Consumers for Health Care Choices
Consumer Testimonials
As Consumer Driven Health Care rolls out in the market place and attracts larger numbers of people, the real test of the approach is the effect it has on the lives of real people. Do people feel empowered? Do they have more control? Do they shop for products and services? Can they get the information they need? Is the patient/physician relationship being restored? Are people really saving money? Are they satisfied? All the statistics and policy papers in the world won’t matter much if consumers are not happy with the experience.
Consumers for Health Care Choices will be collecting real-life stories and publishing them here. We don’t just want to hear happy stories, but we want to hear about problems as well. Please share you experiences with us. Submit your adventures to: --support@chcchoices.org Please include contact information and a photograph if you have one.
We'll Sell No Other
Founding Member Edward Dee Hinds writes:
On July 15, 2005 we had a client (24 years old) jump in a swimming pool and break his neck. He is now a quadraplegic. On July 29, 2006 the son of a client (15 years old) jumped in a lake, and is now also a quadraplegic.
Both of these people are covered under an HSA system, and both claims were handled superbly. These claims went so well that we will no longer sell any other type of health insurance.
Dee Hinds
Paso Robles, CA
Cash = Health Care Savings
“Do you give a discount for paying cash?” When the doctor’s office asks for your insurance card, responding with that simple question is one way to control the cost of health care.
I recently saved 50 percent on an arm X-ray for my daughter because I paid cash and covered the cash outlay from pretax money that was set aside in a Flexible Spending Account. That question also saved me 5 minutes of filling out the insurance form information and untold amounts of time of the doctor’s staff filling out forms. I was surprised, but the immediate care center instantly said they gave a 20% cash discount over using an insurance card. It would have cost $271 if the insurance card had been used. Since it was the first claim of the year, eventually I would have had to pay all $271 anyway as part of the deductible. To come up with the $271 payment for using the insurance card I would have had to earn $425, of which FICA would have taken out 15% and income tax another 25%. By asking a simple question, “Do you give a discount for paying cash?” I paid only $216 and saved myself $209, or nearly 50 percent over using an insurance card.
It’s not illegal for a doctor’s office or hospital to have two price schedules, one for using insurance coverage and a discounted price for cash-paying customers. If they take insurance, they should offer both payment options and the prices should be posted. Every opportunity you get, ask the question, “Do you give a discount for paying cash?” Even doctors will love you for asking because they get paid immediately and don’t have to spend staff time and money trying to collect from a third-party insurance company.
Jim Porterfield
Fairfax,. VA
Testimony Submitted to U.S. House of Representatives Ways and Means Committee, June 28, 2006
Click here to read the document.
To Whom it may concern:
I have had the good fortune to be included in my Company’s Health Savings Account (HSA) plan for a number of years and have found it to be a wonderful way to maintain high quality health care for myself and my family at reasonable cost.
My family HSA plan does have what is considered a high deductible at $3500 per 12 month period. I have had enough time with the plan to have secured over $9000 within the account through my employers contributions and through “painless”, pre-tax payroll deductions.
I am 56 years old and have been diagnosed with high blood pressure. I take three medications each day for this problem and a 4th medication for a Hypo-Thyroid condition diagnosed years ago. The counter cost for these daily medications at the local Pharmacy was approximately $250 per month. In my old HMO-PPO plan, I could care less about this since I had a $10 co-pay plan for prescription drugs. Since I had to pay out-of-pocket this amount using the HSA plan, I decided that this monthly cost was too much for me to want to bear. I shopped around and guess what I found? By traveling to another pharmacy outlet, I was able to reduce this monthly fee to half the cost for the same RX! Each time I used the HSA funds for these prescriptions, the total was applied against the yearly total deductible within my account.
In the past 12 month period I had a series of health issues requiring hospital stays and surgery. This was the first major health issue I’d faced since having the HSA account and quite frankly, I was worried about how this coverage would work.
February 14th, 2005, I suffered a mild Stroke. I was admitted to the Hospital and underwent C.A.T. and M.R.I. scans to confirm the initial diagnosis. I ended up in the Hospital for 10 days and underwent a battery of physical and mental tests with several Physicians to determine the extent of damage. My $3500 yearly deductible was exhausted quickly with this stay and treatments. The balance of the monies required by the facilities and staff for this incident was covered 100% by the umbrella policy. I received a pile of bills from the Insurance provider in the ensuing months … all with a $0.00 balance due. I’m sorry I didn’t add it all up in order to list the total amounts saved in this testimonial, but after the first couple were received, I paid them little (read NO) attention at all.
Since my yearly deductible for the calendar year had been met and the Umbrella plan worked so well, that I decided two months after this incident to schedule and undergo Cataract Eye surgery, which had been pending. I had complete lens replacement surgery and the umbrella plan again worked flawlessly.
So, at this time I am well, can see better than I have in years AND I still have over $5500 in my HSA account! That total continues to increase with each “Insurance” payment made into the account by my employer and through “tax deferred payroll deductions as is my prerogative. The fact that in using my own money made me shop around for one (1) afternoon to lower my monthly RX bill from $250 to $125 is exciting to me and something I actually like to brag about!
For fourteen years, my wife was employed by a local Doctor’s Office. Her specialty was submitting and understanding the myriad of differing patient’s insurance plans and programs. She has stated to me on several occasions that our HSA plan was one of the best coverage plans she has ever seen. The umbrella plan worked flawlessly after the $3500 deductible. I gladly chalk up this deductible as a real-life “Cost of Living” expense.
Bottom line: An HSA plan is one I would heartily recommend to anyone who will listen. I take my health care seriously and this HSA plan has exceeded my expectations.
Sincerely,
James P. Marshall
612 S. Concepcion Ave.
Santa Maria, CA 93454
805-922-3753
Chris Krupinski of Fairfax, Virginia, is a self-employed graphic designer. She owns CK Art and Design. She writes:
“I am a widow with three children and have had my own business for about 10 years. Although I have kept insurance during that time, I could only stay with a company for about a year and a half before the policy would get too expensive and I would have to look again for another company. Before finding out about HSAs, I was paying $900 a month for a family plan that had a $2,000 deductible for every health event. That meant when I had two knee surgeries in one year – I owed $2,000 for each of them before my insurance kicked in.
“Then I heard about Health Savings Accounts. I now pay $350 per month for my family, with a yearly deductible of $3,500. Each month, I put aside another $350 into my HSA account. That HSA account is my money, and yet, I am still paying less per month than I was under the old policy.
“The beauty of the HSA is that if I have anything left over at the end of the year, that money is mine. It gives me options, and it is much better financially. Before, when I wrote those premium checks out each month, that money was just gone.”
To reach Chris Kupinski, please contact: Katy Dyer, National Association for the Self-Employed. kdyer@nase.org, 202-466-2100.
Ben Cutler is President and CEO of USHealthGroup in Fort Worth, TX. He writes:
“USHEALTH Group is a small (under 200 employees) insurance company headquartered in Fort Worth, Texas. In March of 2005, we received a renewal notice from our group insurance carrier, UnitedHealthcare. The company had a traditional group health plan, with a $500 deductible and a $15 doctor office co-pay. Employees were pleased with the health insurance plan, but the loss ratio for the past year was 103% and our broker warned us to expect a sizable rate increase. The plan was costing $5,600 per employee prior to any rate increase. As expected, the renewal notice from United was hefty -- a 19% increase which translated to a new cost per employee of $6,600!
“Fortunately, we had requested a quote from United for an alternative high deductible HSA qualified plan. Neither our broker or United recommended that we do a complete conversion, feeling it was far too radical a move. They counseled there would be serious morale consequences. Moreover, they reported that no other local employers were contemplating such a dramatic change in their health insurance plan for employees. Against their advice, we decided to install an HSA programs featuring $2,000 individual, and $4,000 family deductibles. The premium savings were compelling; instead of a 19% increase, the high deductible premium was 28% less than we had been paying. That lowered our cost per employee from $6,660 to just under $4,000. These savings, combined with a small increase in the employee cost sharing of the premium allowed the company to contribute $1,750 for individual and $3,500 for family into the HSA account and match additional employee contributions up to the full deductible.
“We thought we were prepared for a sizable employee backlash, but we underestimated the level of employee objection. People were not at all happy with this change. Working with our broker and United, we prepared a comprehensive education and communication campaign that included several evening sessions where spouses were invited. Armed with a more comprehensive understanding of how the plan would likely impact them financially, employees grudgingly accepted the change.
“One big concern was the financial consequences of a sizable medical expense before sufficient funds were accumulated in the employees HSA. We agreed to provide an interest free loan up to the full HSA contribution if that occurred, with repayment coming from future employer contributions into the employees account. As it turned out, several employees took advantage of that financial bridge.
“As an additional employee incentive, First HSA, our HSA plan administrator, was able to provide 6.15% interest on employee account balances. The behavioral change occurred almost instantaneously. Now employees were spending their own money for healthcare services. Within a few weeks, the stories of what happened when employees became “shoppers” and not just consumers of healthcare services began to emerge:
• Kim is a 42-year-old divorced mother of two. Her eldest son was diagnosed with ADHD. Neither Kim nor her daughter had health issues. Kim was quite concerned about how she was going to afford the expensive medications for her son on her $27,000 a year salary. She came to see USHEALTH Group’s human resource officer Jan Fogg to find out how the new HDHP was going to work for her. Jan and Kim researched the costs of the required medications and applied them to a financial outlay model demonstrating how the plan could be used in situations like this. The answer to her particular problem was first and foremost a timing issue. She was able to get her son’s first prescriptions filled on the previous plan and by the time she needed refills, she would have enough to pay for them out of her HSA. It was also important that she use the 90-day mail-in prescription method rather than monthly trips to the pharmacy which saved her quite a bit of money overall.
• Mary Jane is a 47-year-old employee who has bronchitis and asthma. She was quite skeptical about having the necessary funds in her HSA to pay for her monthly medications. When we implemented the new HDHP, Mary Jane immediately went to her doctor and explained how the plan worked and that she would not have enough money in the account to pay full price for her medications. Her doctor was able to supply her with enough samples that would last until her account had a sufficient balance to start paying for regular prescriptions on her own. Mary Jane’s doctor further understands that not only medications, but office visit costs must be paid in full by the HDHP patient. It is her practice to not require any payment at the time of visit, but to allow the billing process to run its course through the insurance company for repricing and then issue a bill once the EOB has been created. The entire process can last nearly two months, allowing the patient to have delayed billing. For Mary Jane, the HSA plan works and she even has accumulated enough at the end of the calendar year to have money in her account for the next deductible year.
• Jerald is a 56-year-old employee and one of a handful of employees who has a chronic condition (diabetes) which requires several doctor office and lab visits per year in addition to maintenance medications. He has elected to pay for the costs from his personal checking account, leaving his HSA intact. By doing a cost comparison on the best method of purchasing his medications, he is able to manage his purchases through either the mail-order method or a monthly purchase at his local pharmacy. His HSA continues to grow and earn interest at 6.15%. At 56, Jerald is hoping his HSA account will accumulate a sufficient sum to cover excess medical expenses when he retires.
• Jack, a 36-year-old employee with a family, did some research on his own during the weeks of education prior to the implementation of the HDHP and HSA and found that his doctor understood the issues Jack’s family might have with the HSA and supported the idea of ordering maintenance medications at twice the strength to allow for pill-splitting and thus, a cost savings of almost 50% on his family’s medications. Jack was ahead of his time. Several months into the plan year, the carrier issued a notice to covered employees that recommended pill-splitting. Several employees have been diligent about “comparison shopping” for healthcare services, such as x-rays or colonoscopy fees, and have shared that information with other employees who have also been able to realize a cost savings.
“The final piece of good news recently arrived in the form of UnitedHealthcare’s 2006 renewal notice. The Company’s broker was all smiles as he communicated that based on United’s projection of a 67% loss ratio under the new plan, United was offering a mid single digit renewal increase!!! As USHEALTH Group’s management had hoped, the new HSA plan was a huge success for all concerned!!!”
To reach Ben Cutler, Please contact: Patti Bunch, US HealthGroup, 817-878-3316. bunchp@ushealthgroup.com
Lawrence Kneisley, MD, is a physician in Torrance, California. He writes:
My son Andrew, then age16, broke his arm (distal radius and ulna) snowboarding in December, 2003. He was hospitalized for urgent surgery at Torrance Memorial Hospital. He was admitted in the afternoon, spent about 2 hours in the OR under the care of the orthopedic surgeon who performed an open reduction under general anesthesia using a C-Arm X-ray for alignment. He was hospitalized overnight on the pediatric ward and discharged at noon the following day. I shared his room that night keeping an eye on him but he recovered well from anesthesia. Total time in the hospital-about 20 hours. The hospital charge was $18,834.03! This did not include the orthopedic surgeon's fee. Our HSA (at the time an MSA from Medical Savings Insurance) determined that Torrance Memorial Hospital Medical Center's reasonable and customary charge to be $4961.64. This was based on the Medicare diagnostic related group (DRG) according to the diagnosis and procedure codes provided on the hospital bill.
“Medical Savings Insurance paid the hospital $2,019.36. I paid the remainder, $2,942.28. I felt this was fair and reasonable. After some investigation and discussion, the hospital accepted this amount as payment in full.
“The lesson I learned was that if Medical Savings Insurance had not investigated and challenged the claim amount that the hospital wanted to charge, I would have been forced to pay most of the inflated bill. I got educated to the fact that hospitals accept lower but still profitable rates from big insurers such as Blue Cross and various HMO's such as Health Care Partners and still make money. They then charge smaller insurers, and patients with MSA's (now HSA's) huge markups , some 350% in my son's case when compared to Medicare and the HMO contracted rate. Certainly if the Medicare payment rate and HMO payment rate are acceptable to a hospital then the self-paying patient deserves the same deal.”
To reach Larry Kneisley, call 310-530-8822 or write to LarryKnei@aol.com
Ian Duncan, an actuary in Hartford, Connecticut writes:
“Susan and Clark Furlong own a small organic farm outside Phoenix. They supply local markets with fresh produce and sell their products on the Internet. They have three children: Tucker, 6, Will, 4, and Tess, 2. Susan has a background in diabetes and lactation education, and works part time for Lotter Actuarial Partners. As a part-timer, she’s not eligible for benefits, so she and Clark shopped around for a high-deductible policy, eventually buying one from Fortis. Their policy covers 100 percent of medical costs after a $4,800 family deductible. The quarterly premium is $753, before contributions to the optional medical spending account. The Furlongs decided to forgo the optional drug rider, self-insuring their drug benefits because they’re not on any maintenance medications.
“As parents of young children, the Furlongs have their share of emergency room visits. Recently, Will fell while playing a recorder, which scraped the back of his throat, resulting in a fair amount of blood and discomfort. The Furlongs wanted to have Will examined by a doctor. The first decision they faced was: hospital emergency room or walk-in medical center? The walk-in medical center was closer and likely to be cheaper, so that’s where they went. Because the Furlongs didn’t have comprehensive first-dollar insurance, the medical center wanted payment in advance before the doctor would see Will, so they paid the $200 fee. But the doctor decided that he couldn’t help, and told the Furlongs they should go to the emergency room. Before they left the walk-in center, Susan negotiated her advance payment back.
“Two things immediately differentiate the Furlongs’ response under the high deductible plan, compared with a typical insured’s response: first, a cost-benefit evaluation of the clinic vs. emergency room setting, and second, getting their money back from the clinic.
“In the emergency room, the Furlongs faced a decision about having an X-ray, which they decided to do after discussing cost and benefits with the physician. Will was checked out and given a clean bill of health, although he was uncomfortable and couldn’t swallow. His physician prescribed Augmentin (a name-brand antibiotic) and Lortab elixir (a brandname painkiller). Susan checked both of these carefully, particularly the antibiotic, which cost $94.99 per prescription. The painkiller cost $27.39. In the end, she chose a generic antibiotic (Amoxicillin) at $69.69 and a generic painkiller ($14.79). There wasn’t much the Furlongs could do about the emergency room costs, but every other expense associated with the accident was checked carefully and evaluated. They made each decision before incurring the expense. How carefully would an indemnity plan member evaluate similar expenses?
“Susan is the first to admit that she feels more comfortable with the health care system than the average consumer because of her professional background. Nevertheless, armed with good information and tools, most consumers could have made the same evaluations and come to the same good purchasing decisions, provided they had the appropriate incentives to make the effort.”
To contact Ian Duncan, call 860-570-0180 or write iduncan@soluciaconsulting.com
Jeffrey Dunham runs a trust and investment company in San Diego, California. He writes:
“We looked at (no... put through the ringer ) the pros/cons of HSA's for at least a year perhaps two for the 45-ish employees of our trust and investment company. We looked at its effect on single folks, on married folks, on those with families, on older employees, on younger ones..... You get the picture. We heard every potential heart ache we could think of. Yet, in the end ...... I did it because it allowed (forced) the employees to have a vested interest in the health care choices they made. It touched everything from what they ate.... to how much they exercised..... to whether they needed to see the doctor... or not....... and whether they needed the 2nd - 3rd opinion.... or not. They got to have the care they wanted when they needed it....... and benefit from the savings they created by good decisions. It was fair for them... fair for us. We all now had "skin in the game"...... for what these costs would look like in the years ahead.
“At first there were many nay-sayers. What if this ... what if that....... yet, by the time enrollment came around the word began to spread that the company was doing something good for them.... giving them more options -- more choices. Far more than we thought signed up for the HSA option. I expect more to follow each open enrollment period. In short - it worked better than we had expected.
“It took some pushing to get it done. It was worth the effort.”
To contact Jeffrey Dunham, write to him at: jeffrey.dunham@dunham.com
Jeff Hancock is with John Deere Health in Moline, Illinois. He writes:
“One of our clients, Gazette Communications, would be honored to offer testimonials on their HSA experience. Gazette owns a couple of newspapers, radio stations, and television stations near Iowa City, IA. They began their HSA in Jan 2006. They did an extensive HSA training schedule during November and December last year. They held roughly 60 pre- and post-enrollment HSA meetings for their 600+ employees. They had over a 60% adoption rate of John Deere Health's HDHP vs. a tiered deductible plan. Almost all of that 60% chose to open a Wells Fargo HSA, which Gazette lets their employees fund pre-tax. In order to encourage HDHP/HSA adoption, Gazette is picking up 65% of the premium for the HDHP vs. only 50% of the premium for the tiered deductible plan. This meant that the employees would be paying 1/2 as much premium if they picked the HDHP.”
To contact Jeff Hancock, call 309-765-1076 or write to HancockJeffreyM@johndeere.com
Evelyn Preston recently purchased a non-group HSA in Michigan. She writes:
“I only have one prescription and knowing I will now pay for it with my HSA dollars, I checked on the prices. Before, this was not much of a concern to me as I would have paid my $15 copay for a prescription regardless of where I bought it. It turns out that Walgreens, where I had been having it filled, charges $18 more than Meijer. Of course, now I’ve switched my prescription to Meijer.
”I was talking to my son, married with 2 children. They pay $5 co-pay so it doesn’t matter to them where they get their prescriptions filled...again totally convenience. Now that the dollars are coming out of my medical savings I will look at price.”
To contact Evelyn Preston, write to: evelyn.preston@sbcglobal.net
Kirby Nielsen is a broker in Worthington, Ohio. He writes:
“The critics of HRAs and HSAs have it about 180 degrees wrong in their assessment of chronic health problems and High Deductible Health Plans.
“I am a member of Consumers for Health Care Choices as well as a person with a chronic health problem. I have "Paraneoplastic Syndrome” that involves the failure of my immune system. It is a rare disease that few physicians remember hearing about in Med School. The thing that complicates this part of the diagnosis is that the failure is in relation to cancer which may or may not have manifested itself. In short, my immune system makes antibodies to fight cancer that (for me), has not yet appeared. In fact my antibodies are actually bad guys that are destroying my peripheral nervous system. My deterioration is progressing slowly due to my willingness to push immune suppression therapy to the limit.
“My annual medical bills run over $30,000 per year for the two years I have lived with this diagnosis (the amount approved by the insurance company). This year I have a high deductible health plan (HRA) and it is so much better than my old traditional plan with a $250 Deductible 80/20 to $10,000 with a physician’s co-pay and an Rx card.
“The first thing with a chronic condition is not so much the advantage of choice (which would be an advantage to a healthy person) as to whether or not to have tests and other medical services; it is that all these expenses go directly to my deductible early in each plan year. Another way to put it is I get to fulfill my $4,000 deductible quicker.
“Secondly, when I reach my deductible, I have 100% coverage. Believe me; having met my deductible and having 100% coverage does not encourage more health care spending. A person who is chronically ill is tired of tests and medical services and would rather not get more health care. Our motive is only to find the underlying cause, treat symptoms, and relieve pain. I met my deductible 6 weeks into the plan year and now I have no more co-pays, no Rx card, and no hassles at all other than the disease itself.
“If you are thinking that these plans are OK for us middle to upper middle income folks but don’t serve the lower wage earner well, I think that is a fallacy as well. Medical providers will agreed to take a monthly payment or payment over three installments. $4,000 is nothing at all compared to the astronomical cost of spending for Chronic Health Conditions. And the $1,500 HRA reimbursement, plus the Section 125 pre-tax for un-reimbursed medical care lowers my actual out of pocket cost considerably.
“This is also why some sort of tax credit or other means to purchase High Deductible Health Plans is a good idea. They work so well if you are healthy and even better if you are sick, regardless of income.
“With the HDHP, I pay the same out of pocket as I used to pay, but I hope I have shown some of the reasons why a HDHP is really a good deal for a person with a complicated and expensive chronic health problem.
“I would be willing to talk about this HDHP situation with any one who would like to discuss it since it has opened my eyes so much having been through it personally. It is so much less stressful than having to worry about ongoing co-pays and co-insurance. “
Contact Kirby Nielsen at 614-784-1528, knielsen@insight.rr.com, or nielsenins@sbcglobal.net
Mike Whitney is a broker and third-party administrator in Dallas, Texas. He writes:
“Last January I had a heart cath and they put a stent into my right coronary. 20 hours in the hospital and a total bill of $42,000. My fully insured carrier repriced to $18,000 (that is another story) and I received a bill from the hospital for my $5,000 deductible. I have been in 100% coverage all year and all my RX (3 brand or non-formulary per month) are a zero cost to me. My additional follow up tests are the same. My other treatment, including skin check for potential cancer is also the same. In short, that $5,000 is my total medical bill for the year, for myself and my wife.
“However, that is not the full story. When I received the bill I called the hospital finance office and acknowledged that I owed them the money. I asked what options were available, assuming we would set up a payment schedule and after 2 or 3 payments I would attempt to negotiate a discount for paying it off early. That was not needed. The first words out of their mouth, "if you can pay it now we will give you a 30% discount."
“Therefore I wrote that check and paid my $5,000 out of pocket cost with $3,500 of cash. Can you do that with a co-pay plan?
“One more point, I have documented the expense but not withdrawn from my HSA. Rather we are storing it in our "claim vault" for future tax free use whenever we decide to remove it from the shelter. My reason, why would any rational person take money out of a tax sheltered investment to put it into a taxable investment? Since I have other savings and since there is no time limit on tax free withdrawal for qualified expenses, what else would anyone do? “
Contact Mike Whitney at Flexible Benefit Group, PO Box 702473, Dallas, TX 75370, 972-248-8246, Mwhitney@flexiblebenefitgroup.com
