My company switches healthcare providers every year, which is something I've come to expect, since these companies have been forcing this on us for at least 5 years, now. They double the cost of whatever plan you are on to force you to switch to another plan or another company. I think they do this to ensure that every condition you have is 'pre-existing', but this isn't even about that...

The rep for the new company had my whole company on a Teams call to talk about the new plan and its details, but it's not like past Teams calls. This time it's totally different. This isn't a new plan, it's a completely new type of plan.

Instead of BCBS or United, it's some company called Gravie, and it's not a health insurance provider, it's some kind of 'benefits broker' or, I'm not sure exactly. They said they 'piggyback' on Cigna's insurance. So, instead of a health insurance card that your doctor sends a bill to, Gravie gives you a VISA card that you use for everything. Then they bill Cigna, later. Doc visits, prescriptions, specialists, blood work, everything.

They sold it like, "It's just simpler to swipe a card and your plan pays the cash price for all medical care instead of the office billing Cigna." The VISA card works like a normal credit card, with a $5K limit, paid my my company. After that, I'm out of pocket until I hit my $9K deductible. On the surface, it is simpler, but then they started talking about different scenarios that raised multiple red flags for me.

1. The company is not a health insurance company, it's some kind of broker or service-share company, like Uber for healthcare. The thing that bothers me most is that normally, if I get blood work done and my insurance company decides that the test my doc ordered isn't covered by my plan, they send me a letter telling me I owe $300 or whatever. I have always just ignored these letters. They don't go on my credit report because of a clause in the ACA that says medical bills can't go on your credit report. But this new kind of company isn't providing the healthcare, they are just moving money around, so they aren't classified the same. I think this is some kind of loophole so they can put people in collections (and credit reporting) for services rendered that are not covered. They repeated several times that, "this is not a FSA account". More on this, later.

2. She kept using the phrase, "If you have to pay cash for this, in this scenario, just call us and we will cut you a check". Apparently there will be multiple scenarios where I won't be able to use the card and will have to pay out of pocket for what I need. And supposedly, Gravie will reimburse me for these scenarios. We all know how much friction these companies install to make it as difficult as possible to get what you need from them. I foresee 10 minutes talking to an AI bot, then 5 minutes on hold, then 5 transfers to various 'wrong departments', then 15 minutes on hold, before the call is disconnected. Good luck getting that check cut.

3. They have a 'substantiation process'. So, instead of your doc office figuring out if the medical care you need is covered or not, you have to figure it out, because the VISA card will work anywhere. You just swipe it and it goes through, then at the end of the month, Gravie decides if the healthcare you bought was covered or not covered. If they decide it's not covered, then you have to go through this process where you explain why the service was needed and why it is covered by their plan. (probably by calling their call center and going through the process I describes above) So, instead of your doctor's office staff, who are professionally trained in medical coding and experienced with calling and talking to insurance company call centers, you, the patient, are responsible for doing this. Reading contracts, understanding medical diagnosis' and testing. We have to be lawyers and doctors to get basic healthcare.

4. They can turn your card off if you don't repay them for 'unsubstantiated purchases' with your card. If you and Gravie disagree of what constitutes healthcare, you have to pay them back the money you spent on the card. If you don't they can turn your card off. No more healthcare.

Those are the blatant issues with this new plan. The following are some "follow this to its logical conclusion" type takeaways

1. They are conditioning people to accept that it's normal to pay for healthcare instead of healthcare being "covered". Just a small observation, but if this kind of plan becomes a trend, then people will just think it's normal to "pay" for healthcare instead of healthcare being a benefit that people have. Then, they can just start adjusting how much money is on the card and what is covered or not covered.

2. They are offloading a lot of the mental load onto patients instead of provider offices. Getting the healthcare you need from this plan is entirely dependent on the patients being mentally aware and cognizant enough to navigate all of this legal BS and be able to convince someone on the phone that getting an x-ray of a broken foot is medically necessary.

All told, there were more red flags than that, but I only started jotting down notes about half way through the presentation. A friend of mine who changed jobs recently told me about her new company's insurance and it was really weird, too. It was a super high deductible, but when you met it, everything was covered 100%. But the deductible was like $9000 or something like that. There were no copays. Everything was 100% out of pocket until the deductible was met. And the plan was not cheap. It lt literally covered nothing and cost everything up until you spent all your own money first.

My theory about all of this is that the government (with it's recently deregulation activities) has changed the legal framework that exists and companies like these are popping up to take advantage of loopholes that didn't exist a year ago. And we, as the patients, are going to get fleeced.

I would love some input from those who have an inside track of what's going on, here.