Saturday, February 24, 2018

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.