How to Build Smarter Health Care Consumers

How to Build Smarter Health Care Consumers

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Health premium increases for 2020 have been giving many of us an unwanted surprise. Costs are trending up by about 8.6% based on the health care CPI and taxes alone. Add the increasing cost of specialized drugs and procedures, and stir in your own claims experience, and you get a concoction that’s hard to stomach.

While remedies to pricing and taxes may be out of your control, you CAN influence your claims experience by helping employees become smarter health care consumers. Here are some fundamental things they can do to manage their costs – and yours.

  1. Choose a primary care doctor and schedule an annual visit. Find someone you trust who can get to know your health history over time. Having an annual visit can help you spot health issues early – when they are easier and less costly to treat.
  2. Stay in your network. You’ll pay less when you see providers and use facilities that are in your plan’s network. Always check to make sure your provider and facility are in your network before your visit. Going outside the network means you’ll face higher copays, deductibles and out-of-pocket maximums.
  3. Ask about generic medications. Why pay more for a name? Generic drugs are approved by the U.S. Food and Drug Administration as safe and effective. In fact, they’re the same as their brand-name counterparts. They have the same active ingredient, dose and form. You’ll need to advocate for yourself when your provider writes the prescription. Be sure to ask whether there’s a generic option and have your provider indicate on the prescription that a generic is OK.
  4. Consider using a prescription discount card. Your employer may offer one, or you may have direct access. These programs often offer steep discounts. They can be especially helpful if you have a high-deductible plan. For more information, search online for prescription discount cards.
  5. Understand your treatment plan. When your provider suggests a test, medication or procedure, make sure you understand the where, why, how and how much. For example:
  • X-ray or another test: Where can you go to get this test? Do you have to use the facility associated with your provider, or can you choose an outside source? Labs and imaging facilities that are independent of a health system can cost less.
  • Surgery: How long will the procedure take? What type of rehabilitation will you need afterward? Do you need to stay overnight in the hospital or is it a one-day procedure?
  • Feel uneasy? Ask about other options. Do you have alternatives that are less invasive? Can you correct the problem with lifestyle changes such as altering your weight, diet or environment before going on medication or having a procedure?
  1. Review and save your explanation of benefits or EOB. This is the document you get from the insurance company. It will show how much the service cost, what’s the allowable charge for your insurance network, how much your insurance will cover and what you will be responsible for. It’s also important to save your EOB until a bill arrives from your provider; compare them to ensure your bill is correct.
  2. Get a second or third opinion. It may take some extra time, but it’s a great idea – especially if you have questions about your diagnosis or treatment.
  3. Be your own advocate. Whether you’re shopping for a health insurance plan, sitting in the doctor’s office or paying your medical bills, ask questions. You are your own best advocate. Pursue the information you need to make informed decisions about your benefits and your health care.

To learn more about managing your costs and communicating with your employees, email

By Robert Falke, Account Executive





See Also:

Pharmacy Cost Management: How to Make Pharmacy Discount Cards Work for You and Your Employees

Pharmacy Cost Management: 5 Tips For Managing Your Pharmacy Benefits Partner

Open Enrollment: Tips For Continual Improvement

Benefits Communication: Tools You Can Use To Boost Engagement



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