Do You Know How Your Health Insurance Works?

It’s not exactly a secret that most Americans struggle with comprehending how their healthcare insurance actually works. Then there’s actually using it, which sometimes challenges even people inside the industry! If you don’t really know how your health insurance works, you’re in great company. A 2017 United Healthcare (UHC) Consumer Sentiment Survey of over 1,000 Americans demonstrated that only 9% of those people understood these four basic health insurance terms – health plan premium, health plan deductible, out-of-pocket maximum, and co-insurance. Apparently, we’re getting better, since that’s two percentage points better than when UHC ran the survey in 2016!

This Is a Real Healthcare Consumer Issue

Healthcare customers who rely on their employers to obtain their insurance have some advantage due to internal resources – at least they don’t have to comparison shop for healthcare insurance. But how do healthcare insurance customers on the individual market reliably discern what kind of insurance products they need when they don’t understand the basics of healthcare insurance? Creating more knowledgeable healthcare consumers should help the nation to contain healthcare costs, but health cost information isn’t very valuable when consumers don’t have a baseline understanding of how their healthcare benefits work. 

Don’t Healthcare Insurers Educate Their Subscribers?

Some insurers are making strides in helping their members to make more enlightened healthcare purchases and choices –note the 2% increase in educated consumers from 2016-2017 in the UHC phone survey. However, the healthcare insurance industry has work to do to create better healthcare consumers – and that work may not fully align with business goals. It costs more to educate customers who then will be empowered to make healthier financial decisions – which will curtail insurers’ revenue. And out-of-network claims pose an even greater problem, since insurers will tend to make more money by denying their subscribers the use of out-of-network benefits for which they have paid. All of this leads to challenged subscriber education. Member education, where it occurs, is slow and uneven…rendering it essentially ineffective.

Is There an Alternative?

An alternative that is showing great promise over the past few years is patient financial advocacy. Healthcare patient advocacy is not a new idea; all kinds of groups exist to help people with specific health issues use their insurance effectively. It is an idea with loads of promise. The whole idea here is that an independent patient financial advocate can come alongside a patient and assist them to understand and use their healthcare insurance properly. The result is that patients receive the benefits they have been paying for, providers are reimbursed appropriately for their services, and insurers get an assist in the task of educating their members.

Contego Believes In Patient Financial Advocacy

Contego Solutions works with an independent patient advocacy to offer this service to every patient we serve, so that we can assure that every patient wisely uses the healthcare benefits for which they have dutifully paid. A dedicated patient advocate who knows fully how healthcare insurance works, builds a one-to-one relationship with each patient Contego serves. Each patient has one “go to” resource for the entirety of their claims and appeals process related to their particular surgical event. Contego has been leading the way in the adoption of patient financial advocacy for several years. This stellar patient financial advocacy delivers better health and financial outcomes to the patients Contego serves.