From Hank Stern and Bob Vineyard at Insureblog comes a note that they posted about a problem a CIGNA HSA aka High deductible health plan (HDHP) client had that looks remarkably similar to the now-well-known “colleague”.
Turns out that the CIGNA HSA plan, which is supposed to help insureds be more sensitive to their expenditures by giving them a financial stake in their care, does not appear to allow insureds to access CIGNA’s contract discounts if the insured has yet to meet their deductible.
Evidently other HDHP/HSA plans have similar provisions. While this may make sense in the ivory tower in Edina (home of UHC) or Philly (CIGNA), it makes no sense to a mom with a child screaming due to an apparantly terminal earache, adverse drug reaction, or profusely bleeding head wound. And it will…anger…her immensely, leading her to switch plans (and wonder why this is so complicated and unfair and timeconsuming and stupid).
A reader asked what my opinion of HSAs is.
I believe that getting patients involved in their care, their health, and the financial implications of same is an excellent idea. Twenty years ago I worked for a firm that was trying to do just that – demonstrate to individuals and companies that many health care conditions were due to bad choices. We actually developed a rough algorithm that linked health behaviors, conditions, and attitudes to future health care expenditures. And no one bought it.
So, I still believe in the concept.
What I don’t believe is HSAs as a panacea. I’m not going to get into all the reasons for this; if you‘re interested read here. It also makes me nuts when pundits and politicians and “economists” claim that all we have to do is add a healthy dose of “consumerism” to health care to fix it. What morons.
I do believe that this focus on HSAs and consumerism is largely a waste of time. We should be working to fix our system, not tweaking around the edges. And all this tweaking does is postpone, and make much more expensive and painful, a real solution.
Jul
17
I read your most recent posting then went back over some earlier ones on HDHP/HSAs.
I challenge you to answer the “Can the current package of reforms do it?” question by stating very clearly what are the required conditions for widespread adaptation of reforms.
And I suggest you need to look at widespread reform as a process of diffusion of localized successful innovations, spurred by major power realignments in healthcare marketplaces.
My sense is that pretty much all risk management innovations of consequence can be found to grow initially in very small scale, in which all the influential forces congeal to enable, force a change, and beat back effort to snuff it out. By definition these localized innovations are somewhat isolated.
My favorite example goes back to the origins of modern risk management: the first first insurance company in thw modern western world (late 17th C London) owned its own fire trucks and was controlled by a leading read estate developer. This was the nursery bed for non-marine property insurance as we know it today.
Again, my sense is that all risk management innovations of consequence are born in and prove themselves initially in small, intensive ecologies. Innovation thus is bottom up, not top down. So we should ask what are the stages in which innovations proven in the small scale are leap-frogged into the large scale.
You can create an index of potential for diffusion but you do need to be confident that the actual success stories are on the ground to begin with.
What would such a index’s score be for MA today vs others states without a first generation universal health coverage program? Does that help diffuse ectual successes in place?
Virtually all formally trained researchers fail in my estimation to identify the small scale successes. These successes and their diffusion, perhaps state by state, are under the formal reseacher’s radar and require a fine sense of healthcare power politics.
Professionals like you with your noses right up against the healthcare insurance marketplace can spot these innovations and the forces of diffusion.
I don’t even understand the plans’ motivation. All this will do is help customers max out their deductible sooner and shift costs to the health plan sooner.
Did they have to bribe providers in order to contract as HDHP providers or something? Or is this old provider contract language that wasn’t as damaging in the $500 PPO Deductible Plan days, but now is a tragic mistake and will have to be rewritten as soon as possible? It doesn’t make sense. It pisses off their customers royally and winds up costing them money.
Joe — the comment that CIGNA HSA members do not receive the discounted rate until they’ve met a deductible is complete hooey.
CIGNA discounts for participating providers and pharmacies are automatically applied to all claims of enrollees in all CIGNA medical plans that have the network based products which includes the CIGNA HSA product.