Volume 2, Number 14
Monthly News On Products Promoting Healthcare Cost Transparency And Healthy Living Tips

This monthly newsletter contains information about medical cost sharing programs as well as health insurance plans offered through insurance companies that promote healthcare cost transparency. It provides information about tools designed to maintain or regain your health, articles on health and wellness, and information on complementary and integrative health. It also contains information on other cost-transparent products and services you can purchase or utilize to supplement either your medical cost sharing program or your insured health insurance plan.
When members are living with a serious health condition such as cancer or a chronic condition such as heart disease or COPD, the cost for their care can add up quickly, leaving many with large bills for medical care and prescription medications.

The Kaiser Family Foundation recently reported 67% of people in the U.S. are very worried or somewhat worried about unexpected medical bills . And many people are having difficulty paying high medical bills. The credit bureau TransUnion found that 68% of patients failed to fully pay off medical bill balances in 2016, up from 53% in 2015, and 49% in 2014. That percentage is projected to climb to 95% by 2020.

To help manage the risk of high medical bills and debt, Health Excellence Plus members can deploy several strategies focused on educating themselves on how to get the most out of their medical cost sharing program and utilize support services that help them pay for care and ensure that the medical bills they receive are accurate.

Low Unshareable Amounts

Members pay lower monthly share contributions for a Health Excellence Plus program than they do for a traditional Affordable Care Act health insurance plan. A member can elect an individual Unshareable Amount as low as $500 (the maximum is $5,000 in the Access version of medical cost sharing) per individual, can use any provider, and in most circumstances have no maximum cap on shareable costs.  In contrast, insured Affordable Care Act plans have maximum in-network maximums in 2019 of $7,900 for an individual and $15,800 for a family, and these amounts will increase in 2020. Out-of-network maximums can be double or even more, depending on the plan selected. Monthly contributions for a Health Excellence Plus program are 30 to 90% lower than with a traditional insured Affordable Care Act plan.

Avoidance and Prevention

According to the Centers for Disease Control and Prevention, 86% of annual health care expenditures are for treatment of chronic disease. Chronic disease is responsible for 81% of all hospital admissions; 91% of filled prescriptions; and 76% of doctor visits. A significant portion of these expenditures can be prevented, delayed or alleviated by eliminating three risk factors: poor diet, inactivity and smoking. This could result in the elimination of 80% of heart attacks and strokes; 80% of type 2 diabetes; and 40% of cancers.

Health Excellence Plus focuses on attracting health-focused individuals and emphasizes the importance of avoidance and prevention. Health Excellence Plus offers state-of-the -art avoidance tools such as the artificial intelligence-based functional assessment, the personal medical vault, and the QR Life Code. The program provides the Mayo-clinic developed Twelve Habits of Highly Healthy People educational program and a wide variety of educational programs and discussion groups.

In addition, four of the five programs (the self-directed program is the exception) offer all Affordable Care Act-required preventive care benefits. Members are highly encouraged to use their preventive care services.

Necessity of understanding how the program works

An important step in helping members to better manage their healthcare costs is to make sure they have a strong understanding of how their program works. Health Excellence Plus tries to ensure that prospective members understand the program before joining and discourages individuals from joining if they are not health-focused, not prepared to actively manage their health care, or who do not understand the program. Explanatory welcome calls are scheduled for all new members, and a single point of access through the concierge is provided so that members know who and where to call if they have questions, concerns, or need help in understanding and using the program.

Benefits and services that lower the risk of high unexpected medical bills

There are several ways Health Excellence Plus helps manage and mitigate the impact of the cost of care for members who face high medical costs.

Help members of the partially self-directed program pay for care with voluntary HSA accounts and all members pay for care by establishing voluntary health matching accounts.  Offering these types of accounts gives members a way to budget for and fund expensive healthcare costs incurred before meeting their individual unshareable amount (or for other items not included in medical cost sharing, e.g. dental work).

Provide access to second opinion services:   To ensure members are not only getting the most accurate diagnosis but also the most appropriate treatment plan for their condition, Health Excellence Plus offers members access to second medical opinion services for those who face a new diagnosis, a possible surgery, a change in medication, or a chronic illness, even including one currently excluded from sharing because it's a pre-existing condition.

Members have access to more than 300 nationally recognized, board-certified medical specialists that cover more than 120 sub-specialties. These world-renowned physicians are available for consult via video conferencing or telephone from virtually anywhere in the world within about 3 days, providing program members the peace of mind that they want and deserve.

The program's experience with the second opinion program is that 1/3 of planned surgeries are cancelled; that treatment plans are improved 73% of the time; and that the average savings/consultation are $3,000.

Help with medication costs:   When members are prescribed high-cost medications, the Concierge and Sedera Member Services help the member reduce costs through programs such as World Meds and Pharmacy Checker. They also help the member find the most appropriate and cost-effective setting for administration of the drug: for example when a member needs an infusion or an injection it can be up to five times less expensive to administer the infusion or injection at a physician’s office instead of a hospital outpatient clinic.

Lower the risk of inappropriate care and duplicate testing:  The program offers member access to services of a Sedera Member Advisor who can provide them with information on treatment options as well as gathering and reviewing all medical records to lower the risk of unnecessary or duplicative care, lab tests and imaging.
Connect members with a Sedera billing advocate:   According to some estimates, between 30% and 80% of medical bills in the U.S. contain at least one error, and in nearly a third of those cases, the error represents a significant amount of money. A billing advocate can not only review bills for accuracy and dispute incorrect charges with hospitals and providers but can also help negotiate a cost reduction when members face high medical bills.
The Trump administration outlined a two-pronged framework on July 31 for allowing prescription drugs to be imported from Canada and other foreign countries, something that could help consumers better afford the medicines they need to stay healthy. A provision in the 2003 Medicare Part D prescription drug law already permits importing drugs under certain conditions, but HHS has never approved such a program.

Under one path in the administration's action plan, HHS would issue a regulation outlining how states and pharmacies could obtain the department's permission to import certain drugs from Canada. State proposals would have to demonstrate that the medicines they want to bring into the United States are safe, that the FDA has already approved these drugs for sale here, and that consumers would save money by buying these medications. Not all drugs would be allowed to be imported. For example, controlled substances, biologics and certain injected drugs would be excluded.

Several states have already passed laws authorizing safe prescription drug importation. Health officials in Vermont, Florida, Colorado and Maine are working on proposals to submit to HHS (which is required to approve any state plans). A survey in March by the Kaiser Family Foundation found that 8 in 10 Americans — across all political ideologies — support allowing Americans to buy medicines imported from Canada.

The second path of the administration's plan would allow drug makers to import versions of their own products that are marked for sale in foreign countries. Pharmaceutical manufacturers would have to prove to the FDA that the drug they are selling abroad is the same as the U.S. version.
Programs under the administration’s proposal would be limited and would take some time to implement. Stiff opposition is expected from many Republicans and from the pharmaceutical industry.

See the entire article here .
Both the Health Excellence Plus Access  (Association) and Select (Group) plans encourage the use of and can provide incentives for what is called medical tourism.

This article in the Kaiser Health News outlines an innovative program utilized in the group medical program of Ashley Furniture Industries where patients meet American doctors for procedures to be performed at an upscale hospital in Cancun, Mexico. This program is a win-win both for the patient, the doctor, and the program as a whole, because the cost of procedures (in this case a knee replacement) is significantly less than what it is in the United States—and special incentives (e.g. payment for travel)are authorized by the program.

While the article describes medical tourism as included in an insured group medical plan, Sedera medical cost sharing has a special committee to review the use of medical tourism. If the committee approves and there are savings to the individual and the community, the committee has the authority to offer incentives such as the ones described in this article to the member—while still saving money for the community.

Read the entire article here.
About Paul Cholak
Paul Cholak is the Principal of Control Your Healthcare Costs, LLC (dba Control Your Healthcare Costs) and is an endorsed vendor of the Free Market Medical Association, which promotes transparency in healthcare costs and programs. He's also a Partner/Supporter of the Direct Primary Care Coalition, which promotes the direct primary care provider concept.

He constantly seeks to find new and innovative products that incorporate transparency and focus on reducing costs of the total healthcare bill.

He's a National Healthcare Advisor for  M Powering Benefits , a Certified Affiliate with Sedera Health, and is also appointed by insurance carriers who offer insured products that promote healthcare transparency (for example Health Indemnity insurance).

He offers or refers you to medical cost sharing and insured healthcare products on either an individual, association, or group basis, as applicable, that promote healthcare cost transparency and can result in significant overall healthcare savings to participants. He guides you through the steps of obtaining membership in the applicable program and is always available to help you both BEFORE and AFTER you've enrolled.
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