b'insurance is involved is about $18,000. Since herin higher claim costs which are reflected in higher health insurance policy doesnt pay for elective cos- insurance premiums.metic surgery, she turned to me for help and advice.At the end of the day, we all make decisions based As someone who works in the insurance industry, Ion our personal pocketbook. When we make these know doctors (and even hospitals) routinely dis- decisions, however, its important that we have count their charges when a patients insurance policycomplete and accurate information lest we be duped doesnt cover the medical care or when the patientinto choosing something that might not be in our best pays cash at the time of service. That said, this caseinterest after all. This situation becomes even more even surprised me. After all was said and done, shecomplicated when were paying with someone elses paid $8,200 for the surgery! This global cash pay- money or when something appears on the surface to ment included the surgeons bill, the operating room,be in our best interest but there is a hidden agenda or the recovery room, the anesthesiologists charges,ulterior motive.and all follow-up care, and every one of the provid-ers wrote off any outstanding balance! In this article, Ive tried to pull back the curtain on Example 3: More and more often, prescription drugsomething that on the surface appears to be a gener-companies are offering financial help to individualsous gift, but in reality, is more of a scheme to prop who either dont have prescription drug coverageup pricing, pump up demand, shift costs to insurance or whose policies restrict access to their drug. Theycompanies, and line the pockets of benevolent usually do this in the form of a prescription drugproviders or drug manufacturers. I fully realize that discount coupon or voucher that caps the membersmany (if not most) readers will want to help the copayment at a modest amount like $10 per month.little guy, and are willing to do so at the expense of These medications are frequently expensive brandthe big bad insurance company, but its important to drugs (e.g., Actimmune, Sovaldi or Enbrel), or theyrealize there are unintended consequences with this are drugs that have gone off patent and have a strongapproach. The main consequence is higher premiums generic competitor (e.g., Lipitor, Copaxone anddue to consumer apathy and increased utilization of (soon) Advair). By artificially capping the membershigher-priced treatments, but there are several others cost without lowering the overall cost of the drug,(e.g., sustention of artificial product demand, circum-the manufacturer encourages the member to spendvention of price control mechanisms, price inflation, more of their insurance companys money for the ex- and perpetuation of higher-than-market pricing). pensive brand drug rather than the cheaper generic.These less obvious effects quietly (but inevitably) In fact, in many cases, the insured actually pays lessdrive up claim costs which are ultimately passed on out-of-pocket for the expensive brand drug than thein the form of higher premiums to the consumerequivalent generic drug so the pharmaceutical com- the very person who was supposed to benefit from pany is, in effect, incentivizing the insured to choosethe lower prices in the first place.the more expensive therapy without even trying theIf you have questions more affordable medication. Ultimately, this resultsabout this article or would like to discuss S your companys health insurance progam, feel free to contact me at (801) 263-8000 or info@wmimutual.com.WPMA News / Spring 201921WN19 Spring 17-48.indd 21 3/27/19 10:40 AM'