Entries for June 2008

I was slicing cheese one Saturday morning when the knife slipped, and as I watched the blade bury itself in my finger, I thought, "I am so going to need stitches." Fortunately, I have an emergency room just three blocks away. But as I struggled to get into my clothes with my hand wrapped in a towel, it occurred to me that maybe my health plan wouldn't consider a cut finger suitably dire to justify a visit to the ER.

If my health plan were to deny the claim, I could be stuck with a big bill, I worried, since emergency room care is a lot more pricey than a visit to the urgent care clinic or my own doctor's office. This is not just idle speculation; I've talked to people to whom this has happened. So I sat down at my computer, logged into my health plan's website, and, pecking with one hand, tried to find some answers. Twenty minutes later, I was still looking (though the bleeding had mostly stopped). What I had found was the address of the nearest in-network urgent care center—an inconvenient hour away on the subway. But I bandaged up my hand, and off I went.

This week, the American Medical Association took the bold step of deciding not to decide whether to endorse using "secret shoppers" to evaluate their medical practices. Rather than adopt a tepidly positive report by the group's Council on Ethical and Judicial Affairs, which had offered its qualified support provided certain conditions were met, the AMA's House of Delegates voted to refer the issue back for further study after it had heard doctors' concerns. And so physicians have missed another opportunity to embrace customer feedback, just as they've taken a hard line against online physician rating sites, which I've discussed before in this space.

Secret shoppers are by now commonplace in retail and hotel settings and are considered a valuable tool to improve customer service. They're undercover reviewers who pose as, for example, medical patients in order to assess quality of service. Medical practices have been slow to adopt their use, and the medical sector accounts for only about 2 percent of secret shopping revenue, according to the report.

I talk to a lot of people about their experiences using our healthcare system, and many of the complaints I hear are from people who have health insurance but are still scrambling to cover their healthcare bills. Their share of the premiums alone costs more than a family vacation, and then they're faced with rising deductibles, copayments, and, increasingly, limits on coverage for various services on top of that. What good is having insurance, they wonder, if they're saddled with serious bills when they get sick?

A new study reports that the number of people who are "underinsured" has grown 60 percent in the past four years, to 25 million. Middle- and upper-income families make up the fastest-growing share of this group; rates for those with incomes of $40,000 or more nearly tripled, to 11 percent. Families with incomes under the poverty level (about $20,000), however, had the highest rate of underinsurance, 31 percent.

These days, there's one milestone birthday plenty of people look forward to: the one when they become eligible for Medicare and can leave all their healthcare worries behind. That's the hope, anyway. But the reality is that turning 65 takes care of only a little more than half of subsequent medical expenses. Now a new study from the Employee Benefit Research Institute shows that a couple without employer-sponsored retiree coverage can expect to need anywhere from $194,000 to $635,000 to cover healthcare premiums and out-of-pocket costs during retirement.

To arrive at their figures, researchers developed a model that took into account numerous mortality and investment risk scenarios, different sources of healthcare coverage, and different healthcare needs.