Consumer-Directed Health Plan Thoughts for the day

Well, as an allergy suffered myself, and also the father of 4 young kids, 2 of whom also have allergies, here is my thought for the day. As I started waking up around 2 am this morning sneezing my brains out, I realized I had not taken my OTC CVS brand generic Zyrtec (Up and UP Brand)...45 Bills for 12 bucks folks.

I popped my med, tried to go back to sleep but could not as the med takes a couple of hours to be absorbed. Finally I stop sneezing, too late to fall asleep so I take on my day. I wait until 8:30am and call my family doctor, and get his kind nurse. I tell her my brains are popping out of my nose and that I need my Flonase refilled ASAP...quickly I catch myself, GENERIC Flonase that is, please make sure the doc fills with generic.

This move saved my 30 bucks, as the namebrand is WAY more than the generic and so is my out-of-pocket cost. But most folks would either not know to do this, or maybe get too lazy to even try generics. Well folks, the active ingredient in all generics are the same as namebrands, it can be other things that perhaps cause different side effects (the casing, i.e. makes your stomach upset for example)....I am no physician, but when it comes to "blindly" taking meds that docs write out on their pads, I always opt for generic as the costs are powerfully less. I am also always comparing Wal Mart, CVS, Costco just for starters, as they all have great Rx plans EVEN IF YOU HAVE NO INSURANCE. This in a nutshell is consumerism at its best, as these mega stors know consumer-directed health plans are here to stay, snagging ground, and are the only plans that will be affordable in the years to come for most of us. These mega stores also know the pharmaceutical industry is going to get it's own COLONOSCOPY with reform, and we will probably start seeing less Cialis commercials constantly throughout the day...yes those commercials translate in to costs for you at the CVS counter.

I wish I could scream from the rooftops as an entrepreneur, expert in the field of consumer-directed health care as well as industry veteran, and just plain old consumer...This is the only thing that will save the system, is us asking more questions, comparing costs, checking up on our own doctors etc...not OBAMANOMICS, NOT RAISING OUR COPAYS or passing on more of the employer's cost to employees, it is a shift in the buying and using decisions...there will always be folks to lazy to do so, or too adverse to change who will continue to erode healthcare in the U.S. but when CVS pharmacy's start using what is called a HARD EDIT, employees will start learning what I am talking about. A hard edit is when the CVS DENIES your brand name drug because your employer has chosen that option to demand dispensing generic meds, or you pay THE FULL COST OF THE BRAND NAME DRUG!! The are things that have been used for years for the biggest employers with the biggest budgets, and usually the biggest brains behind them...they have been 10 years ahead of what is happening now (or more)....welcome to the new world folks.

I will brain dump again soon -

Why HealthInsuranceGeeks Rule - Top 10

This is the beginning of what will become our version of the Top 10 Reasons to become a HealthInsuranceGeeks.com client:

10. We are very, very, very smart
9. Along with smarts, we are both marginally handsome
8. Along with "decent" looks and smiles, we have razor sharp whit and light-hearted personalities
7. Your broker based on our knowledge of our industry is basically a criminal if he/she is not moving you to a consumer-direct health plan strategy
6. Why #4 is so targeted?
5. Because other brokers drive Lexus's, where Rolex's and have beach houses....
4. We drive Toyota's and wear Timex Ironman watches..
3. Can guarantee 15-30% savings with our strategies - your brokers do not want that because it means they take a 15-30% pay cut - ESPECIALLY BIGGER BROKERS!!!
2. We happen to be Health Insurance Geeks - we are experts
1. YOU HAVE NOT GIVEN US A TRY....

Top Health Plan CEO Pay (2007)

Ron Williams, Aetna, 23+ million
Ed Hanway, Cigna, 25+ million
Dale Wolf, Coventry, 14+ million
Jay Gellert, Health Net, 3+ million
Michael McCallister, Humana, 10+ million
Stephen Hemsley, United Health Group, 13+ million
Angela Braly, Wellpoint, 9+ million

Well, well...............this is substantial evidence to overhaul their pay....should be seeing this from Obamanomics shortly, as it seems to be a conflict of interest to control payments of illnesses that kill, but take home 25 million?

High Deductible Health Plans

These go waaaaaay back. We were discussing the need for consumer-directed health plans (CDHPs)and consumerism in general as it pertains to health insurance 15 years ago....it is like Malcolm Gladwell's book "Outliers", these CDHPs have been hanging arond waiting for an implosion to then take root.

Now is that time, between Obamacare, which from my perspective will not do much more than open up more individual health plan purchasing, (canabalize the group market)and CDHPs, I think those coupled will develop the new market. We will get used to plans that do not pay first dollar (the copay) yet have deductibles and coinsurance for everything except preventive care. It is about time....if you step back and look at the copay, it is absurd and I am not sure how we got to expect them as a physician visit really should not cost 5, 10 or 20 dollars. With a structure that way (let's not even get in to the 100% inpatient benefit, that has CRIPPLED our healthcare economy) as we have been saying for years, we will end up with $2,000 single employee or personal purchaser rate in the coming years....so bye, bye copay, hello deductible and coinsurance. Couple that with health savings accounts (which can help from a taxation perspective, long-term savings) and network based care, and welcome to the new healthcare landscape. We will be penalized much more for going out of network, and we may also end up with the old referral system we so loved to hate in the 1990s....so basically we will end up Back to the Future, with plan designs like they were before managed care, but the network based care of managed care.

Hate to admit that I along with other colleagues predicted this 10 plus years ago, but that's the truth. I welcome any alternatives to this model, but as I see employers do away with group plans, set a monthly flat stipend per employee to go purchase their own health insurance, I know we are well under way.

Once Obamacare tax incentives take hold, and the greedy health insurance carriers are forced to give FREE preventive visits, un-do medical underwriting and pre-existing condition exclusions, I think we will end up with an a la carte menu much like GEICO auto-insurance, but if we have too much government, here we go:

"Welcome to McDonald's may I take your order please? Uh, yes, I would like a number 2 super-sized (5,000/person deductible, 80/20% coinsurance thereafter up to an additional $5,000 out of pocket) and I live in Charlotte so I would like that from, ummm, Aetna. No problem sir, and when you have any questions, just call our 800 number, we have the wait time down to an hour and 15 minutes. If you have a non-life threatening emergency (like a hip replacement that has kept you out of work) we will put you in our treatment wait-que, but don't worry, we can get that hip fixed in 30-40 MONTHS!!"

I don't know about you, but I do not want the government telling me when and how I can get treatment for a critically ill child or parent, PERIOD. I understand Obamacare et al need to pressure these GREEDY insurance companies (hello Ron Williams, CEO of Aetna, and your 165 million in stock options waiting to be exercised on a good earnings report, so you can buy another house) in to offering a more leveled playing field....yeah, yeah, I get that as well as anybody, we need REFORM, but go away Obamanomics, the government in this country is starting to be a George Orwell 1984 fulfilling prophecy....

Blow up Ron Williams,