I know it sounds crazy, but why wouldn’t you use your health insurance for all health-related needs? I mean, you buy health insurance to cover healthcare costs, right? Yes and no. Compare health insurance to auto insurance. With auto insurance, you only use it for major issues. A bad car accident. A new transmission. In contrast, we were led to believe that health insurance should cover our everyday healthcare needs. Herein lies the difference between the two types of insurance and one reason premiums are so much more costly for health insurance.
Basics are best paid out of pocket, not with health insurance
I recently saw the new healthcare plan for our office. One thing stood out. The copay for lab tests are $40. Each employee’s annual deductible is $2000. So even after you get a lab test and pay the $40 copay, you still owe whatever the lab test costs if you haven’t met your deductible.
Keep in mind that if you use your insurance, you have to pay the negotiated rate decided on between the lab and the insurer. So let’s say the negotiated rate for a basic lab test, like a complete blood count (CBC) is $72. That means you pay the $40 copay and then the remaining cost of the test (because you haven’t met your deductible), which is $32. And that’s assuming your copay goes towards the $72! If you have terrible insurance, you might have to pay the copay plus the full cost of the lab test, ($40 + $72). But I digress.
The new healthcare consumer
To avoid this situation, you have to be a more astute consumer these days. And that means recognizing that healthcare costs don’t have to be so expensive. If you use your health insurance, as in the case above, you’re stuck paying the negotiated rate. As you know from reading this post here, the negotiated rate isn’t always the best rate.
Whereas, if you use health insurance the way you use auto insurance, you’ll save a ton of money by using it only for catastrophic illnesses. In other words, just like you pay for an oil change or new tires out of pocket (auto insurance doesn’t cover these everyday items), everyday healthcare costs are less expensive if you pay out of pocket.
If a consumer checks the BuildMyBod Health pricing database here, a consumer would find that LabCorp charges $19 for a CBC if paid out of pocket. Remember, this is the same test that cost $72 when paid through insurance. Except, even when you pay using your insurance, you’re still paying the tab!
So you can pay $19 out of pocket and leave insurance out of the equation. Or you can pay $40 (your copay) for the “honor” of going through insurance, only to pay another $32 to cover the full amount of the negotiated rate!
Don’t make the mistake of assuming this scenario only plays out with lab tests. Paying out of pocket for most outpatient tests or procedures will benefit you similarly. Check pricing for any outpatient service near you here.
Click here for the original blog post written by Dr. Kaplan for BuildMyBod.
