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Stones & Bones / health care / volume 12 number 5, May 2010 DOSE OF REALITY Finally, Affordable Healthcare! Is this an accolade to the new health care legislation? Nope, it’s the heading on a deceptive—close to fraudulent—full-page advertisement in the Ruralite that Golden Valley Electric Association (GVEA) members in the Fairbanks area receive monthly, as do other electrical co-op members in the Pacific Northwest. Obviously designed to look like an ad for health insurance, this page in Ruralite implies that the cost will be only $59.93 per month for an entire family, and it will cover medical, dental, vision, and prescriptions. The ad states that there will be no restrictions on current health conditions, no limitations on usage, and no age restrictions. Furthermore, coverage includes “doctor visits, hospitalization, 24-hr, nurse hotline, eyeglasses, children’s braces, chiropractic and more.” “CALL NOW! 1-800-503-4582” concludes the ad. Well, not quite; if your eyes are good you can read the fine print just below. As you do, if you hadn’t figured it out already, you discover that this ad is not about health insurance after all. The ad is trying to sell you a “discount health card,” one that it is barred from sale in several states, including Washington state, within Ruralite’s distribution area. Not willing to open myself up to all sorts of unwanted future commercial communications, at first I did not call the listed 800-number, but I did do some investigation on the internet. I Googled the organization placing the ad, as evidenced by a logo showing a blue heart and “PS Family Healthcare.” Right away I was confused because that logo and “PS” showed up on several websites that seemed to be selling health insurance, health discount cards, or confusing combinations of both. I soon realized that I had just opened a can of worms; various organizations were crawling out everywhere, and it was not clear what the roles of some of them were. One of the logoed sites specifically stated that PS Family Healthcare did sell health discount cards in a program called Preferred Solutions that was administered by two other organizations, the Capella Group, Inc. and PME, Inc. According to their web pages, “The purpose of The Capella Group is resource and revenue generation,” and PME sells various medical products in the Pacific Northwest. Why, I wondered, were these entities administering an organization selling discount health cards? Looking more deeply, I begin to comprehend that the Capella Group and PME, Inc. are just links to other organizations referred to as medical networks and also preferred provider organizations (PPOs). The medical network PPOs comprise yet another layer of middlemen that contract with hospitals and health care providers who will actually provide the health care. I thought that PPOs were insurance companies that took in premiums and paid for health care. Not always, it seems. Some preferred provider networks do not actually pay providers for health care; they merely facilitate the payments at certain contracted rates, and the payment is made by somebody else. In the case of the discount card, the payment is by the holder of the card. The holder is expected to pay cash at the point of service. The PS Family Healthcare Preferred Solutions program claims that card holder will receive discounts of 10 percent to 60 percent—if they get their healthcare from in-network providers. I found it difficult to determine just exactly what network PPO the PS Preferred Solutions discount card program works with, but one of the logoed PS web pages points to a major one operating nationwide, Beech Street Health Insurance Company. One web page states, “Beech Street Health Insurance is not an actual health insurance provider, but rather a network provider operating as Beech Street under the Viant network.” Ohmigawd, not yet another organization, I am thinking as I Google on to discover that Viant Health Payment Solutions, formerly Concentra Network Services comprised of Concentra Preferred Systems, Health Network Systems, ppoNEXT, Texas True Choice (and also now Beech Street), is an organization with the mission “to deliver effective and innovative healthcare payment services that focus on timely, accurate and equitable payment for providers, payers and patients.” But wait, there is more! Just two months ago, Beech Street’s owner Viant, Inc., was acquired by MultiPlan, Inc., a major provider of healthcare cost management services. The organization claims to have contracts with more than 600,000 health care providers nationwide, including nearly 900 in Alaska. This is all so complex it sounds like those collateralized debt obligations so much in the news these days. What all this nonsense boils down to is that between you and your doctor there are many hands in the American health care system reaching out to skim off your money one way or another. Health discount cards are just one of the mechanisms for doing it. If you look into the matter you will find that the best approach is to forget the discount cards altogether. A discount card is not likely to get you a discount greater than 10 percent, and if you are not insured you can probably do better by paying cash right away every time you go to the doctor or hospital. (Remember that doctors regularly bill for two to four times what they expect to get paid, and some hospitals also do—however, not Fairbanks Memorial Hospital.) A 10 percent discount is penny ante in the health care business. And of course a 10 percent discount is not much help if you are an uninsured American receiving a $100,000 medical bill. But what the heck; ten thousand bucks is ten thousand bucks. Maybe your friends will hold a potluck dinner for you to pay off the other $90,000. The macaroni salads may not collect that much, but at least the macaroni donors will feel good, believing that they have fulfilled any obligations they might have to fellow Americans less fortunate than themselves. I do not agree with that idea and wish we could do something better. I also wish Ruralite would stop carrying those horribly misleading advertisements. Oh, by the way, finally I did call the 800 number only to learn that the program as advertised in Ruralite was no longer available in Alaska, but the woman on the phone would still be happy to sell me another discount health card anyway, and the price would be even less, only about $20 for a family of four. Neil Davis is a retired geophysicist and author of several fiction and nonfiction books. His most recent book is Mired in the Health Care Morass. More on health care issues can be found at his blog, http://healthcaremorass.blogspot.com. Neil can be contacted at neildavs@mosquitonet.com. | ||
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