Medical Tuesday Blog

Does third party healthcare deliver optimal care?

Feb 9

Written by: Del Meyer
02/09/2018 2:02 PM 

When you have someone other than yourself pay for your health care, you have to remember that the third party, whether insurance or Medicare has to add their cost to your care for managing it. However, your basic healthcare costs are recurring. The cost of your doctor visits, the laboratory, the electrocardiogram, and the chest x-ray are very basic and increase with age. Some need to be done every year and some every five years.

These basic costs do not need insurance. You should consider those as being your deductible and pay out of your own bank account. You will not save money by buying insurance for recurring known costs. Of course, your health care could be large and cause you to go into bankruptcy. You need health insurance for these costly items in excess of your basic costs. Your unforeseen costs. This is call high deductible insurance.

But there is a great misunderstanding between a deduction in excess of your known costs and a health savings plan which can have two to five thousand dollars stashed in the plan and paying all your costs out of this investment. This investment pays for all your costs which you may not otherwise be able to afford. In our experience, patients have felt that they were not in a position to make an investment. We would recommend an insurance program that starts after the usual costs for your age group. These plans are quite reasonable in cost. But they do protect you from major healthcare liability.

Suppose in your 20s, your third decade of life, you need a basic blood count; a lipid panel to reassure you that you don’t have a life-threatening cholesterol problem; and a urinalysis to rule out kidney disease. Of course, you would need a medical exam to order these and the total costs would be about $300 to $500 for the year or $25 to $40 a month for all your health care. This should be paid out of your own bank account. Your high deductible insurance for emergencies, unforeseen expenses should then be a yearly deductible of $500. So, if your insurance premium is over $40 a month, it would be excessive. Insurance should never be used to cover basic known costs.

In your 30s, or 4th decade of life, you should have a basic blood and urine check every five years and if your cholesterol was high, this needs to be repeated every year. The cost of health care in your 30s would not be significantly greater than in your 20s.

In your 40s, or 5th decade of life, you may want to have an electrocardiogram just to make sure your heart is normal and a chest x-ray to make sure your lungs are free of disease. If these are normal, a recheck every 5 to 10 years is also adequate. Thus, the basic yearly costs would now be approximately $400 to $600 a year or $35 to $50 a month. Thus, your high deductible insurance should start at $600 a year.

In your 50s, your 6th decade of life, you will need your basic blood counts, chemistry panel, electrocardiogram, chest x-ray, once or twice depending on their previous levels. If they were elevated, you may need yearly checks. This the decade that you may need other tests depending on your diagnosis. If you have diabetes, these drugs are relatively inexpensive initially and the testing kits are OTC (over the counter without prescriptions.) Your costs for this decade would be around $600 to $800. Thus your deductible should be about $800 per year.

The high deductibles as outlined above should also have a modest copayment of 5 percent for hospital care and 10 percent for outpatient care or you won’t be in charge to monitor and control your health care costs.

These high deductible insurance policies are vastly cheaper than total insurance to cover both basic and unusual or total expenses for your decade of life. We have seen policies that are less than half or even a third of the costs of standard health insurance. Of course, if you’re married you need to double the above estimates. If you’re planning to have a baby, you would need to triple these costs a year before the expected delivery.

This type of HealthPlan that we recommend does deliver optimal care because you’re always in charge of all your expenses. However, if you have a managed care plan, either an HMO (Health Maintenance Organization) or a PPO (Preferred Provider Organization) that pays your entire medical bill without a deductive or copay, they will police your every request to see if they can afford it and still make money. This is where suboptimal care begins. And it’s totally avoidable by following the above options.

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Medical Myths originate when someone else pays the medical bills.

Myths disappear when Patients pay Appropriate Deductibles and Co-payments on Every Service.

Categories: Medical Myths

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