Consumer Driven Health Plans

The concept of a Consumer Driven Health Plan may or may not be a good thing for you. Typically, the employee gets a lower plan cost in exchange for having a higher deductible, i.e. accepting more risk. In theory the employee becomes a more knowledgeable and discerning purchaser.

The Realities:

• Reduced costs?
  Not many doctors or hospitals have been pressured to contain costs because you have a higher deductible. The primary benefit plan cost reduction is because you have to accept more risk.
   
• The patient becomes a more knowledgeable consumer?
  Asking a relative or a neighbor for a doctor reference is not becoming more knowledgeable. Most patients do not have access to data that addresses both the quality and the cost of care.
   
• How much risk are you accepting?
  While you are under the deductible you still must adhere to your benefit plan’s rules. If you violate the rules, some expenses will not apply to that high deductible.

How to become a knowledgeable consumer:

• Check the site on this web page Selecting a Provider that will help you determine if your doctor of hospital is in network.
   
• Check to see if the doctor has had any licensing problems in New Jersey.
   
• Learn how often does the hospital perform the procedure you are going to undergo.
   
• Contact your plan administrator and understand any rules that might apply regarding procedures such as stress tests, MRIs, physical therapy, and even simple blood tests.
   
• Stay away from tests done in a hospital if they can be performed elsewhere. You may save a great deal of money.
   
• Most important, talk with your doctor. Understand what your options are. If you did not understand the answer, ask again.
   
• Check the site www.hospitalvictims.com. This site can help you if you believe you are being overcharged. It will also can you an understanding of what a hospital charges in relation to its actual costs.