The June 6, 2007 issue of USA TODAY has a cover story entitled, "Is a little medical coverage that much better than none?" It presents the case of several people who had health care insurance provided by their employers that had limited coverage and maximum amounts for various conditions . . . called "Limited Benefits Plans." These people were surprised when they had a medical condition and went for treatment. They then discovered the limits in their coverage.
This raises three big questions for home care leaders.
1) Is a little coverage better than none?
Many of the home health agencies and private duty companies we work with are struggling with this issue of how to provide healthcare coverage for their employees. Our research shows that this is one of the most sought-after benefits of healthcare workers.
Yet, when limited benefit plans are offered, or when plans are offered in which the employee must pay part of the premium, few employees take advantage of the benefit.
2) Whose responsiblity is it to understand the healthcare insurance plan.
The cases presented in the article described people who learned about the limits of their healthcare plans only after they sought treatment. It seems to me that employees have some responsiblity to learn about the benefits included in their health plan, and not to assume that everything will be covered.
Part of the problem with the cost of healthcare insurance in America today is that many workers believe that their healthcare costs should be covered in full by their employers, and that they should be entitled to the best care money can provide without having to pay for any of it. Consequently, healthcare is one of the few areas where we insure frequently recurring, relatively low cost services such as doctors visits, prescription drugs, and medical supplies.
Your home owners insurance doesn't cover your electric bill, plumbing repairs, and outside painting. Your car insurance doesn't cover oil changes, new tires, and a brake job.
3) How do we deal with patients who find out that their insurance doesn't provide the coverage they thought it did?
What do you do when you provide care for a patient and later find out that they have limited benefit coverage and your services are not covered? Do you bill the patient? How to you collect for your services?
As home health care in America continues as the fastest growing segment of healthcare, our need for employees will continue to grow, and our need for effective healthcare insurance programs will continue to grow.
As leaders, we need to be more aware of what's happening in the insurance industry.
What do you think? What's your experience? Give us your comments below.