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Tiering - Will
you be
willing to
pay more for your
doctor? | As the cost of
health insurance premiums continue rise sharply,
employers and health care plans are looking to the
consumer to shoulder more of the cost of their health
care. One recent study found that in 2002 alone, health
insurance premiums increased on the average of 21
percent.
With no end in sight, alternative concepts of
controlling health care costs are being considered by
health care plans and employers alike. Many of these
concepts fall under an industry term called
"consumer-drive health care." The theory is the more
you, the consumer, are aware of the cost of your health
care, the more prudent you’ll be in using your
benefits.
One method being implemented in some parts of the
country is called "tiering." Consumers who have
Preferred Provider Organizations (PPO) as part of their
health care plan already choose whether they will use
in-network providers or more costly out-of-network
providers. As far as the consumer is concerned, tiering
is similar, just a little more complicated.
With a health care plan that includes tiering, your
health care providers would be divided into several
groups, such as low, medium and high, based on the fees
they charge for services. In some organizations, the
health care providers could set their own prices,
allowing them to choose their tiers, as opposed to
current PPOs, where providers have negotiated with an
employer to provide fees at a lower price.
Under a tiering system, you can choose a low-tier
provider, which would require you to pay nothing or a
small co-payment for services. If you choose a medium or
high tier provider, you would be required to pay more
for your treatment, either with a bigger contribution to
your monthly premium or a higher co-payment.
In some areas of the country, the tiering of
hospitals is already in place. Under these plans,
consumers pay more each day to stay in a medium- or
high-tier hospital.
If tiering becomes part of your health care plan, how
do you know what level to choose? Here are some tips to
help you make decisions:
- Do you like your current physicians? If you’re
just lukewarm about your doctor, choosing low-tier
providers may be an option for you.
- Do you have any medical conditions that need to be
monitored? If so, it may be worth it to pay more stay
with the current health care provider who knows your
case.
- Where does your physician have hospital
privileges? If your doctor practices only at a
high-tier hospital, you may want to consider making a
move.
- If you are unsure about who to choose, meet with a
low-tier health care provider before you are sick. You
may pay for this visit out of your own pocket, but it
may be worth it in the long run.
- Consider a Healthcare Reimbursement Account (HRA)
to pay the higher co-payments for medium and high tier
providers. If your employer offers this plan, you can
choose to have a fixed amount earmarked for medical
expenses deducted from your check before taxes. If
your plan requires you to pay higher insurance
premiums for higher tier care, this won’t be an
option. Premium costs can’t be deducted.
- Talk to your family and friends to find out what
they know about low tier providers. You call also call
your local medical society or other health care
provider trade organization to get
information.
Being informed about changes in your health care plan
can help you budget for future medical expenditures.
Under tiering, you may have to do more research, but the
savings could hold down your health care premiums for
years to
come.
© 2004 by Roger
Lacocoa, Affordable Health Insurance
Quotes.
~~~~~~~~~ About the author:
Roger Lacocoa is a professional
consultant with Affordable Health Insurance
Quotes, specializing in the areas
of health, life and disability
insurance.
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