Are Your Patients Getting the Most Out of Their Insurance?

posted by Pivotal Health Solutions on Friday, November 28, 2014

Health care costs are high ... and growing. "Hidden" or out-of-pocket costs can push these costs even higher. By empowering themselves, consumers can get the most out of the coverage they have for both traditional and complementary medicine. USA Today reports on the high "hidden" costs of health care and what your patients can do.

How much are you really spending on health care? Probably more than you — or the government — anticipates.

Americans spend nearly $2.8 trillion a year on medical services, prescription drugs, long-term care and other health needs, according to the Centers for Medicare and Medicaid Services' 2012 National Health Expenditures report. But CNBC got an early look at a new Deloitte study that posits there's $672 billion in additional "hidden" costs — including unpaid care for a family member, vitamins and supplements, and complementary and alternative medicine — pushing the spending total to almost $3.5 trillion.

"When you take that into account and roll it up together, it's a much bigger amount," said Sarah Thomas, director of research for Deloitte's Center for Health Solutions. "It has a huge effect on consumers' budgets."

Government estimates put per-capita, out-of-pocket medical expenses at $1,045 in 2012. The hidden costs add $367 to consumer's tab. Worse, under-the-radar expenses are mounting faster. Consumer spending on government-tracked medical expenses rose 3% over five years, reports Deloitte, while spending on the "hidden" costs is up 4.7% in the same period.

Of the extra costs, 79% stem from unpaid supervisory care for a family member or friend who cannot care for himself (or herself), and 3% from community care homes. It's a financial burden one-third of Americans currently shoulder, or expects to, according to Northwestern Mutual's recently released 2014 Long-Term Care Awareness Study. And more than half of those caretakers see an impact on their budget and retirement plans as a result of those unpaid hours.

Deloitte's report says other significant unrepresented out-of-pocket costs include vitamins and nutritional supplements (9%), and complementary and alternative treatments such as acupuncture or massage therapy (5%). 

What's the Solution? 

Such expenses underscore the importance of being an informed, empowered consumer. "More people have high deductible plans, but we're not used to asking a doctor how much things are going to cost," said Carolyn McClanahan, a medical doctor who now works as a certified financial planner in Jacksonville, Fla.

Thinking about your "medical mindset" — how often you seek out medical care, and for what — can help you pick the right plan at open enrollment and better anticipate care costs, she said. Assess deductibles and co-pays rather than just the premiums to make sure you can afford the out-of-pocket costs.

Before you open your wallet, explore avenues to see if some expenses might be covered. With a prescription, some vitamins and supplements (including prenatal vitamins or iron tablets for someone with anemia) may be eligible expenses in a pretax flexible spending account.

A 2004 Kaiser Family Foundation survey found that 47% of employees have coverage for acupuncture and 87% have chiropractic care covered. More recently, "there's been a slight forward trend toward more coverage of alternative therapies," said Michael Cohen, founder and president of Beverly Hills-based Michael H. Cohen Law Group, which specializes in health-care law. Even when treatments aren't covered, he said, some insurers have discount programs that cut costs if you go through a partner provider.

Given the high odds (and high costs) of helping with a loved one's long-term care, it's a particularly important expense to plan for, McClanahan said. Ideally, discuss as a family what preparations are already in place — retirement savings? a long-term care policy? — where important documents are stored, and who will step in if care is needed. "Who's going to be responsible?" she said. "Create an agreement in advance." That can help make sure whoever is designated as caretaker gets more support and compensation.