Family

Discount healthcare? Value and dangers of discount cards

With growing numbers of people looking for healthcare solutions in these tough economic times, insurers are starting to offer low-cost options for those who can't afford full insurance.

Blue Cross Blue Shield of Florida recently entered a market previously occupied mostly by fringe companies: discount cards. It's not insurance, but the program boasts it can offer discounts of 5 to 40 percent for those providers who take the card.

Blue Cross, as well as several others, also now offer limited-benefit insurance, which generally helps pay for routine medical care but not for catastrophic problems.

For some these work fine. Nancy Wittyngham, a mother of three in Weston, says ProMedical Plan, a discount insurance, does "very well, " offering her "good doctors." She pays about $136 a month for the family, then $10 for each visit to her obstetrician-gynecologist or the kids' pediatrician. "I'm very happy."

But the plan doesn't cover hospital costs -- a crucial gap if anyone in her family gets seriously ill.

Discount cards, too, remain somewhat problematic, even with the best brand names. When a reporter tried the offices of 10 South Florida doctors listed as providers for the FamilyBlue card, one said she accepted the card.

Two of the 10 had never heard of the card or Coverdell, the company that administers it. Two weren't sure. One was a wrong number. One phone was disconnected. Two didn't return the call. And one said if the doctor was listed, it meant they probably accepted it.

"Is there a niche for it?" asks Ron Weintraub, benefits manager for Broward County schools. "I'm sure there is a niche [for discount alternatives]. But people should be extremely aware that this is not a full healthcare plan. Of course, they're not paying the premium of a full plan either."

The FamilyBlue card costs $20 a month to get discounts on doctor visits, prescription drugs, dental care, vision care, hearing care, diabetic supplies and vitamins.

The card just became available in September, says Craig Thomas, Blue Cross's vice president of marketing. It's available statewide, but at present it's being marketed only to Miami-Dade Hispanics, many of whom are uninsured. So far, about 400 have signed up.

The FamilyBlue website suggests sample savings: A routine doctor's visit, with an average price of $99, can cost $67 with the card. Magnetic resonance imaging of the back might have a gross charge of $1,326, but FamilyBlue members could pay $704 at places that accept the card. "These are examples only, " says a Family Blue brochure. "The actual costs and savings may vary."

For hospitalizations costing more than $1,500, FamilyBlue offers to "work with the financial resources you have available to negotiate a settlement or set up a manageable payment plan."

FamilyBlue is administered by Coverdell, which has set up a network and administers discount cards under 75 names. About six million people use the card, says Kathy Lannen, Coverdell's executive vice president.

She says Coverdell is working to expand its network in South Florida with the introduction of FamilyBlue. "We always make clear that this is not insurance." People can try the card and see how it works for them, " she says. "There's a 30-day money-back guarantee. We don't force people to stay."

Discount cards have had a troubled past in Florida. From 2003 to 2005, about 1,000 complaints flowed in to state authorities about them, primarily from people who thought they were buying insurance.

LICENSED NOW

In 2005, the state insisted the cards be licensed by the Florida Office of Insurance Regulation. That weeded out many of the problems.

In 2006 and 2007, the state examined 51 discount medical plans and issued consent orders against 34 of them, settling charges ranging from exaggerated marketing tactics to not making their provider networks available to the public as required.

In the past two years, complaints have reduced by two-thirds, with 370 complaints filed. Most were against unlicensed entities. Ninety-three involved cards licensed in Florida. The most frequent complaint: Trying to get refunds.

A list of licensed cards can be found at floir.com/Com panySearch/.

At present, 47 entities are authorized to sell discount plans in Florida, although, like Coverdell, some do so under several different labels. One card with a single label is CareNet, administered by Community Health of South Florida. For $25 a month for an individual and $55 for a family of four, it offers primary care at more than 20 community health centers in Miami-Dade.

A brief doctor visit costs $25. Some basic lab work can be done for $5. Discounts on prescriptions are possible. Hospitalization is not covered.

"We really focus on prevention, helping control things like hypertension and diabetes, to keep them out of the emergency room in almost a diabetic coma that could cost $4,000, " says Rachel Bennett, who administers CareNet.

Another card is offered by a division of UnitedHealth Group, OptumHealth Allies. It has about 15 million members nationwide, says Chief Executive Marcee Chmait. Many of them have full health insurance through UnitedHealthcare and use the discount card to access items not covered by their insurance, such as acupuncture or chiropractic services.

For individual consumers in Florida, OptumHealth offers several discount plans that include pharmacy, vision, behavioral health and medical. The most complete card goes for $29.95.

In the past several years, some discount cards have evolved into offering cheap, limited insurance. One is ProMedical Plan, operating out of Weston, with about 25,000 members. For $52 for a person and $130 for a family of four, ProMedical offers what is technically known as a "prepaid health clinic" along with a discount card.

By law, a prepaid plan does not pay for hospitalization. ProMedical emphasizes it offers primary-care doctor visits for $10 and cheap basic lab tests at a variety of locations in Miami-Dade and Broward, plus a discount card for such things as specialists, pharmacy and vision.

Volosin said the plan works because doctors agree to deliver care to members for a set figure each month. "We know up to the penny what our costs are."

State records show that ProMedical has had one customer complaint filed against it in three years.

Weintraub, the benefits manager for Broward schools, said ProMedical applied for a contract to be a provider for part-time employees and substitute teachers. The district decided not to award a contract because it feared confusion between ProMedical and full health insurance. But the plan is being offered directly to those who want it on an employee Web page. He says he hasn't heard any complaints.

Another prepaid plan is Florida Health Solution, based in western Miami-Dade. It covers about 20,000, plus another 10,000 who have the discount card only. For $40 per person, those in the prepaid can get basic, limited care from a network of 1,000 providers. State records show the plan has had 18 complaints filed against it in six years with nine of them coming this year.

'LIMITED BENEFIT'

Though Gov. Charlie Crist has spoken often about his creation of Cover Florida, a discount heath insurance program scheduled to start next year, the laws already allow some "limited benefit" insurance.

Blue Cross Blue Shield of Florida offers some of these plans. In one, a 40-year-old nonsmoking female might pay $175 a month for a plan that has a $1,000 deductible, $25 co-pay for primary care (limit of six visits for sickness a year), paying 30 percent of the charges for some things, a $750 co-pay for hospital stays, plus an annual maximum benefit of $10,000.

Aetna, meanwhile, is marketing limited-benefit coverage in Florida primarily to employers with many part-time or seasonal workers. "Things like tourism and entertainment, " says Mark LaBorde, president of Aetna's Florida markets.

The policies generally are limited to $10,000 annually. Sometimes employers pay a portion, sometimes not, says LaBorde. Aetna has 16,700 persons enrolled on limited benefit plans in Florida.

"I've always been afraid of these kinds of things, " says Sandra Foertsch, an independent agent who runs South Florida Health Insurance Services. "I had somebody on prepaid and they needed to be hospitalized, and that wasn't covered. People think they are going to get a deal, but that's not necessarily so.

"This might be suitable for a young, healthy person, but I'd rather sell a higher-deductible, something that's affordable, " which would protect people if they because seriously ill, she says.

DISCOUNT CARD BASICS

1. They are not insurance. You pay the cost of your healthcare, generally at the time you receive treatment. 2. They can cost $20 to $70 a month. For that, you get a network of doctors, pharmacies, labs and perhaps vision and dental providers that agree to mark down prices from the huge gross charges, which only the uninsured pay. 3. They rarely, if ever, cover hospitalization. 4. They should be used only by those who can't get health insurance or who need types of care, such as acupuncture, not covered by their insurance. 5. Cards that are licensed in Florida are listed at floir.com/CompanySearch. Select discount medical plan organization as company type and discount medical plan as authorized line of business. Check out the cards' websites or brochures to see if your providers are covered, then call the provider to make sure he or she takes the card. 6. If you're uninsured, it might be worth trying a card for a month or so to see how it works. The cards don't cost much and might save you a bunch of money -- or maybe not. Many offer money-back guarantees. -- JOHN DORSCHNER

LOW-INCOME DRUG DISCOUNT PROGRAMS

If you don't have insurance that pays for prescription drugs, a bunch of alternatives offer savings which might range from a little to quite substantial. None will make users think the new administration in Washington should forget about healthcare reform, but they could help in a pinch. * Florida Discount Drug Card. Available to anyone 60 or older or persons without insurance who earn less than $2,553 a month for an individual, $3,423 for a family of two or $5,163 for a family of four. There is a one-time application fee of $1.50. The program says it offers savings of 5 percent to 42 percent on major drugs. Thirty 20 mg tablets of Lipitor, the cholesterol drug, cost $104.38 with the card, compared with $120 at Drugstore.com. Plavix, the heart medication, costs $146.65 for 30 75mg tablets, compared with $151.94 at Drugstore.com. More information at floridadiscountdrugcard.com or 1-866-341-8894. * Together RX Access card. Created by major pharmaceutical companies, the program is open to people without health insurance who earn less than $30,000 for a single person or $60,000 for a family of four. There's no charge for the card, which boasts savings of 25 to 40 percent. Prices depend on location and the pharmacy chosen. The website doesn't reveal detailed price information. More information at Togetherrxaccess.com or 1-800-444-4106. * Partnership for Prescription Assistance. Another effort of Big Pharma. It lists 475 patient assistance programs, mostly from drug companies and nonprofit programs, aimed at those with no insurance. Many drugs are offered at discounts or free, depending on need. Many programs are open to individuals earning less than $19,000 a year or families of three with less than $32,000 annual income. Abbott, for example, says it gave away $179 million in drugs in 2007 to 113,000 patients. More information at pparx.org or 1-888-477-2669. -- JOHN DORSCHNER

  Comments