Ross Klosterman is the CEO and co-founder of Poppins Health of Columbus, a new health insurance policy for small businesses.
When answering the question “Why does a health insurance company exist?” Reasonable people would say that the role of health insurance companies is to negotiate and use their influence to keep members’ medical costs low.
This same person, as a virtually unbargaining bachelor, may be furious to find out that insurance companies may pay less for medical services than they negotiate on their behalf.
This leads to the following suspicious, but general scenario. A family of four pays an average of $ 22,000 a year for insurance, in addition to a deduction of approximately $ 5,000 before insurance begins. we?
more:Ohio hospital prices vary greatly with the same procedure
The answer may be how broken medical costs are. Most knee and hip replacements are done at providers “in the network” (meaning insurance has negotiated with them). As a result, the total amount, and ultimately the amount paid by the members at their own expense, can vary significantly, even within the same facility.
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According to recent data, the cost of the same procedure at a San Francisco hospital ranges from $ 22,865 to $ 101,571. Different hospitals and insurance companies have different processes for determining procedure costs, so one patient pays thousands of dollars more than others in the same location.
In the traditional health care model, costs are confusing between out-of-pocket, co-insurance, and deductibles. As a result, health insurance members do not know if they are paying a lot for the procedure.
Enter your modern health plan. Lesser known to business owners, it is a newer and more innovative health insurance option that allows employees to “shop” for surgery.
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Let’s use knee arthroplasty as an example. Employees with the latest health insurance will be able to know exactly what they are willing to pay in advance and will be given choices in advance. This “dynamic” out-of-pocket cost is determined by three factors:
- Physician Quality: Modern health insurance looks at objective data such as patient outcomes, infection rates, and readmissions to determine quality scores.
- Procedure Cost: This number is determined by looking at the amount charged by the provider compared to other providers in the area.
- Facility Billing Practices: This score is related to the financial experience that members have experienced at a particular facility, based on the incidence of surprise claims.
After considering the above, the resulting out-of-pocket options for the member will be determined. If an employee chooses the option of a high quality doctor with low cost and good billing practices, he will pay $ 0 for knee arthroplasty. Perhaps she wants to meet a doctor who is still of high quality but a little expensive. In this case, the cost of the option could be $ 1,500.
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With traditional health insurance plans, if there is a deductible $ 4,000 on a traditional plan, in all scenarios the patient will pay $ 4,000, regardless of the quality of the doctor or the underlying price (1 in Ohio). In one metro area, knee arthroplasty) prices range from $ 18,000 to $ 45,000).
To better understand the cost of pre-procedures, companies can take advantage of the latest health insurance, such as those mentioned above, to compare employee prices with providers and save thousands of dollars on out-of-pocket costs. There is sex.
Providing good health insurance is a great tool for retaining employees, so it is important to consider carefully when choosing the best one for your company.
Ross Klosterman is the CEO and co-founder of Poppins Health of Columbus, a new health insurance policy for small businesses.
