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Including the cost of diagnostic procedures in Urgent Care Copay
It would benefit BCBS if while simultaneously urging their members to take advantage of lower cost alternatives to the ER they implemented policies to reduce the cost to the patient. I recently opted to go to Urgent Care instead of the ER while having chest pains, but because I had yet to meet my annual deductible and BCBS treats the X-Ray and the actual visit as separate events; my total out of pocket cost was greater than my ER co-pay. I would have been burdened less financially from a trip to the hospital, but BCBS saved thousands. That's counterproductive.
from Let’s Talk Cost 2012
Dawn, You are a great student of thought. The premiums we set for individuals and small employer groups are directly adjusted for age and gender. We do see in our claims experience large differences across age groups -- as younger males (under 25) and children are typically our cheapest individuals to insure, with older males (over 65) our most expensive. By appropriately reflecting the costs by age, we are able to attract a wide cross section of individuals and groups, which helps keep premiums more affordable for the entire population and prevent subsidies across age bands.
from Let’s Talk Cost 2012
I am not sure if this has any relevence to your idea but I was thinking that maybe health plans could be designed by age like birth through puberty, puberty through young adult lets say 25 then 26-65 then your elderly plan. Maybe cost could be detered by plan and age appropriate preventive care. If you know your child is going to need Long term or lifetime care you can plan accordingly. This way if you take care of your children and yourself you will know for future what kind of health plan you may or maynot need . I am not a professional I am a student just a thought
Michelle, we agree that patient centered medical homes are a great option for individuals living in an area where one is available. Through our data, we see that North Carolina patients treated by physicians with PCMH recognitions showed 52 percent fewer visits to specialists, 70 percent fewer visits to the emergency room, lower radiology costs and lower inpatient utilization.
Given these great results, BCBSNC is working to expand the PCMH model to rural areas. One way we’re doing this is through our Blue Quality Physician Program (BQPP). Through this program, participating physicians who meet a set of criteria, that includes nationally recognized, evidence-based standards for quality of care, are eligible for higher payments. Our goal is to help 50% of primary care practices in NC operate as PCMHs.
Participating physicians in the BQPP agree to achieve certain standards to improve the patient experience. This standard measures the physician’s ability to provide patient-centered needs such as after-hours care and electronic visits. The other standards include administrative efficiency and clinical quality outcomes. Customers can find practices that have maintained these standards by using the Find a Doctor tool on mybcbsnc.com.
Thanks for the feedback on EOBs, Michelle.
EOBs are different than the bill your doctor provides. They show what a doctor or hospital may charge for a service. They also show a record of your benefits.
As you mention, it’s important to compare your EOB to your medical bills to verify the costs for services. We recommend asking your doctor’s office for an itemized bill when you have questions about what exactly you’re being charged and to check for possible discrepancies.
One additional note, EOBs can be found online at www.mybcbsnc.com.
Hi Michelle, I enjoyed reading your post and the comparisons you made about how health insurance works. I encourage you to continue to share your ideas and perspectives with us. Thank you for taking the time to talk with us and others about your experiences.
Thank you for your question. You raise many good points regarding benefit pricing.
BCBSNC will do an analysis to determine how much we think it is appropriate to adjust premium rates for smokers based on actual cost experience. The Affordable Care Act will allow insurers to increase premiums by up to 50% for smoking but the State of North Carolina may decide to enforce a lower limit. That decision is not yet finalized.
You also raise some interesting points on benefits, which we will analyze to see what makes sense in the marketplace. We are continually exploring new products to sell in the market, and appreciate your comments.
Bobby, We hope you’re feeling better and appreciate you sharing your recent experience with urgent care.
According to our data, the average out-of-pocket cost in North Carolina for an urgent care visit is $54. It obviously sounds like your experience was well above the average. It is important to keep in mind that there is the possibility that the ER visit could have been as much as ten times higher than your urgent care visit depending on the tests, attending physicians, and procedures used during the ER visit. How was your experience, and do you think it may have saved you some time compared to a couple hours wait in the ER?
BCBSNC has set up a website, www.bcbsnc.com/urgent, that features information for anyone who wants to know their options for various types of care based on symptoms, potential costs and wait times. We encourage everyone to understand their alternatives in order to consider the most appropriate level of care and the most cost-effective choice.