From the summer 2016 issue pdf format of fybsummer2016.pdf
file size 3MB of For Your Benefit newsletter

Health Care Costs

Editor’s Experience at Urgent Care

I love summer, so it was particularly disappointing to be sick most of July.  After a week of not being able to swallow, I broke down and visited my PCP who confirmed I had a virus and not a bacterial infection.  I followed (most of) her instructions and slowed down a little and stopped exercising, but still dragged myself into work and kept up my usual hectic pace.  A week later, I had the joy of adding pink eye to my symptoms.  Not wanting to take time off from work, I decided to seek care after hours.  I considered going to a retail clinic, but the closest one is a few towns over from where I live, and I was exhausted after my commute home.  To save time, I decided to visit a nearby urgent care facility. 

Lesson #1 – Know Your Benefits

This one was easy for me.  Since I write about the GIC’s benefits, I know them.  The urgent care facility staff insisted that my copay was $60.  I knew the copay had gone down to $20 effective July 1.  My health plan’s customer service unit was closed, so I accessed the Plan’s website on my phone and showed the copay change to the urgent care center manager.  He relented and charged me $20 instead of $60.

Lesson #2 – A Retail Clinic Would Have Been More Than Sufficient

Two nurses were in my room.  This definitely seemed like overkill for my condition.  One entered information into a computer and the other assessed my symptoms.  It was a pretty easy diagnosis and my (generic!) prescription was transmitted to the pharmacy quickly.  A physician stopped by to check on me and I shooed him out of the room concerned about unnecessary physician-related charges. 

A few weeks later, I received my health plan Explanation of Benefits (EOB).  The total billed charges were $327 and the plan paid $108.  My $20 copay was reflected and I was pleased to have no deductible-related charges.  My son had recently visited a retail clinic for a similar non-complex condition and the total billed charges for his visit was only $99 and the plan paid $72 – also subject to a $20 copay.  If I had elected to drive a little farther, I would have saved the GIC $26.  If I had no health insurance, I could have been billed an additional $228.  If I had a high deductible plan, I would have paid $26 more and it might have been worth driving two towns over.

Lesson #3 – Using Telecommunications Would Have Been an Even Better Option

In retrospect – besides taking better care of myself – I should have called my PCP to see if she could have helped me by phone.  If that wasn’t possible, I would have liked to have been able to have a telemedicine visit.  Either option would be more convenient and no more costly than the route I took.

This information provided by the Group Insurance Commission .