Financial health literacy for the integrative practitioner

By Nancy Gahles

In my experience as a healthcare practitioner, patients rarely know what their insurance plan covers. The norm is for them to call the office and ask if you take their insurance. The expectation is on the doctor to call the insurance carrier and determine the exact parameters of coverage. The patient may or may not know the amount of their copay or if they also have a co-insurance fee. They are certainly not likely to know the difference.

Earlier this month, David Himmelstein, PhD, and colleagues authored a study that revealed the ominous truth of the state of health insurance.

“Private health insurance is a defective product, akin to an umbrella that melts in the rain,” he said.

In 2014, The American Institutes for Research (AIR) found that only one in five Americans was likely to correctly calculate what he or she owed for a routine doctor’s visit. Fifty-one percent cannot predict their out-of-pocket healthcare costs for 2019, a troubling finding from research by Alegeus Technologies, a consumer healthcare funding an education platform based in Waltham, Massachusetts. The same research predicts that consumers will leave nearly $85 billion in tax savings unclaimed this year due to a lack of health cost fluency.

While the dynamics of the healthcare marketplace have shifted to empower the consumer, they continue to struggle to do so effectively. According to the 2017 Healthcare Consumerism Index, “healthcare consumers are more engaged and thoughtful about buying a TV and booking travel than they are about making decisions that concern their own healthcare.”

Negotiating the waters of health insurance is no easy feat. There are frequent changes that are often unpredictable. One service was covered last year and not covered this year. The number of office visits allowed per year changes as well. Consumers do not typically keep abreast of these changes. They expect the doctor to do so. The first time that they become aware is when they receive a bill in the mail.

The conundrum lies in the question of who is ultimately responsible for the educational requirements of procuring the insurance that suits you and your family’s needs. In bygone days, the insurance salesman would provide the explanation of your benefits package. In today’s healthcare, people are left to figure it out on their own.

I personally found that the insurance options offered only listed a cover page with little information other than basic numbers for premiums and copays, out-of-pocket limits, and hospital benefits. When I inquired further about the whole policy, I was told they don’t have such information. You do have to go into the purchase without all the information, and you’ll find out what was covered or not only after you have entered the claims process.

Galit Tsadik, founder and CEO of Tsadik G. Management in Rockaway Beach, New York, shared a similar experience.

“I was paying $600 a month and I was scared to use it because it was not good insurance,” said Tsadik. “It was an 80/20 policy, but it wasn’t clear what that meant. I foresaw hospital and medical bills that I could not predict. There was no dental, no vision, and no out-of-network benefits. I was scared to use it. It actually prevented me from getting healthcare.”

This attitude represents the other end of the financial literacy spectrum. Individuals pay the premiums, but lose by not taking care of healthcare needs that could lead to extreme or emergency conditions later on. Either way, the consumer loses and the insurer wins.

Tsadik claims that people need to be educated about how to make intentional purchases with their money in general.

“The problem is that people are not paying attention to their budget, to where their money is going,” she said. “They operate from fear. From a poverty consciousness. It is a desperation mentality, not enough, never enough. When they look at their reality, they likely only must reallocate things. Then they can know how to manage their budget, their lifestyle, their health in finances, and their body and mind.”

She empowers her clients by saying, “you can’t win a race if you don’t know where the starting line is. That’s where the power lies.”

The “foundation course” necessary to avert financial devastation such as bankruptcy from medical bills is education. Financial health literacy, according to Alegeus, must contain significant education, tools, and support for consumers to assume more financial responsibility for their healthcare costs.

Tsadik counsels their clients to be educated and financially literate in all areas of their finances. Purchasing healthcare insurance is one area that can predict a healthy bottom line and can prevent financial collapse. She advises her clients to open their eyes. She counsels them to set intentional goals, and to use the money to achieve those goals.

“Money is never your end goal,” she said. “Don’t wait until you have enough. If you waited until it’s perfect, you’ve waited too long.”

You don’t need to be Bill Gates. You don’t have to find yourself on the precipice of disaster, “just one serious illness away from bankruptcy.”  The solution is simply another face of self-care. Self-reliance, as Ralph Waldo Emerson wrote, is the foundation. His famous quote is one of my favorites.

“The power which resides in him is new in nature, and none but he knows what that is which he can do, nor does he know until he has tried.”