As consumers, we have the power to ensure we are getting value for our money. Comparison shopping can be done with ease; there is an abundance of information available to make informed purchasing decisions. From buying airline tickets to getting a haircut, being an educated consumer allows us purchasing freedom. We can buy what we want, when we want, once we are comfortable with the purchase price. There is an exception to this that I’ve experienced in both my professional and personal life: It’s navigating the complexities of medical insurance and its costs.
When I began my career in human resources nearly 20 years ago, there were two primary employer-sponsored medical insurance options for employees: health maintenance organizations or preferred provider Organizations. An HMO provides group medical insurance for health services through covered providers for a fixed fee, with referrals needed for medical services other than one’s primary physician. A PPO offers medical insurance without the constraints of requiring referrals for medical services. Employees rarely requested counsel from HR on either plan; the covered medical services and associated expenses were straightforward.
Fast forward 20 years later and I am happily still an HR professional, but the medical insurance landscape has changed drastically. Employees now have to navigate a multitude of employer-sponsored medical insurance options. Some well-known plans include: high deductible health plans with or without health savings accounts or health reimbursement arrangements; standalone health savings accounts; standalone health reimbursement arrangements; exclusive provider organizations; and point-of-service plans. Medical insurance coverage and options are typically a key component of an organization’s benefits program. On top of all these choices, there are also FSAs, HSAs, wellness programs, and/or HRAs for employees to understand and manage.
Who has been impacted from all this change and choice? Employees. Why? Every medical insurance plan has its own coverage parameters and specific offerings. It is a lot of information to process and, like most things in life, this is not static information. I’ve received feedback from employees that managing their medical insurance plan can feel like a part-time job. As a medical insurance plan participate, I understand their challenges.
For me, these challenges culminated when I recently received a phone call from an employee. She called to vent her frustrations about her medical insurance coverage after receiving an unexpected and substantial bill for a recent medical service. After experiencing leg pain, she decided to see her physician and was referred for an MRI. While there were several MRI facilities close to her home, she inadvertently picked the most expensive MRI facility. She assumed her medical insurance coverage for the MRI was the same, regardless of the facility. Not being aware of the difference in fees, she was left responsible for the sizable copayment.
In our consumer-driven economy, medical insurance coverage is not a one-size-fits-all. There are huge differences in costs depending on where you receive medical services. It’s now up to the consumer to price shop for their medical services. Like purchasing an airline ticket or getting a haircut, the expectation is you shop for the best price available.
Health insurance has become enormously complicated, even for those of us whose job it is to help employees make the best choices for themselves and their families. It’s why we take the time and make the effort to keep updated on the changes that occur year-to-year so we can support our colleagues and fully understand their medical insurance options in this complex landscape.
Cynthia Dodick Seyffert is the US and Global Infrastructure director of human resources at Stantec, a global design and delivery firm.