Consumers With Health Coverage Sometimes Skip It

By Courtney Perkes, The Orange County Register, Calif.

Jul. 19–Gail Higgins has health insurance through Aetna, which charges her a $15 co-pay for a month’s supply of medication. With four prescriptions she takes daily, that adds up.

So instead of handing over her insurance card at the pharmacy counter, she instead flashes a Costco card.

Costco charges her no more than $5 for a monthly prescription.

“What’s frightening is if Costco puts it through my insurance, it costs me the $15,” said Higgins, a 57-year old human resources consultant from Irvine. “If I go and say ‘Don’t put it through my insurance,’ it’s $5 a month.”

While discussions about health care costs often focus on the challenges of the uninsured, the movie “Sicko” — among other things — has sparked discussion about the struggles of insured Americans. Some patients in Orange County say they routinely bypass their insurance. In some cases it’s cheaper. Other times it’s more convenient, even if it costs more.

The move toward so-called consumer-driven health care received a big push this year when Target and Wal-Mart began offering $4 generic prescriptions. And later this year, CVS will open low-cost Minute Clinics in some Orange County stores, where patients with routine health complaints can be seen on the spot by nurse practitioners.

“If you’ve got a $25 co-pay and a Minute Clinic is going to cost you $50, I think a lot of people are starting to value their time and don’t want to wait two weeks for an appointment or wait in the physician’s office for an hour and a half,” said Michael Howe, chief executive of Minnesota-based Minute Clinic.

Jim Lawrence of Trabuco Canyon has a high-deductible Blue Cross plan. Last November, after injuring his knee playing soccer, he went in for an MRI. His insurance didn’t cover the test, so he paid nearly $500.

A few months later, he received a letter saying Blue Cross had denied a $1,310 claim from the MRI. The doctor’s office then billed him for the difference.

“I managed to get my bill down. I only had to pay another $150,” Lawrence said.

But the way Lawrence sees it, he received a higher bill simply because he had insurance.

“Anything else you buy in society you usually know the cost upfront and you agree to it,” said Lawrence, 48. “In the medical field you get your services, and then you find out how much it is.”

Eva Meyers, a Pasadena nurse practitioner, has researched the popularity of the Minute Clinic, which was started by an entrepreneur frustrated by a two-hour wait for his insured son to receive care for a sore throat.

“Consumers are ready for a change,” Meyers said. “They’re ready for applying some proven business concepts to health care. All the prices are transparent. They’re posted on the wall as you walk in.”

But comparison shopping for health care isn’t as simple as knowing the price.

A study conducted this year by the nonpartisan Center for Studying Health System Change found that consumers struggle with comparison shopping when it comes to health care. Even when patients do know prices, they have no way of knowing what option is low in cost and high in quality.

Researchers studied LASIK eye surgery, seen as a model for comparison shopping because it isn’t covered by insurance. The study found that patients often did not know what services were included in a package. Some consumers fell prey to misleading advertising or had no way of gauging a doctor’s success rate.

And there are those who can’t afford to shop around.

Marsha Blake, 63, says she skips necessary health care because she can’t afford to meet the $5,000 deductible on her Blue Shield plan. Instead, she relies on self-treatments and over-the-counter medications.

Blake bought the $330-a-month plan after losing her job at Boeing three years ago. She suffers from osteoarthritis, and visits to a specialist can run her $150. Rather than pay that much, she sees a chiropractor for $40 and takes Tylenol for pain. She also does yoga at home and sits in the Jacuzzi.

Blake has signed up to participate in a clinical trial so she can receive free blood work and physicals.

“I can’t even work every day of the week because I have such bad back pain,” said Blake, who provides travel agency services from her Fountain Valley home. “It’s hard to find a job at my age, but I can’t work full time because of the pain.”

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