Matt Kirchner Goes to the Eye Doctor

I don't like going to the doctor. OK, I HATE going to the doctor. The medical doctor, the chiropractor, the dentist (especially the dentist)— any of them. I'm glad we have them, I recognize their value to society. I just hate going.

The first reason I hate to go is that I'm usually there because I have a problem. Back pain, rash, replace a filling, have pneumonia (last January), whatever. Second, the idea of another individual pushing, prodding, pricking and poking me has always put me off a bit, and in the case of the medical doctor, way more so since I turned 40.

So I wasn't overjoyed last month when the time came to visit my eye doctor. My one-year supply of contact lenses, which I had managed to stretch to two years, had finally run out, and the doctor refused to renew my prescription without an office visit. So off I went for the visit to the guy in the white coat who shoots high-pressure puffs of air into my eyes, dilates my pupils to the size of saucers, and leaves my vision blurry and my eyes ultrasensitive to light for the remainder of the day.

Following the exam, the doctor's assistant entered the room. "The doctor is recommending that you switch to a new brand of lenses. The fitting fee will be $89."

At this point I should note that my employer switched to a "consumer-driven health care plan" earlier this year. That is Human Resources code for really high deductibles and out-of-MY-pocket costs. In short, the $89 fee the eye doctor was imposing upon me—against my will—was MY $89. Not my employer's $89. Not the insurance company's $89. MY $89.

So I asked what exactly it was that I got for MY $89. The assistant explained to me that the $89 covered the "fitting" for the new lenses. She went on to explain that the fitting fee for the old lenses would be $39 if I opted against the fitting of the new lenses. "What's the difference?" I asked. The assistant explained that the $50 covered the cost of the follow-up visit to make sure the lenses were comfortable.

"Trust me, if they're not comfortable I'll let you know. Do I really need to come back? What if you just charge me the $39? If everything is fine I promise not to call for at least two years and I'll keep my $50. If I need to come back in a week, we can talk about the $50 then. How would that work?"

"I need to get my supervisor."

Long story short, the doctor and I settled on $59; $30 less than he would have received if: A) My employer still had the archaic low-deductible, everything's included, health insurance plan; and B) I had not taken it upon myself to understand what I was paying for.

The moral of the story is that consumer-driven healthcare plans—in spite perhaps of being less convenient than their Cadillac ancestors—work to control healthcare costs. My employer is only one of the many companies in our industry that have figured this out.

Earlier this year, Milwaukee-based metal plating company America's Best Quality Coatings made the switch from a traditional health plan, wherein the insurance plan covered almost all costs of healthcare, to a modified Health Retirement Account structure that functions as a hybrid between a Health Savings Account and a Flexible Spending Account. Under the new structure, employees have more control over how dollars contributed by the company are used for the employee's benefit.

"This was a pretty major and innovative change in the way we provide benefits to our employees, and like any change, it will take time for our associates to become completely comfortable with it," notes company president Brian Stoddard. "As a result of this change, though, we believe that our employees have much more flexibility and will take a greater role in making sure that health care dollars are spent as efficiently as possible. We see this as an excellent way to control costs while still providing an attractive level of benefits to our people."

Consumer-driven health care plans come in many shapes and sizes, but are generally structured such that an employee uses a Health Savings or Health Retirement Account (HSA or HRA) to pay for the cost of routine healthcare and higher deductibles, while catastrophic medical costs are covered by health insurance.

In the case of my employer's plan (which I admit to helping devise), the reduction in the employer's cost of insurance premiums was used to help fund the employees' HSAs. As demonstrated in my story, given the individual's role as a consumer, better spending decisions are made, which helps to drive down costs.

If you haven't already considered how consumer-driven health care can work for your company, now is a great time. I suggest a meeting with your current insurance agent or carrier as an excellent place to start.