What Members Want From Health Plans: In Their Own Words

We recently completed a consumer survey to better understand how people research health care prices, whether they understand their out-of-pocket estimates and if they trust the cost information received from their health plans. While there were some very interesting findings in the aggregate, we found the open-ended responses on one particular question to be illuminating.

The question: “What types of cost information, if any, do you wish your health plan would provide that it currently does not?”

The responses: We categorized the comments into four themes below.

Theme 1: People want specific information and they want it to be easy to find

  • “I wish it was easily posted on a website – where you can search by provider and services and obtain a quote. Right now it seems you have to talk to multiple people, obtain codes from your doctor, obtain negotiated rates from hospitals/clinics etc.” – Female, 45-54 with Private (Employer-sponsored or Individual Marketplace) insurance in the Midwest
  • “I wish they could give a total out the door price, so I knew exactly what I was expecting.” Female, 25-34 with Private (Employer-sponsored or Individual Marketplace) insurance living in the South
  • “I think they will provide to meet my needs but would be nice if it was easier to find on my own.” Female, 35-44 with Private (Employer-sponsored or Individual Marketplace) insurance living in the South
  • “I wish it was easier and faster to get cost information, and it was more specific cost information” Male, 65+ with Private (Employer-sponsored or Individual Marketplace) insurance living in the South
  • “I wish the information would be slightly more true to my specific cost, not the overall cost of the procedure or other necessary treatment.” Female, 18-24 with Private (Employer-sponsored or Individual Marketplace) insurance living in the West
  • “Break down of all cost involved in a medical procedure: who charged what and why.” Male, 55-64 with Private (Employer-sponsored or Individual Marketplace) insurance living in the West
  • “How much the insurance pays versus what the patient pays.” Male, 35-44 with Private (Employer-sponsored or Individual Marketplace) insurance living in the Midwest
  • “Exact costs of surgical procedures not just generalizations or stating call Customer Service.” Female, 65+ with a Medicare plan living in the Northeast

Theme 2: They want help finding what’s best

  • “I wish that it would provide other alternatives, so it’ll be more affordable.” Female, 35-44 with Private (Employer-sponsored or Individual Marketplace) insurance living in the South
  • “I wish it would provide potential cost savings for choosing a different procedure or product.” Female, 45-54 with Private (Employer-sponsored or Individual Marketplace) insurance living in the South

Theme 3: They want the more detailed information

  • “I wish it would let me know the TOTAL cost of the surgery/procedure. It just estimates parts of it, and there are always ‘EXTRA’ costs.” Female, 35-44 with Private (Employer-sponsored or Individual Marketplace) living in the Midwest
  • “I wish everything was upfront. Too often additional costs happen.” Male, 25-34 with Private (Employer-sponsored or Individual Marketplace) living in the West
  • “I think they should be more transparent in small costs like urine analysis or blood tests.” Female, 25-34 with Private (Employer-sponsored or Individual Marketplace living in the West
  • “Better clarification of items that after performed in office that are not included as part of the copay.” Female, 45-54 with Private (Employer-sponsored or Individual Marketplace) living in the South

Theme 4: They want to know about costs ahead of time, not after the fact

  • “Actual, final, real and full costs for services. How much, if any of that, they will cover. How much, if any of that, I will have to pay. How much, if any, of what I pay qualifies toward my deductible. Getting -any- solid information before having a procedure, rather than having it, then crossing my fingers that afterwards I will be able to afford it, would be very helpful.” Male, 55-64 with Private (Employer-sponsored or Individual Marketplace) insurance living in the South
  • “Most of time, you don’t know truly how much you pay out of pocket until after procedures, when you receive info on what insurance picked up and how much you owe out of pocket, which is too late.” Male, 45-54 with Private (Employer-sponsored or Individual Marketplace) insurance living in the Northeast
  • “If services aren’t covered by the insurance and what the balance is before in go to the appointment.” Female, 25-34 with Private (Employer-sponsored or Individual Marketplace) in the West
  • “I’m not completely sure what information is provided and what is not, but it would be nice to see an estimated cost of services up front.” Female 25-34 with Private (Employer-sponsored or Individual Marketplace) living in the Midwest
  • “How much out-of-pocket costs are required for dental surgeries sooner than the day of the appointment.” Female, 18-24 with Private (Employer-sponsored or Individual Marketplace) insurance living in the West

If you want to learn more about the cost transparency solutions that HealthSparq can offer your health plan members, contact us.