemy (although the Medicare donut hole changed senior's spending behaviors prior to the Walmart change, it wasn't really until seniors had the $4 formulary (and all the big pharmacies followed with similar low-cost alternatives) that they could take to the doctor's office with them that they started switching in droves))

[Clark Addison]

I read that about 20% of companies only offer high-deductible plans this year and that may jump as high as 45% in 2014. The move from traditional healthcare plans to high-deductible plans has some interesting implications for both the consumer and the healthcare provider such as...



I am guessing that we will see more and more healthcare providers publishing prices in the near future.

I think you are correct. My company still offers a PPO-like plan, but if your income is over a certain amount, you are not eligible for it. Also, I certainly see the benefits of a high-deductible plan, We definitely have scrutinized our health costs more. Having said that, we, like a lot of people, have some fixed health care costs. Today is the January 16th. So far this month, we have paid over $700 out of pocket for prescription drugs. The first few months until we hit our deductible are not going to be fun.

[Uncle Ted]

I think you are correct. My company still offers a PPO-like plan, but if your income is over a certain amount, you are not eligible for it. Also, I certainly see the benefits of a high-deductible plan, We definitely have scrutinized our health costs more. Having said that, we, like a lot of people, have some fixed health care costs. Today is the January 16th. So far this month, we have paid over $700 out of pocket for prescription drugs. The first few months until we hit our deductible are not going to be fun.

Ouch. Have you considered moving to Texas? We have found that prescription drugs are a lot cheaper if you take a weekend trip across our southern border. And no prescriptions needed and they seem to look and taste the same.

[Uncle Ted]

That isn't my fault. The person that should be publishing costs is the insurance company, not me. If I charge a level four visit, each insurer pays differently.

I tell my self pay patients up front how much it is going to cost. I can't do that for insured patients because it is the insurance company that ultimately tells me how much it is going to cost and I can't balance bill.

So, don't blame the physician, blame the insurance company for not disclosing prices.

Also, I had a lady today who had a cough and sinus congestion. I noted a heart abnormality on exam today and that led to an EKG and the diagnosis of atrial fibrillation was confirmed. This led to a ct, which led to an echo. If I had said, your visit will cost you 80 dollars, that would have been wrong. I did a good job and then ended up costing her thousands of dollars today. But, I have significantly reduced her liklihood of having a stroke.

via a galaxy s3 far far away

I have found when I tell the doctor that we are paying "cash" (actually using our HSA card) he loads up up with a bunch of trial drugs so we don't have to buy so much of the prescription. Also, he gives us what he says is his "cash" discount. You do that with your customers as well? Maybe we just look poor or something.

[Donuthole]

Very few Americans should not be on an HSA.

Liability to the physicians? I have no knowledge of what the lab is going to charge. That isn't my responsibility. The consumer should call and ask. Why isn't always the physician's fault? Let the patient do the legwork and find out how much it is going to cost. Their the consumer, not me. In only provide recommendations and it is their choice to follow my recommendations. If they follow them or not, that is their decision that they have made as a consumer, not because I forced them to do anything against their will.

[. . .]

Over 25 percent of my patients are on HSAs and it has completely changed my management. I order significantly less tests, but I have longer talks about risks and I document very well.

[smokymountainrain]

I have found when I tell the doctor that we are paying "cash" (actually using our HSA card) he loads up up with a bunch of trial drugs so we don't have to buy so much of the prescription. Also, he gives us what he says is his "cash" discount. You do that with your customers as well? Maybe we just look poor or something.

If you do that, however, the cost of the visit doesn't apply to your deductible, right? Because you aren't giving him your insurance information? Seems like a bit of a conundrum.