110% coinsurance

Soon we will engage in our yearly ritual of choosing next year’s health insurance plan. I found the process frustrating last year because I was trying to figure out which insurance plan would be the right choice. Many aspects of the two plans were apples and oranges, despite both being Blue Cross PPO plans. Would I prefer a $150 copay for an MRI, or 10% coinsurance? Hard to decide. What I didn’t realize at the time was that the plan summaries are inaccurate and many of the plan details change during the year, so there is no way to make a rational choice. That will take a lot of the pressure off this year.

I’d prefer 110% coinsurance for everything short of hospitalization. I’ve seen enough medical bills for ER visits and doctor’s appointments to understand that the major benefit of health insurance most years isn’t about covering enormous unexpected expenses of major injuries or illnesses – the benefit is the insurance company pricing. ER visits that are $850 for the uninsured are $65 if you have Blue Cross. A specialist consultation drops from $200 to $38. Tests drop from $250 to $22 or even free. Medical care is suddenly much less expensive. If I could pay the insurance company pricing (100% coinsurance) plus a small surcharge in exchange for the insurance company handling the paperwork (so make it 110% coinsurance), I could afford the direct cost of routine health care.

A huge added benefit of 110% coinsurance would be that the insurance company could stop reviewing for medical necessity as a way to save money. The health care decisions could be between doctor and patient, the payment process at insurance companies could be streamlined, and many arguments about medical necessity could be avoided entirely. Everyone wins. So how do we convince Blue Cross to offer this as an option?