Thursday, March 1, 2018

Our Cards Have Arrived

As promised, our cards have arrived and they look very much like insurance cards. These are the cards we probably missed in the mail the first time. As we’ve discussed, our healthcare providers don’t utilize them so for now they’ll stay in our pockets. Nonetheless, it’s nice to see what things look like. I hope you enjoy the photography.

Saturday, February 24, 2018

Cash Flow Considerations – Time Lag Between Payment and Reimbursement

Let me be clear – this post may not be relevant to you. If your healthcare provider sends itemized invoices directly to Liberty after appointments/procedures, and then you are reimbursed, you will not experience this issue. However, if your healthcare provider views you as a self-pay customer, and you need to pay before appointments, this is a relevant consideration for you.

As we documented in our prior post, our healthcare provider requires us to arrange for payment prior to scheduling an appointment. What that means in practice is that we’ve fully paid for an appointment in late February that we won’t have until early April. If we use this example, here’s what a likely pay cycle will look like:

February 23 – Payment is made (money out of our pocket)

April 3 – Date of appointment (roughly 40 days later)

April 10 – Let’s assume it takes at least a week to receive the itemized bill because my gut feeling is it’s not something they’ll provide at the appointment 

April 11 – Submission of itemized bill to Liberty

May 25 – Let’s assume it takes approximately 45 days to receive payment once submitted to Liberty

In this particular example, it would be approximately 3 months from the time we paid until the time we were reimbursed. This is an important consideration for individuals or families that may not have the free cash flow to front these types of payments before receiving reimbursement. With traditional insurance, if it’s being reimbursed, the health care provider will work with the insurer directly before you see an invoice. 

We are in the fortunate position that we are able to cover this lag from payment to reimbursement. However, if we needed to arrange for a significant procedure up front, before being reimbursed, that would be much more challenging. In that case, I think we would connect Liberty with the Clinic to work something out beforehand.

There’s some silver lining here: At least Liberty’s structure provides for full reimbursement on wellness visits as well as on any expenses over the $1,500 annual unshared amount. Even if we have to wait a while, we’ll at least get reimbursed. Nonetheless, we just wanted to share this as something to think about as you prepare financially for the making the switch.

The Realities of Non-Traditional Health Insurance – Scheduling our First Appointments

When we made the move to a healthshare from traditional insurance we thought we would get better visibility into how healthcare providers operate and price their services. As our primary healthcare providers now viewed us as self-pay customers, we were curious how easily they could provide us a quote for an appointment or procedure and how efficiently the process would operate. This post details our first experience scheduling appointments as self-pay customers with our healthcare provider. 

Scheduling the Appointments

There are two appointments we were looking to schedule in the March timeframe:
  •         My wife’s annual wellness check with her OBGYN
  •         My 9-year old son’s annual wellness check
I’ll start with my wife’s appointment because that’s where we experienced the most inefficiency. My wife was contacted by her doctor’s office to let her know that the appointment she had scheduled at the end of March would need to be re-scheduled due to the doctor’s schedule. When asked whether her insurance was up to date she mentioned that we are now with Liberty Healthshare. The office informed her she would be viewed as self-pay now (which is consistent with what we were told coming into this) and would need to speak to a Financial Counselor before being able to re-schedule the appointment. After some inefficiency trying to get connected to the right Financial Counselor, which took a few days, we were connected to the Financial Counselor that serves her doctor's department.

My wife explained that we are now with Liberty Healthshare and we are considered self-pay customers so the office told us we needed to speak with a Financial Counselor before we schedule an appointment. The counselor informed us that we’d need to arrange for payment before scheduling the appointment. We would need a quote for my wife's appointment and after a few minutes of holds we had our answer:

$418 but if we pay now we’ll receive the 35% discount which will take the cost to $271.70

So we got our credit card out and paid for our wellness check, that will occur at some point in the future. This brings up a reality regarding cash flow that some will need to consider if your health care provider considers you a self-pay customer. We’ll follow-up this post with a more detailed analysis of that consideration. After paying for the appointment my wife was transferred back to the doctor’s office and was able to re-schedule her appointment for April 3. 

Now that we had this experience under our belt, setting up my son’s appointment was much easier. The Financial Counselor we spoke with in pediatrics was very knowledgeable and friendly. My son’s appointment cost $369 and $239.85 after the 35% discount. So once again, we paid in full on February 23 for an appointment that will occur on March 22. 

What Does this all Mean?

In reality, the process worked as our provider suggested it would. You should understand the process may be a bit more complicated than what Liberty describes on their website if your provider considers you to be self-pay. It would be nice if our providers could reach an agreement with Liberty on a discount rate and process but for now, this is what we’ll experience.

As we documented in some of our first posts, we did contact our healthcare providers before making the change so this was not that surprising. I do think it will become more efficient as we move forward – we’ll know the drill. And ultimately, we like our health care provider enough that we don't want to move to another (they have great doctors) - so it's ultimately our choice to deal as self-pay customers.

Questions We Have that Will Get Answers to as we Move Forward

One of the great things about documenting our experience here is the ability to inventory the questions we want to make sure we get answers to moving forward. Here are a couple that came out of this experience:

·        Will our upcoming visits be covered by Liberty since they are “wellness visits”? According to Liberty, up to $400 of wellness/preventative procedures are covered, per person, per year. Thus, each person in the family should be able to have one wellness visit per year. I called Liberty to understand how they would know an invoice is related to a “wellness visit” and they explained it’s all a matter of how the healthcare provider codes the procedure. You qualify for this once you are a member for 60 days and both of our appointments will occur after this threshold for us.

·       What would happen if we had an emergency and didn’t have time to go through the process of speaking with a Financial Counselor first? We actually asked a Financial Counselor this question and they said we wouldn’t be refused service, they’d allow it. As we know, sometimes things work differently in practice but hopefully we don’t need to test this anytime soon.

Our effort here is to document the practical experience that we’ve had. Your healthcare provider may be different and have a different relationship with Liberty. The punchline: Do the work to understand how things will work beforehand and understand the reality, particularly as you go through this the first time, may be different.

Tuesday, February 20, 2018

About Those ID Cards (for all of your anxiously waiting)

Again, not that failing to receive our Liberty ID cards will prevent us from receiving medical care I did want to provide a little update on this. As of our last update we still had not received our ID cards so after giving it a few more weeks I did place a call to Liberty today. The good news is I reached a human within under a minute and they were very engaged. The gentleman I spoke to was friendly, looked up our account information and noted that while we should have received them he’ll gladly have new cards sent immediately. Perhaps we missed them in the mail (oops, we could have!). I’ll take a picture using my high-end photography skills as soon as we get our new cards. So for those of you becoming new members in the future – if you don’t get your cards within the first 3-4 weeks just give them a call (hope you enjoyed that bit of rocket science)!

In other news, we have our first doctor appointments under Liberty upcoming. They are both fairly routine – one for my son and one for my wife. Stay tuned for an update on how the process goes down and how we rate the experience!

Friday, January 26, 2018

Folders, Pamphlets and Forms…Oh My

Over the last two weeks, we’ve received a couple pieces of what the marketing folks might call “collateral” welcoming us to Liberty and SavNet. For those keeping score (none of you) we have not received our membership cards. Ultimately, it matters most how quickly payments are processed so there’s no reason to jump to any conclusions. While we wait I’m proud to show off the folders, pamphlets and forms you’ll receive as new members. Hold on to your seats.

There are two obvious things you’ll be thinking as you review this picture: (a) My photography skills are outstanding – I must just have one of those eyes and (b) Why do I even care? Well, you shouldn’t care that much but if you are anything like me you like to know what you’re getting into when you try something new – in that spirit, I want to share as much as possible so you can make an informed decision. A few notes on what’s included:
  • Our welcome folder was the first set of information we received. It includes a welcome letter, refer a friend ad and your 2017 Guidelines (which apparently must be the same as your 2018 Guidelines). Also included are a few forms:
-       Authorization for Release of Medical Information – This form authorizes Liberty to get access to your medical related information. Essentially, you are authorizing your healthcare providers to provide Liberty with access to your medical records, bills, etc. to help with case management. It may sound intrusive but I can see why it would be necessary for Liberty to have these agreements in place.
-       Medical Expense Need Agreement – This is a form that basically says I won’t use the money I receive for medical bills to address other expenses. Basically, I won’t be a jerk, submit false bills, all that stuff.
-       Medical Expense Processing Form – This is the form that needs to be filled out and submitted to Liberty any time you are submitting bills for a medical need.  
-       Provider Information – This is a form you can use to “nominate” your healthcare providers to be part of Liberty’s recommended providers list. I would assume Liberty uses this information to contact the provider, let them know one of their patients is now with Liberty, and try to negotiate discounted rates. Given our situation, it is unlikely I will use it (our healthcare provider is familiar with Liberty). 

When I saw these forms I thought we had already signed off on a few of them as part of the application process but we sent them back nonetheless.  

  • A few days after receiving our welcome folder we received a pamphlet from SavNet. This is a nice summary of what the SavNet Health Savings Program provides including the discounts on dental, vision, chiropractic and hearing services. Keep mind this is a separate SavNet program than the discounted prescription program. We have separate dental insurance which works out well for our family of 5 so I’m not sure how often we’ll use this but it’s nice to understand how it all works. If we wanted to forgo our dental insurance and change our dental providers to a SavNet provider, a routine check check-up, under SavNet would be $37 according to the information we received. For a family of 5, receiving 2 check-ups a year like us, that’s $370. For now we really like our providers and the estimates SavNet provides are…well…estimates. Nonetheless, it’s nice to know it’s there if we need it.
So that’s what you can expect in your welcome folder, pamphlets and forms. Not as scary or exciting as lions, tigers and bears but good to know if you are considering Liberty.  

Wednesday, January 10, 2018

Interesting Information in our First Liberty Newsletter

Liberty sends members a monthly newsletter with articles of interest, reminders on Liberty practices and other information helpful to members.

One piece of information we thought was particularly interesting was found at the bottom of the newsletter. I’ve often wondered, as have many people who are aware we’ve joined Liberty, how much money Liberty receives in shares in a given month and how much they pay out for medical expenses. At the bottom of the newsletter Liberty provided this information. Obviously, if the amount of money Liberty pays out is much higher than what we receive, this could eventually lead to higher monthly share amounts or higher unshareable amounts. Below is the information from December: 

First off, I think it’s great that Liberty is this transparent with members about what is received and what is paid out. After all, the members serve as the community and this isn’t traditional insurance. I think the transparency builds confidence. It will be interesting to see how these numbers change. If there’s a month that deserves an asterisk it’s one where payments of medical expenses (paid out) exceed what was shared (paid in) by $9M. Liberty is able to review this information in the context of past months and similar periods so they have far better information to determine if this is a trend or not. Nonetheless, I appreciate the transparency and thought it was an interesting piece of information to share from the newsletter. 

It’s Officially 2018 and We’re on to Liberty…Membership Cards and an Initial Trip to the Pharmacy

When the clock struck midnight on the east coast our traditional health insurance officially expired and our stint as Liberty Healthshare members began. As our family traveled back from our holiday destination my wife and I did have a moment where this sunk in. It wasn't a bad feeling, it was just an acknowledgment that we’re under a new system and prepare for the change. We are actually excited about seeing how things work.

As we turned to the new year I was interested in receiving our Liberty Healthshare member cards. Similar to traditional insurance, these are the cards Liberty suggests you provide to your healthcare provider instructing them where to send bills and coordinate payment. In my conversations with my primary healthcare provider, it sounds as if they won’t care if I have this card or not – they don’t view Liberty as an insurer so they’ll just send me the bill. Nonetheless, I’m interested in trying it out and would like to receive the card. If I don’t receive the card by the end of next week I’ll give Liberty a call. 

On another note, we did receive membership cards for the SavNet program. The SavNet program provides discounts on prescription drugs and other healthcare services including dental, hearing, vision and chiropractic services. While this is not insurance, it does provide discounts when you present the cards at eligible providers. We’ve found most pharmacies in our area work with SavNet. Membership in SavNet is included in the $449 family monthly sharing amount.

There are two cards that Liberty sends to you – the Pharmacy Program and the Health Savings Program. To be clear, the Health Savings Program is not equivalent to the Health Savings Account. It is what is presented at participating dental, vision, hearing and chiropractic providers.

Within the last few days, my wife had to pick up a routine prescription at our local drugstore. I had not informed her we received the SavNet card yet so she paid for the prescription as a self-pay customer. She received a self-pay discount at the pharmacy and her cost, for this routine prescription, was approximately $15. We had done research prior to joining Liberty to understand what the unsubsidized cost would be for this prescription and this experience was in line with our expectations. It will be interesting to see what the cost is with the SavNet card. My wife said our cost for the prescription under our past plan was approximately $7-8.

We’ll let you know when we receive our Liberty Healthshare member card and if it means anything to our providers. Stay tuned.