Confusing terms may keep people from getting full benefit of coverage

PORTLAND – Whatever the next election delivers on promises of health care reform, consumers face a steep learning curve to understand common concepts that describe their coverage.

“Almost nine out of ten people in this country have some kind of health insurance coverage. But our focus groups show they don’t understand the language and that makes them afraid to use it,” said Robert Harris, who oversees Regence’s market research. “It will be difficult for many health system reform ideas to get traction when people literally don’t know what we are talking about.”

Regence research measures – for the first time – true levels of consumer understanding of health insurance concepts. Previous surveys gauged self-reported understanding, but Regence asked 961 people with insurance to define terms and calculate their bill.
• Sixty percent answered correctly just half the time
• Four in 100 achieved an 80 percent score
• Fear and embarrassment keep people from asking what words mean, according to research following the survey

“One thing we learned is that glossaries don’t cut it,” said Harris. “Our industry must simplify our language to help people get full value from their health plan.”

Regence offers member education and assistance features such as:
• mouse-over industry-specific terms to get instant definitions
• myRegence: Live Help instant chat to advise and navigate; email questions
• Customer Service training: Emphasizes advocacy and problem-solving
• Case management nurses: Help people understand their coverage

Other findings:
• People rate their health plan as the most trustworthy source of information on their insurance coverage
• 9 in 10 insured people feel adequately protected by their health plan

Out-of Network
Typical office visit
You pay a $30 co-pay
(Deductible Waived)
You pay 50% of the office visit charge
Co-insurance for professional services (i.e. surgery, diagnostic radiology and lab, and maternity care).
After meeting the deductible, you pay 10% of the charges
After meeting the deductible, you pay 10% of the charges
Maximum out of pocket
(Includes what you pay for in deductible and coinsurance but excludes co-pays)
(This includes what you pay for in deductible and coinsurance)
Lifetime maximum
About Regence
Regence is the largest health insurer in the Northwest / Intermountain Region, offering health, life and dental insurance. Regence serves three million members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueShield (selected counties in Washington) and Regence BlueCross BlueShield of Utah. Each health plan is a not-for-profit independent licensee of the Blue Cross and Blue Shield Association. Regence is committed to improving the health of our members and our communities, and to transforming our health care system. For more information, please visit

Sample questions
Define Co-insurance1
? A fixed dollar amount paid by the insured person for a medical visit.
? The dollar amount for each medical visit that is shared by the insurance company and the insured person.
? The percentage of medical expenses the insured person must pay after the deductible is paid.
? The provision which applies when a covered person is covered by two insurance plans at the same time so that the payments of both plans do not exceed 100% of the covered charges.
? Don't know

Calculate medical bill2
Last year Bryce injured his back while doing some landscaping at home. His doctor told him that he had a herniated disc and started treating it. However, Bryce still suffers pain in his back today. Now his doctor recommends that he has back surgery.

Bryce will be going to a in-network surgeon who charges $4,000 for back surgery. Bryce has met his deductible at his last doctor's visit. Using the explanation of coverage below, how much will Bryce pay for the back surgery?
? $100 ? $400 ? $500 ? $1,000 ? Don't know


1Third choice is correct

2Second choice is correct