Though a majority of Americans still obtain health insurance through their employment, the trend is clear: health insurance is increasingly detached from employment. For those still in the land of employer sponsored health insurance, the ritual is as familiar as it is confusing: march down to HR, get a whole lot of paper and online information pushed at you, and be prepared to choose (if, indeed, you have a choice) fairly quickly. The selection process can be even more disorienting if only two options are offered: the first a reasonably comprehensive health insurance program and the second a high deductible plan twinned with a health savings account. The latter is the darling of large employers, of late, and it is easy to see why using the offering as a mechanism to induce some cost-consciousness into enrollees may appeal to employers.
I recently met a new faculty member at the university where I teach. This person is a licensed health professional in addition to being a professor. This person volunteered that they had just completed their HR experience and I was curious to listen to them describe how bewildering the health insurance options were, this person having had limited personal exposure to high deductible health insurance in previous employment And, yet, had this senior hire been practicing a health profession for the several decades that seemed likely, surely that person's patients had during that time had considerable exposure to high deductible health insurance.
This summer, when I queried a provider about her sense of the likelihood that a recommended scan would actually be authorized by my provider or whether we should also develop a Plan B for diagnosis and treatment, she replied "That is between you and your insurer." How very odd. I had just advised that if insurance would not authorize, I would likely not pay out of pocket for the scan, so it was her issue insofar as she would have to develop another recommended treatment plan. I kept quiet. But the world is changing. Yes, the relative thinness or richness of my insurance cannot help but be relevant to the treatment options presented.