Empower Yourself in the Health Care Marketplace

October 27, 2015

We've talked about the importance of staying educated and informed in the current health care marketplace. The good news is the health care service model, from both medical and cost standpoints, is becoming more user-friendly and approachable for patients every day. The bad news is those changes are also making it difficult for patients to keep up with new medical developments, technologies, plans, pricing structures, and networks.

Whether you are a patient yourself, or a caregiver, the sheer amount of information available can be overwhelming. For example, if you are the caregiver for an elderly parent who may need a hip or knee replacement, then providers, plan options, deductibles, co-pays, and rehabilitation are all factors you will need to consider. You might need to ask the following questions:

  • Who is the best provider for that particular procedure?
  • Are they in network?
  • Do you know which plan your parent chas, and the level of coverage for the procedure?
  • What is the deductible?
  • Is your parent responsible for any co-pay?

A recent study by the Blue Cross Blue Shield Foundation showed the average cost for total knee replacement surgery can vary between $11,000 and $69,000. Costs can vary significantly depending on your location, but surprisingly, costs for the same procedure also vary significantly between hospitals in the same area, even hospitals in the same part of town.

When researching, you may also want to see whether the plan offers any special bundles or other fixed-price selections for the type of surgery or other medical procedure you or a loved one may require. For example, Colorado PERA has partnered with Anthem, local HealthONE health care facilities—including Rose Medical Center, North Suburban Medical Center, Swedish Medical Center—and skilled orthopedic surgeons to provide a fixed price for surgery and medical services related to hip and knee replacement procedures, from intake to discharge. Retirees participating in this innovative program will receive quality care at excellent facilities, with a clear understanding of the complete cost of the procedure and significant out-of-pocket savings.

When you are faced with the stress of making a decision directly impacting your health or the health of a loved one, being a smart health care consumer can make a big impact on the quality, cost, and overall satisfaction with services. It is important to understand your insurance coverage, and to research providers and networks as early as possible in order to make the best educated decision when the need for services does occur. Arming yourself with that knowledge will help reduce your stress so you can focus on your or your loved one’s recovery.