Even when you know that transparency is the key, how do you communicate to your clients or employees that this is the best option against industry standards? You need proof.
Sixty-seven percent of people who file for bankruptcy do it because of medical reasons. This rings loud to me because when I was 16, my dad was diagnosed with multiple myeloma. He had a bone marrow transplant, chemo, radiation and very expensive medications resulting in $1.2 million in billed claims. Even though my parents both had health insurance through their jobs, my family had to file bankruptcy. I was young, but I can still remember overhearing my parents' conversations filled with worry and disbelief–but above all, confusion.
Recommended For You
I became determined to understand the labyrinth that was the health care system. I earned a degree in Risk Management and Insurance from Florida State University and decided to go into the health benefits industry. I believed that the bigger the company was, the more significant the impact I could create to help families like mine. As I began working for one of the world's largest consulting firms, knowledge followed, but it did not take me where I wanted to go.
In 2020, the average deductible was $4,364 for individual coverage and $8,439 for family coverage. The average American had $2,000 or less in their bank account.
Be sure to attend Lester Morales' session, "Here's the Proof – Why Transparency is the Answer" at the BenefitsPRO Broker Expo, August 17 at 4:45 p.m.
I started to notice that I was constructing health plans that had $3,000 to $5,000 in deductible costs with $6,000 to $8,000 of out-of-pocket maxes. After understanding the labyrinth, I had become part of the problem. I was destroying families with the health benefit plans I was constructing.
I realized, as an advisor, I was doing things that did not make sense.
I built health plans that did not ask members to think before they acted. This approach does not provide any education or advocacy. We did not ask them to shop for their health care, and you cannot impact what already happened.
We spend a great deal of time comparing cost versus quality on almost every purchase we make in our lives. How much will it cost if I buy a house in this neighborhood versus the other? Which big-screen TV brand will provide the best quality for the least amount of money? Some of us even clip coupons to save 35 cents on green beans, but we never think to compare prices on health insurance or medical procedures. Our doctor recommends a procedure, a location is selected and we have it done—all without knowing the cost until we receive a bill and never gaining any insights about quality.
Consumers of other products have an immense amount of data at their fingertips, but health care consumers have a limited amount of information available. Health care, unlike most things, has an inverse relationship between quality and cost. Higher quality procedures are often amongst the lowest when it comes to cost. But there is no transparency to this, and it has long been an industry norm.
For example, in my hometown of Tampa, the cost of an MRI can range between $600 and $3,000. When you look at more complicated procedures, the difference in pricing can vary more than 1,000%. Again, with no mention of quality.
I had my knee reconstructed at age 31. I did not spend time researching and comparing prices or quality. My selection of surgeon and hospital was based on a friend's recommendation. The procedure came to a total of $90,000 in billed charges. I paid my $5,000 and my employer, "the insurance," covered the rest.
I now know there is a center specializing only in orthopedics that is only 1.2 miles from the hospital where I had my surgery, and they bundle that procedure for $19,300. In the types of plans we create now, the employer would have saved a significant amount of money while helping their employee get better health care and waiving the $5,000.
Advocate + Transparency = Success
With a transparent health care model, all players win. Employers save money on one of their most significant expenses, health care, and take care of their biggest asset, their employees. Employees access better quality care for less cost. Also, when done correctly, providers can focus on providing health care and receive payments more efficiently.
Even when you know that transparency is the key, how do you communicate to your clients or employees that this is the best option against industry standards? You need proof.
At my session at the 2021 BenefitsPRO Broker Expo, I'll share how you too can create employee benefits plans that create the triple win by:
- Looking at concrete examples of the impact that transparency can have for employer-clients' health benefits programs
- Examining specific ways to add transparency to plans, ensuring everyone wins
- Going over how to talk to employers about this innovation
I'm not the only one who thinks this system is in dire need of change. Many advisors and employees are changing the way we approach healthcare benefits. Join us in August to hear our ideas and get inspired to continue creating an impact.
© 2025 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.
