Bobbi Buell: What You Should Know About Your Health Insurance Policy
The Group Room sits down with Bobbi Buell at the 2012 Community Oncology Alliance (COA) Annual Meeting. She gives some eye-opening information that patients need to understand about what to look for in your health insurance policy — if you have cancer and if you are healthy. In this ever-changing health climate, we all need to be very aware of what our coverage looks like and what we need to prepare for going forward.
The Group Room interviews at the Community Oncology Alliance (COA) 2012 annual meeting in Las Vegas was made possible by the generous support of our members.
VIDEO TRANSCRIPT
Selma Schimmel, Founder & CEO, Vital Options International
This is Selma Schimmel for the Group Room at the Community Oncology Alliance meeting taking place in Las Vegas, and I’m joined now by Bobbi Buell who is Principal in Charge of Practice Research and Reimbursement at onPoint Oncology in Hudson, OH.
Hello.
Bobbi Buell, Principal, onPoint Oncology:
Hello.
Selma Schimmel:
I know soon, you’re going to be giving a talk here, but we got you first.
Bobbi Buell:
Right.
Selma Schimmel:
We’re going to be talking about the very thing you’re going to be addressing to your colleagues, and to I believe, patients as well regarding drug reimbursements, and we hear so much about reimbursements. But I don’t know if the average person really understands what that is all about. The most important sense, we all know what a reimbursement is, but the consequences also, and what it means in the world of oncology.
Bobbi Buell:
Well, I think when you’re a patient you don’t realize how the insurance business or industry, cause many of the insurance companies that cover health insurance are for-profit, some are not. But you don’t realize how it really works until you get a great big bill – be you a cancer patient or a cardiology patient. But in cancer it’s pretty definite if you have surgery, if you have radiation or if you have chemotherapy, you’re going to get a great big bill at the end of the day. And that’s when you find out how effective your insurance policy is, and also the physicians or hospital that is treating you, they also find out how good your insurance is. But that’s a bad time to find out about it. Patients unfortunately don’t find out the truth until it’s too late.
Selma Schimmel:
I think having gone through the cancer experience myself, it doesn’t take more than a matter of days, it feels like when they all start coming and you have to look at every code, and it’s really a daunting experience because when you’re sick it’s really hard – you become so easily overwhelmed and this is not just getting a simple bill.
Bobbi Buell:
Right, and when I went into cancer 22 years ago, there weren’t very expensive medications, so when the patient was treated with a chemotherapeutic regimen it wasn’t a burden for them, it wasn’t very much a burden for the cancer practice or clinic that was treating them; everybody was satisfied with insurance at that point. As drugs become more expensive over the years some as much as $30 thousand a treatment, and with radiation there are treatments that are even more, then people really find out the truth. The other thing is, the tendency for some of the private insurance plans have very high deductibles, so the patient after their first couple of treatments, may get a bill in the thousands of dollars; this is something that people really have to be aware of because high deductible health plans are a trend that has been growing greatly over the last ten years, and for cancer patients it’s something they do find in a matter of days.
Selma Schimmel:
Other area being that oncology is such an interdisciplinary field so you’ve got all the diagnostic imaging – pet CT.
Bobbi Buell:
Right, right. And there’s imaging everywhere. I mean all of your specialists have imaging now – cardiologists like my husband, their offices have imaging, oncologists have imaging, so these are bills you also don’t expect. Particularly because a lot of patients either have to have cat scans or pet scans every time they’re re-stage, and this is a recurring expense as are drugs. So it is something also that you may have to pay out of pocket for. You also may have to get separate approval for it.
Selma Schimmel:
Let’s address this then from two viewpoints. One is the person who already is insured and gets cancer, has their first real confrontation with a major health crisis; and a person who has never been sick and is maybe shopping for insurance or changing policies and maybe getting insurance through a new employer. So let’s start with the person who has cancer, is already insured, there’s not going to be any change in their insurer now – that’s their policy.
Bobbi Buell:
I think if you’re a cancer patient the smartest thing you can do is either consult with your employer, benefits manager, or if you feel like doing this prior to going to sleep one night, read your insurance policy because there are things in your insurance policies that don’t benefit patients and things that do. Obviously your co-payments, your deductible, all your drug benefits, your pharmacy benefits, your specialty pharmacy benefits – some people have separate specialty pharmacy benefits where they can actually get some of the drugs that they take in the doctor’s office a little bit cheaper, so you have little bit less of a co-pay, so you want to look at all of those. If you have an annual out-of-pocket cap.
What’s an annual out-of-pocket cap? It means that your insurer is only going to allow you to pay so much, and after that they cover a hundred percent. So that’s something patients really want to know, or do they have a coverage cap? That’s the opposite – that means they’ll only cover so much under your policy, either you have an annual limit or a lifetime limit, and after that your insurance is gone. And when you have cancer that can be devastating. So it’s really, really important to read your policy or have your employee benefits manager explain it to you, or a social worker or financial counselor at either the practice or the hospital that you attend.
Selma Schimmel:
What are some of like the danger clauses, or big warning signs that may be in the small print of your policy that you really have to pay attention to?
Bobbi Buell:
Certainly, the annual or lifetime cap because a lot of cancer patients hit that.
Selma Schimmel:
What could that range? The annual cap?
Bobbi Buell:
Well it used to be some of them now are much lower. They used to be between one and two million dollars, and sometimes as high as five million dollars, but now we’re seeing policies with six hundred fifty, seven hundred fifty thousand. And if you’re hospitalized a lot you can blow through that fairly quickly.
Selma Schimmel:
Really quickly.
Bobbi Buell:
So that is probably the most dangerous. The other thing that we see is patients who are sick and they are paying their premiums every month. They don’t have it on auto-pay, or they don’t have it taken out of their bank account automatically, and they’re terminated for non-payment of premiums. Sometimes in your policy they will say ‘if you don’t pay for 30 days, you’re out’, and cancer patients often times are too sick, and they don’t have anyone they can depend on. So one other tip I would say to cancer patients is if you are paying your insurance out-of-pocket, make sure you put it on auto-pay once you get sick just in case you can’t pay your bills.
Selma Schimmel:
Exactly. So now the person who has never been sick, doesn’t anticipate getting sick…
Bobbi Buell:
Right.
Selma Schimmel:
What do they need to know and what should they be looking for when they read their perspective policy?
Bobbi Buell:
First of all, look at the deductibles, and imagine if you had to pay that. I mean a high deductible means your health plan is going to be a lot cheaper out-of-pocket for you every month, but just imagine yourself having cancer and having to pay that all in one fell swoop – you wouldn’t like that. So don’t think if you have a $5000 deductible and it’s really helpful to you now, it might not be if you can’t afford to pay that when you’re sick. The other thing is you have to look at that if it has all components of benefits. That means a major medical, prescription drug benefit – you have to have a prescription drug benefit when you have cancer – it’s very important because you’re also taking oral drugs, and many new cancer drugs and drugs in the pipeline are going to be oral, so you must have oral drug coverage in your policy. And sometimes people just have major medical.
The other thing you want to see is what your co-pays are on drugs – do you have co-insurance? Are there drugs caps in your policy because if there’s a drug cap for cancer that can be devastating even if all you have are oral agents and you have an oral cap. So it’s very important to make sure that there’s not a separate drug cap on an annual basis.
Selma Schimmel:
Is there a big difference between carriers, the large carriers, the Blues or – I can’t think of the names of the companies right now but – is there a difference in well-known ones to the less known ones?
Bobbi Buell:
I would say there’s a great difference in plans – even among the Blues. United Health Care there’s a lot of similarities in their plan but the Blues – Blue Cross, Blue Shields of the world are a franchise operation. They do have a governing body but it’s very voluntary for them, so every Blue plan is a little bit different. And it depends upon what you as an individual want to pay if you’re an individual buying your own policy, or how much your employer wants to spend. So I would say there’s a great difference between say all the Blues plans. There’s not much difference in United Health Care and Edna and some of the insurance companies that are governed from above.
And obviously Medicare is pretty standard. If you stay in Medicare and you don’t adopt the Medicare private plans which are called Medicare Advantage, which I think is an oxymoron by the way – I don’t think there’s any great advantage to it.
Selma Schimmel:
What about the person who has an option for insurance with an employer but the person isn’t happy with the policy that their employer offers?
Bobbi Buell:
Well it depends on the policy but sometimes you can get a coordinating policy. It’s like a secondary policy – and for Medicare you absolutely have to get a secondary policy – particularly if you have cancer. So if you have Medicare and you don’t want to pay the 20%, the deductibles, the blood deductible and all of the things out-of-pocket for Medicare, you buy a plan called Medigap. If you have private insurance you can possibly buy a coordinating supplemental plan. It just depends on the plan that you have and what the gaps actually are. Unfortunately some coordinating benefits, some coordinating plans don’t cover caps and things like that that private plans have, so you just really have to find out and the best way to do that is get a credible insurance broker to kind of walk you through it.
But if you’re a Medicare patient and you’re looking for Medigap there are really good ones offered through AARP and there are several different plans you can go to depending on what you want to pay.
Selma Schimmel:
I was just going to ask you about AARP because people become eligible for AARP well before they’re 65, in their 50s, and they have these supplemental policies. What’s your viewpoint on people obtaining one of the AARP supplements, and if you have a pre-existing condition of cancer are you eligible?
Bobbi Buell:
There are no pre-existing condition clause on AARP. The only thing that I would find out is if you feel like you’re going to have trouble affording AARP you may in fact qualify for Medicaid secondary to pick it up, and therefore you wouldn’t have to pay for it out-of-pocket. But there are AARP plans that are very reasonable and then of course there’s the super deluxe AARP plans – like I have one that will cover my out-of-pocket costs out of the country because I do travel around the country. So you can go all the way up the line with the AARP plans.
Selma Schimmel:
So if you had to recap right now and give closing thoughts to patients, family members, loved ones, what would that be?
Bobbi Buell:
Well, I think that the best thing that you can do as a patient, or if you are unable your caregiver can do for you is to be really savvy about your insurance. I do think it’s important that every bill is reviewed; I mean I can give you a great example from my own life, my son went into the emergency room one time to get stitched up and he got charged for a bowel prep. I don’t think he was going to have a bowel prep when he was getting his leg stitched up, so there are things on your bill that can be a mistake. You have to make sure your insurance is sticking by their part of the deal and not changing your out-of-pocket for one reason or another, and you also have to make sure that you yourself as a patient track your out-of-pocket costs because there are tax deductions when you are out-of-pocket costs exceed a certain limit. And you might get a tax deduction for the amount that you pay, and it’d be nice to get some of that back.
One other thing patients should know, particularly with hospital bills, if you have a tremendous amount of payment, payment plans are available, if you are self-pay in other words you don’t have insurance certainly you can negotiate those rates; they’re all negotiable.
Selma Schimmel:
Doctor’s offices will work with patients as well.
Bobbi Buell:
Yes, they will. As far as cancer patients if you don’t have insurance many of you would qualify out there for free drugs, you shouldn’t think that just because you’re not poor that you would not qualify. These patient assistance programs are very generous; I used to run 60% of them in cancer, we used to give away a tremendous amount of drugs to uninsured patients and now these programs are even more generous. So it’s important that you investigate those if you think there’s a least chance you can get assistance.
Selma Schimmel:
For viewers that may want to inquire, have questions, is there a resource for patients to go to, you know they don’t totally understand their policy, they don’t want to call their insurance company, they want to have a neutral party, or they want to get objective information, is there a source?
Bobbi Buell:
There are so many different sources for patients. Certainly if you’re on a specific drug the drug companies have hotlines, 800-lines – I used to run these where if you’re a patient and you have a reimbursement question and they can verify your insurance, they can call your insurance plan, ask them questions and get back to you. Certainly a financial counselor hospital at your hospital or practice where you attend or a social worker can go over your options with you. The American Cancer Society also has some but I think that you’re better off being in your own community or with your drug company if you’re on a cancer drug, asking specific questions. Big, national organizations aren’t necessarily the place to go.
Selma Schimmel:
Thank you very much. I think that you’ve helped to highlight what’s so important for cancer patients – it’s the business side of having….
Bobbi Buell:
Right, and it’s the last thing you want to think about so if you’re a cancer patient and you have somebody in your family you can trust to take care of some of this stuff for you while you’re sick, I certainly advise that.
Selma Schimmel:
Thank you, Bobbi Buell, Principal in Charge of Practice, Research, and Reimbursement for onPoint Oncology in Hudson, OH.
Bobbi Buell:
Thank you.
END OF VIDEO