No Free Lunch?

The new calendar year brought new and revised insurance plans to many people. Now that we are several weeks in, I have noted some unsettling trends.

For the first time in several years, many co-pays have gone down. Additionally, federal law has eliminated cost-sharing for preventive health services. Patients are delighted with these changes.  But as we know, there is no free lunch. In return for what seems to a lower out- of-pocket expenditure, the insurance companies have increased premiums. It’s a rare company that doesn’t pass on some of the burden of these increases to the employee – a increased $100 monthly deduction from a paycheck doesn’t make a $10 ‘discount’ for a medical visit co-pay look that great.

This year I am finding more constraints on prescription medications: not only are certain medications being denied, but also I am finding limits on how many pills are allowed. There is not always a substitute medication. Patients have the choice of paying out of pocket and hoping to win an insurance denial appeal, or doing without.

As insurance companies restrict payment for true medical services, the glossy promotional brochures tout the added value in their policies. Upon close inspection, the discount offered for eyeglasses is no better than what is printed in the newspaper supplement. Offering a promotion to sign up with a weight loss franchise that requires purchase of private brand meals but not covering visits to a registered dietician is troublesome.

Patients are stuck. The reality is that the true purchasers of medical services are the large employers. Sometimes they just don’t know what they have bought – it sounded good at the time.