Transcript PowerPoint on Healthcare Consumerism

Healthcare
Consumerism
www.gallagherbenefits.com
Mount Vernon Nazarene University – October 2012
Common Insurance Terms
Deductible
Coinsurance
Maximum Out of Pocket
Procedure Code
Diagnosis Code
Network Discount
Pre-Certification
How a Claim Gets Paid
Services are received by member at provider –
members shows their identification card
Provider completes claim form identifying
procedure and diagnosis codes and sends it to UMR
for processing
UMR electronically matches member identification
number, procedure and diagnosis codes and
electronically adjudicates the claim applying
discount and employee cost sharing
Payment is sent to provider and Explanation of
Benefits is sent to the member
Future of Health Plans
Factors Influencing Healthcare Costs
• Technology Advances – MRIs $1890 vs. Chest X-ray
$175
• Prescription Drugs – Generic vs. Brand
• Increased Patient Demand – 30% of healthcare
treatments viewed as unnecessary
• Government Regulations & Coverage Mandates –
HIPAA, PPACA
• Increased Financial Pressure on Doctors & Hospitals –
malpractice insurance, consolidation
• Lifestyle Choices – 50% of all healthcare costs stem
from preventable lifestyle choices
Factors Influencing Healthcare Costs
• Direct-to-Consumer Marketing
– TV Commercials
– Magazine Ads
– Billboards
• Increased number of chronic conditions
• Increased availability and access to care
Consumer Tools
• Discounted Prescription Medications
–
–
–
–
Wal-Mart - $4/$10
Kroger - $4/$10
K-Mart - $5/$10 with Pharmacy Prescription Savings Club Membership
Meijer - Costco – no membership required
• Websites to Compare Prices
– www.healthcarebluebook.com
– www.fairhealthconsumer.org
– www.rxaminer.com
• Online Drug Stores
– www.drugsource.com
• Physician & Hospital Quality
– www.healthgrades.com
– www.hospitalcompare.hhs.gov
– www.umr.com
• Consumer Reports Health
Consumer Tips
• Get the Most of Doctor Visits –
www.choosingwisely.com
• Ask for prescription samples from your physician
for short-term medications
• Ask your physician for copay assistance
prescription cards for long-term medications
• Review medical bills
• Stay in-network
• Utilize generics
• Shop around
Additional Tips
• Prescription Drug costs can change daily and
vary widely from store to store
• Generic drugs are not cheaper than brand name
drugs the first six months on the market
• You can negotiate your provider bills
• Antibiotics and Prenatal vitamins are FREE at
Meijer
Questions