Sunday, January 5, 2014

What's it Worth to You?

Q:  Why did the young, healthy yoga teacher buy health insurance?
a) it's mandated
b) she might actually use it 
c) to help subsidize the charity care her mother receives

Like most middle class Americans I struggle with my health insurance. My unique issues have included pre-existing conditions, self-employment and a desire for integrative care. Now that I am covered by an ACA-compliant, employer-sponsored policy and eligible for a flexible spending account (FSA) I'm faced more acutely than ever with questions about values. How much should I put into my FSA, for starters: do I feel lucky? Do I want to continue relationships with providers  who are "out of network?" Is it important enough to pay out of pocket for some types of care?

Other recent encounters raise similar questions:

A colleague wondered aloud about how to choose a surgeon for a delicate but necessary operation. As a Kaiser Permanente patient, she could stay in "the system" and all costs would be covered. But is that the safest / wisest choice? 

A gainfully employed family member recently had a colonoscopy. Apparently his provider coded it as a diagnostic procedure, not a routine screen. When this patient opened up the explanation of benefits, he was shocked to see his share of the bill.  He appealed, spending annoying hours on the phone with both insurer and provider.  But he hadn't made his deductible for the year, so what's the difference to him? 
The Price is Right!

Self employed and early-retired friends have found their way (mostly through Covered California, luckily) to ACA-compliant coverage. Some are happy. Some are not. I believe their perceived value is a big part of the difference. Perhaps they didn't realize how much of the cost was previously born by their employers. Or they distrust the Byzantine way carriers negotiate prices with our providers, but hide them from the consumers (us).

But it is also true that the healthier people are less happy to pay. 

What DO these fine people spend discretionary money on? You can probably guess: travel, restaurants, gifts and the like. Philanthropy, even.  These expenditures leave my friends and family feeling good. They feel in control of those bills.

I suppose it's human nature to appreciate health more after we lose it. Even my PCP admits he has new sympathy for his asthma patients now that his child is suffering. But know this: I pay extra for him! Along with his honesty, compassion and skill in integrative medicine he brings convenience and seamless health IT to the game. 

And those are worth cash money to me, whether Blue Shield thinks so or not.

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