How to use the Surest plan while you're at your doctor visit

Knowing your doctor visit costs — in real time.

Whether you’re a new patient or an established patient, it’s not unlikely to experience a scenario like this: You schedule an appointment with a primary care doctor or specialist, show your insurance card when you check in, pay a copayment (copay, or flat charge for services) on the spot for your visit, then — surprise! —get a medical bill in the mail weeks later. You probably won’t know what’s included in that visit. What’s the average cost of an allergy test (or a scope to check a sore throat, or a lab test, or an X-ray)? What are the potential out-of-pocket costs?

And what if you schedule a preventive visit with an in-network doctor, but then want to discuss a specific health concern or condition? With the Surest plan, you can pull up the app while you’re with your doctor and see what’s included in a single visit. (And see that questions about a specific health concern, condition, or injury — and any X-rays, lab work, or additional tests related to those concerns — are considered an office visit and not a preventive visit, which may include a separate charge.)

Understanding copays and deductibles.

Copays are standard when you have health insurance through your employer. When you see a doctor (or any care provider), there’s a copay range for health services. For example, you might pay a $20 copay every time you see your primary care doctor for an annual physical exam. With the Surest plan, you can look up these copays in advance. See what you’ll owe if you choose a virtual visit vs. an in-office visit, or what you’ll pay for urgent care vs. a trip to the hospital emergency room.

But copays are just one part of what you pay out of pocket for health care — not the whole story. If your health insurance plan has a deductible and coinsurance, you’ll also pay a fee before insurance takes over and picks up the coverage on your behalf.

A deductible is what it sounds like: the amount deducted before your insurance company pays.

Deductibles were introduced more than 20 years ago as a way for employers to contain the rising costs of health care. The rationale is that if people are on the hook to cover more of their medical bills up front, they’ll avoid unnecessary spending. (Some have used the analogy of going out to dinner. Many people will choose carefully when spending their own money vs. how they might order when using an expense account.) Deductibles may be effective in helping some employers control costs, but the tradeoff isn’t all that favorable: Employees often wind up shouldering the cost burden. And deductibles keep going up.

According to Kaiser Family Foundation, “Deductibles are rising almost six times faster than wages. Deductibles are growing steadily, and in some cases steeply, while wage growth has been sluggish.”

According to a 2021 study in the Journal of the American Medical Association (JAMA), chipping away at a deductible can deter people from going to the doctor. The study reported, “Participants with high-deductible plans were significantly more likely to forgo health care than those with low-deductible plans.” For some, the barrier of a deductible can feel a lot like being uninsured. And high deductibles can come with another consequence: narrower provider networks. A narrow network means there's a smaller pool of physicians, specialists, and hospitals to choose from. And in certain situations, having fewer opportunities can leave people in a bind — at a time when they want to have choices. (Going out of network can also cost a considerable amount more than staying in network.)

A different design can bring opportunities to save.

With the Surest plan, members access the broad, national UnitedHealthcare provider network, and there is no deductible. “Surest provides members with first-dollar coverage and transparent copays so they can plan financially and make informed decisions,” explains Matt Chock of Surest. “Deductibles get in the way of these goals.” For those who don’t use a lot of health care in a plan year, chipping away at a deductible doesn’t feel like much of a benefit, and those who receive a lot of expensive care “will go through the deductible so quick it doesn’t have any effect on their selection of treatments or providers,” Chock says. Most people don’t have the information to tell the difference between high- and low-value care. Not so with the Surest plan.

“We try to make it easy to identify high-value providers,” Chock explains. Different factors go into how a copay is set, including the price of the service, as well as “the probabilities of decisions leading to other treatments.” Expensive services more likely to address the issue at hand without leading to future costs may be priced lower; whereas a treatment that could lead a member down an inefficient, ineffective path (and future treatments) could be priced higher. It comes down to having choices. Within those choices are a multitude of online options.

The advantages of virtual care.

The COVID-19 pandemic helped more people become comfortable “seeing” their doctor through a smartphone or tablet, particularly when in-person visits were suspended.

But even before COVID became a household name, Surest recognized the advantages of virtual appointments and telehealth options — an expansive virtual health network is integrated into the plan’s design.

Without a facility fee, an online visit is often less costly. The other benefits of telehealth, according to the Department of Health and Human Services at telehealth.hhs.gov, include “increased access to specialists to manage and treat chronic conditions; access to health and wellness programs for smoking cessation, nutrition, and weight loss; increased access to mental health care, and fewer hospitalizations and visits to the emergency room.”

That’s good news for the one in 10 rural adults who don’t live near a hospital or clinic, according to a study by AARP.

Again, options. Need to talk to someone? Online therapy is available through Doctor On Demand. Need a prescription for a common condition without leaving the house? Not a problem. Have a question for a board-certified doctor? Schedule a virtual visit. And when you want to see a doctor in person, you have the resources you need to make informed decisions.

How to become an empowered advocate.

Let’s say you slip and fall and hurt your ankle. You feel like an in-person visit would be most beneficial. A doctor takes a look and recommends an MRI. This is where you can pull out your phone, open the Surest app, type in “MRI,” then search, compare, and decide. You have price visibility. And because the prices of procedures and treatments can vary by location with the Surest plan, the app can help you see where you have the potential to save money if you switch.

You’re in control. But you’re not just in control, you’re in control in the moment.