Dear CareFirst Blue Cross Blue Shield,
I just received your letter, announcing the 20 percent hike in my health insurance premiums, due no doubt to rising health care costs. And I understand how insurance works: The healthy pay for more than they use to subsidize those who need more than they could afford to pay for. I'm grateful to be in the first group rather than the second (at least, so far).
As your records will show, the benefits you've paid on my behalf over the past 16 years amount to a small fraction of the premiums you've received from me. In part, this is because I've been lucky enough not to suffer a traumatic injury or be diagnosed with a catastrophic illness. But it's not only luck. I keep up with preventive maintenance, like Pap smears and flu shots. I buckle my seat belt. I eat right, exercise, and maintain a healthy body weight. (What's more, I spend the bulk of my professional life encouraging others to do the same.)
But the most significant thing I do, by far, is this: Whenever a practitioner proposes a test, drug, or procedure, I explain that I have a high deductible health insurance policy and will be paying entirely out of pocket. They almost always respond with an alternative plan that is equally satisfactory but less expensive. It turns out that an $8 antibiotic is often just as effective as an $80 one. A $100 ultrasound can sometimes render a $1,500 MRI unnecessary. I'm not talking about under-treating conditions or taking unnecessary risks. I'm talking about prudent measures that make more efficient use of medical resources without compromising the quality of care.
This simple practice has saved me (and you) thousands of dollars over the last decade and a half. If you count a "preemptive" surgery that was recommended but turned out to be unnecessary when I pushed for a more conservative period of watchful waiting, your savings stretch into the tens of thousands.
But my little campaign of one is a drop in the bucket. My doctors have been wonderful partners in this process. But why are the most cost-effective treatment plans offered only upon request? Imagine how much you'd save if all the practitioners (and patients) in your system were trained, incentivized, or required to choose the least expensive path to the best outcome... every single time.
Your annual regret at having to raise my premiums and your sensitivity to the "financial pain this may cause" isn't good enough anymore. What you are you doing to stem the overuse of services that don't improve outcomes? More precisely, what are you doing that's working? And why aren't you doing more of it?
Monica Reinagel, MS, LDN, CNS
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