Open enrollment time again – what to do about Tiered Insurance Plans

September 1, 2012 in Health Insurance, Member Stories

Ahhh, September!  Summer scheduling chaos is over, back-to-school shopping is done, the kids are back in school, and I can now use my precious free time to….worry about open enrollment for health insurance?!  Yup, even though we have until December, it is already on my mind.  Actually, it never really left my mind, because I have been dealing with the fall-out of Tiered Insurance Plans since last open enrollment.

As I have posted before, last year I struggled with the new option of Tiered Health Insurance Plans.  Personally, I tried to figure out if choosing a Tiered Plan would actually save my family money.  After many hours of research, I concluded that I could draw no meaningful conclusions.  Because my family’s physicians and hospitals were ranked on different tiers for different insurances, I couldn’t conclude that these tiers were based on meaningful, standardized data.  We opted for the more traditional, non-tiered, health insurance.

Professionally (I am a pediatrician), I have been surprised at the lack of understanding that families have about the tiered plans.  My practice also falls into the category of being ranked differently for different insurances.  Conversations in my office usually go something like this:

Parent:  I think your office is billing me extra co-pays by mistake.  Every time I pay my $25 co-pay, I get a bill from your office for another $25.

Me (lightbulb going off in my head): Let me see what kind of insurance you have.  (Confirm that they have the insurance that ranks us as Tier 3).  Did this increase start after your insurance changed with open enrollment?

Parent (surprised): I am not sure.  Oh ya, I think it did.  We didn’t have any choice this year when we signed up for health insurance, our company picked a Tiered Plan.

Me:  Let me explain this the best I can…

And the discussion continues, including me expressing my understanding that a $50 co-pay can be prohibitive if your child has chronic health problems or an acute illness that requires several office visits, or if they have several children that need to be seen.   So far no family has left my practice for another provider with a lower co-pay, but I find I am doing much more phone-medicine for these patients and combining sick/well/follow-up visits.

I think the Tiered Plans are here to stay and will become more common as more companies opt for them.  I am hopeful that the information on which the tiers are based will become more transparent to physicians (this has improved somewhat this past year, or maybe I am just paying better attention) and to families.  If the data is based on meaningful information about which providers are most cost efficient while providing quality care, then I hope that the Tiers will become more standardized across different insurances.

For now, I am trying to be more pro-active in my discussions with the families in my practice. It may take more time out of my schedule, but I realize that I may be the first tier of information about the choices they will soon face.  Or would that be the second tier, or the third…?

2 responses to Open enrollment time again – what to do about Tiered Insurance Plans

  1. Sarah – interesting to think about the things you are doing differently to help patients having to pay another $50 co-pay.

    Besides the fact that patients are staying, what else do you hear from them in response to your explanation about tiered coverage?

  2. It is very interesting to me that once I explain what tiered coverage is and why their co-pays are higher, I do not get a strong reaction from the parents of my patients. My impression is that once they know why their co-pays are higher, the attitude is much of a “palms-in-the-air, shoulder shrug, what can I do about it?” The real answer will come during re-enrollment – do they change plans if they can, or do they stick with what coverage they have? Do they stick with me?

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