It’s your money.
The St. Louis – Kansas City Carpenters Regional Health Plan is taking the responsibility to help you become educated healthcare consumers. Beyond the Plan’s education, it will be your responsibility to make the best healthcare decisions for you and your family. Our goal? To keep as much money in your wallet as possible.
“What’s In Your Wallet?”, the financial services slogan coined by Capital One®, says it best when it comes to the topic of healthcare spending. It’s no secret that healthcare costs are going up in a country where our population is considered to be one of the sickest. Carpenters Health Plan is on mission to help you learn the ins and the outs of your health benefits, not only what these benefits include, but how you can take care of your healthcare needs, spend wisely and make a positive impact on your wallet and on the Plan’s bottom line.
Shop first.
You likely wouldn’t pay $100 for an American-made hammer from your local hardware store that you knew you could get at another local store for just $42.88. In this case, you likely knew the price difference because you did your homework in advance and that homework led you to make a wise decision. There’s no reason to put an additional $57.12 into the exact same product purchased at another local store, is there?
Healthcare works the same way. Consider that your local hardware store is your out-of-network health benefit. And the second local store is your in-network health benefit. Instead of a hammer, the product you are shopping for is an urgent care visit. Same care, different facility, different out-of-pocket cost. Why pay more?
Know before you go.
It’s important to realize that your physician will not always know or refer you to a specialist or a facility that is in your network. Most physicians refer to doctors, specialists and facilities they know. It is always the patient’s – your – responsibility to make sure the provider you are visiting is in-network. Look at the difference below of using an in-network hospital or outpatient surgery center vs. an out-of-network hospital or outpatient surgery center.
|
In-Network Hospital
|
Out-of-Network Hospital
|
| Actual hospital charge: |
$22,000
|
$22,000
|
| Amount recognized by plan: |
$14,000
|
$22,000
|
| Member deductible applied: |
-$200
|
-$600
|
| Health plan pays: |
90% of discounted rate after deductible: $9,480 x 90% = $8,532
|
50% of billed amount $21,400 x 50% = $10,700
|
| Member pays: |
10% of discounted rate plus deductible: $948 $200 = $1,148
|
50% of charges plus deductible: $10,700 $600 = $11,300
|
While the example above is for an average hospital visit, visits to other out-of-network medical providers or facilities would also result in 50% coverage paid by the health plan using the same formulas as outlined above. Check out what the actual cost of common services look like in-network.
|
Plan
|
In-Network
|
Wellness Center |
Using Healthcare Bluebook
|
|
Service
|
Avg visit cost
|
Avg visit Plan pays
|
Avg visit you pay
|
You pay
|
You pay/Reward
|
|
Urgent Care*
|
$714.40
|
$295.33
|
$105.78
|
$0
|
N/A
|
| Initial Wellness Visit |
$120.19
|
$120.19
|
$0
|
$0
|
N/A
|
| Established Office Visit |
$714.40
|
$295.33
|
$105.78
|
$0
|
N/A
|
| X-ray of knee** |
$93.59
|
$43.59
|
$50
|
$0
|
$25 reward
|
| MRI of knee** |
$235.57
|
$185.57
|
$50
|
$0
|
$50 reward
|
|
| Physical Therapy |
$106.21
|
$97.71
|
$8.50***
|
$0
|
$0
|
|
*Low to medium severity of care
**After $200 deductible is met
***Average number of physical therapy visits per person per year = 20 or $170 out-of-pocket cost vs. $0 at Carpenters Wellness Center.
Remember that when you pay more for medical care, that cost translates into less money for other daily, weekly or monthly budget items, such as entertainment or even food and gas. Choosing your care providers with intention will result in more money left in your wallet.
