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Consumer-Driven Health Insurance Replacing Traditional Model

Armen Hareyan's picture

For those of you that are not familiar with what Consumer-driven Health Insurance Plans are let's take a few minutes to go over this topic.

First, Consumer-driven Health Plans mean that YOU decide who you want as your primary health care provider. If you sign up with one of the traditional health insurance companies they have a list of providers that they work with and you as the consumer are stuck choosing one off their lists. Sometimes you will get lucky and the health care provider that you want to deal with is on those lists.

According to the annual BCBSA survey in 2007, the number of consumers using Consumer-driven Health Insurance Plans has increased by 25%. Interest in Consumer-driven Health Plan is growing rapidly. The Deloitte and Touche survey found that four out of ten employers alone plan to offer a Consumer-driven Health Plan to their employees in the near future. This trend is growing due to two main factors:

First, physician's and consumers are frustrated by the restrictions and complexity of managed care. They hope that these plans will reduce the intrusion of health insurance into the practice of medicine and restore independence to the doctor-patient relationship. By eliminating the middle-man and different prices for the various providers, it allows the consumer to have one uniform fee schedule, physicians with greater patient satisfaction, and provides them with the quality care they require.

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Second, many consumers are frustrated by higher deductibles and co-pays. They also find that the prescriptions that once were covered under their health insurance plans now are not. Consumer-driven Health Plans give more control and flexibility to allow consumers to manage their own health care expenses. These Health Plans are becoming the more attractive option to Traditional Health Plans.

Now that we have defined what Consumer-driven Health Plans mean, let's focus on the problems people face and how Consumer-driven Health Plans can solve these problems for consumers.

  • Problem #1 - Traditional Health Insurance Plans do NOT cover pre-existing conditions.
  • Solution - Consumer-driven Health Plans do not care what your situation is or who you are. They cover any type of condition pre-existing or otherwise no questions asked.
  • Problem #2 - THP do not cover all prescription medications without prior authorization.
  • Solution - CDHP cover over 150 commonly prescribed medications at an average savings between 25% - 94% depending on the medication. There is no prior authorizations required.
  • Problem #3 - THP do not cover certain diseases or conditions such as Lupus or Autism.
  • Solution - CDHP absolutely NO ONE is turned away or denied coverage due to any specific medical condition or chronic disease.
  • Problem #4 - Certain THP require pre-authorization for tests such as MRI's, CT scans, Ultrasounds, and Stress tests. The main companies that require these are BC/BS and Medical Mutual.
  • Solution - CHP save you between 20% - 64% on MRI's, CT scans, Ultrasounds, and Stress tests. Savings depends on the test done. No prior authorizations required.
  • Problem #5 - THP don't cover diabetic supplies such as test strips, syringes, or glucometers if the consumer does not live in a nursing home. The meters alone are approximately $60 over the counter. Many products for incontinence are not covered by THP either.
  • Solution - CHP have a specific discount plan geared towards diabetics for one monthly charge it covers all their supplies for the month such as syringes, test strips, insulin, etc.
  • Problem #6 - Consumers between the ages of 55 to 64 have the highest health insurance premiums of any age group because they use more health care services than younger people. Conventional policies can cost close to $1,000 per month based on the fact the insured is in good health. Because the price is so high close to 15% of people within this age group are uninsured with women more likely to be without coverage.
  • Solution - CHP offer the same savings to the consumers between the ages of 55 to 64 as the consumers that are between 25 and 54. There are NO age limits.
  • Problem #7 - Certain THP do not cover blood work and the cost to us as the consumer can range anywhere between $400 to $800 depending on what the primary health provider is testing for.
  • Solution - CHP can reduce the amount the you have to pay up to 30% sometimes even more depending on the circumstances.

Now we have defined what CDHP is and also pointed out several critical issued that most consumers run into with Traditional Health Insurance Plans. So, the next step would be to locate a Consumer-driven Health Plan that solves all of these problems and provides a great savings to you and your family.


Jennifer Martinek
[email protected]