Business Insurance reports on industry reaction to the proposed Affordable Care Act rule on the summary of benefits and coverage template.
“There is just not enough here to tell us what to do,” said Rich Stover, a principal at Buck Consultants L.L.C. in Secaucus, N.J. For instance, the examples make no distinction between costs employees would pay depending on whether the service was delivered in or out of network, said Gretchen Young, senior vp-health policy with the ERISA Industry Committee in Washington.
In addition, requiring employers to use government-set figures, which presumably would be national averages, could end up confusing employees if a particular employer's costs are different, which is likely since costs vary greatly across the country." This could end up confusing plan participants,” said Jennifer Henrikson, senior counsel with Aon Hewitt Inc. in Lincolnshire, Ill.
In the FEHBlog's view, use of a national average makes sense particularly when you are dealing with plans that are nationwide or cover multiple states, like many FEHB plans. The last thing that plans would need is to have to issue the summaries based on zip code so that the pricing estimate is accurate (isn't that a non sequitur?). The template needs to be more flexible.
Speaking of provider pricing, the Wall Street Journal reports on websites that help consumers determine their out of pocket costs.
The best place to start is usually your health plan's website or your human-resources department's online destination. Big insurers like Aetna, UnitedHealth Group, WellPoint and Cigna offer some pricing information. Typically, these prices have gaps, but the companies say they're working to enhance the detail.
At the national level, you can at least find averages or Medicare rates for services in your geographic area, which you can use as a starting point. Then you can call individual providers to ask about their charges and, potentially, try to haggle over pricing. Here are some places to look: Fairhealthconsumer.org has figures that are supposed to represent typical rates in various locations, as well as estimates of what consumers might spend to go out of their insurers' medical networks. HealthcareBlueBook.com offers what the company calls a "fair price" for services in a given area. The American Medical Association has a site where you can look up what Medicare pays for doctor services.Good advice.