Are You a Smart Healthcare Consumer?

The rising cost of healthcare concerns us all. As members of our employee health plan, we are fortunate to have insurance benefits to cover a large part of our healthcare expenses.

However, if we think of healthcare expenses only in terms of our coinsurance payments and not the total cost of the service, we are missing the big picture. Though our benefits plan covers much of our care once we meet our annual deductible, it pays those claims with our money.

Here's why: we hire BlueCross to process and pay claims for our medical benefit program and to grant access to preferred providers. For those services, we pay an administrative fee. In addition, we purchase insurance to cover individual claims that exceed $100,000 and to cover claims that exceed a pre-determined amount (this is known as our aggregate liability.) Premiums that we collect from churches, agencies, and individuals are set to make sure that we have sufficient money to pay for administration, insurance we purchase, and the aggregate claim liability. If claims exceed the expected level, we can anticipate an increased liability that must be funded. If we have good claim experience, we are able to meet future obligations without significantly increasing premiums.

The money for the premiums we pay for healthcare comes from members and employers. A premium increase means higher costs for all of us, so we all have a stake in keeping healthcare affordable.

We encourage you, as the member or consumer who buys and uses healthcare services, to take responsibility for making smart purchases and learn more about what we can do to help reduce our total healthcare costs.

Every day, decisions you make about how you live your life have an impact on your health. How you choose to use healthcare services affects the quality of care you receive and how much you and your health plan pays for that care. Being a smart consumer means taking an active role in your healthcare and becoming an active partner to keep it affordable.

An effective consumer is someone who:

• Considers the actual cost of a procedure or service, and not just your coinsurance payment, when making decisions. Actual costs can be obtained from your doctor or healthcare facility.
• Practices prevention and knows what to do for early detection.
• Pursues a healthy lifestyle by engaging in activities to maintain or improve health.
• Talks with his or her doctors and shares in decisions.
• Chooses providers from the BlueCross network to enjoy reduced rates.
• Uses self-care when appropriate.
• Manages chronic conditions and actively participates in disease management programs available through our health plan.

Healthcare consumerism is a process that involves changing your behavior - breaking old habits and developing new healthier ones. A smart consumer knows how to use healthcare benefits wisely and stays as healthy as possible. Know what services are offered by your plan, when you need a doctor versus when you can treat yourself at home and how to get appropriate, affordable care.

Keep in mind that the best time to make informed healthcare choices is when you are healthy. Plan ahead and select a convenient network provider that you visit on a regular basis, before you get sick.

Understanding how your health benefits work is key to getting the most out of them. Know what services are covered, paying special attention to those you use regularly and those you might need in an emergency. Other things you can do include:

• Using FDA-approved generic drugs when available instead of the more expensive name brand drug.
• Saving the emergency room for true emergencies.
• Having your records forwarded if you change doctors to avoid wasting time or money on repeating tests.

Being an active consumer is not all about costs. It is estimated that half of all healthcare spending is related to lifestyle issues. Adopting good habits like following a healthy diet and exercising can increase your energy and improve your health, which in turn reduces your healthcare costs.

You feel better and can enjoy life more when you have fewer health problems. Focusing on health and wellness is a win-win way of controlling the cost of healthcare because you may prevent health problems or catch them before they become severe.

Visit www.SouthCarolinaBlues.com for more information about maintaining a healthy lifestyle and other health and wellness topics.

Doctor Visit vs ER (PDF)
Generic Drugs (PDF)
Know Your Doctor (PDF)

This information is not intended to replace the medical care you receive from your doctor. Always check with your doctor before following any medical advice.

Links

Insurance
Benefits