As health insurance premiums have continued to climb there has been a marked transition to utilization of High Deductible Health Plans (HDHP). According to the insurance industry trade group, America’s Health Insurance Plans (AHIP), HDHP adoption has increased 74 percent from 2010 to 2014 with no sign of slowing down and has become one of the only ways employers have been able to control increased insurance premiums on their employees’ behalf.
This trend toward more consumer risk places the responsibility for the initial dollars associated with deductible expense, which can range from $1,500 to over $10,000, in the hands of the individual health plan enrollee. Unfortunately, this responsibility is counterbalanced by a lack of representation and support of the individuals enrolled in the plan and nothing is done to ensure their financial healthcare well-being. In the March 3, 2013 issue of TIME Magazine, 62 percent of bankruptcies are related to illness or medical bills and 69 percent of medically related bankruptcies were insured at the time of filing.
So, the trend is to move towards HDHPs while not equipping the individuals enrolling in the plan to understand or manage the associated costs and responsibilities. Throw them in the deep end without teaching them how to swim. Sounds like a recipe for drowning.
There are three parties involved in the provision of healthcare: Payer, Provider, and Patient. The financial interests of Providers and Payers are well represented by consulting and auditing firms that ensure maximized reimbursement and accurate billing, respectively. This leaves the Patient as poorly protected and defended. Recently, an industry has begun to grow around backend negotiation and reduction of accumulated medical debt on behalf of the Patient, but it is reactive and does nothing to prevent the inherent stress of managing overwhelming medical bills with other existing debt.
Employers initially adopted HDHPs to save money associated with premium expense, but there is an unseen cost involved, too. Employees who are now responsible for their medical bills are spending their time at work calling doctors, hospitals, and insurance companies to get answers and explanations when they should be working. Because of the hold and wait times the fifteen and thirty minute breaks are not sufficient to resolve their issues and questions. Employees are stressed and unfocused because they are worried about their medical bills. It would be interesting to learn what the dollar value of lost productivity equals. Is all of the money saved in managing premium lost to employees worrying over their newly acquired risk?
HDHPs are not going away, so what is the better approach? The consumer needs to be able to drive and control the process. Because they are dealing with “medical professionals”, people tend to take what is said to them without questioning any of the information. It would be incredibly helpful if providers would reinforce to their patients the need to ask questions and make sure they understand what they are being told and that the answer is in English and not Medicalese. The medical establishment is not infallible, in fact it is estimated there are errors on as many as 80 percent of all medical claims.
Here are some specific recommendations providers can make to consumers to help them inform and protect themselves:
- Take a note pad or utilize the recording function of your smartphone to capture the services the provider has performed, especially for care beyond a standard well-check visit. You will not remember what took place especially if you are under any level of stress.
- When the first bill comes, even before the insurance company has applied the negotiated rate they have with the provider, check the list of services billed against what you documented were provided. If there is language you do not understand or the information is conveyed in coded alphanumeric language call the provider’s office and ask for an explanation. If there are things that do not appear correct to you challenge them.
- The next documentation that you should receive is an Explanation of Benefits or EOB. This is a detail of what the insurance company has determined is allowable, the negotiated contractual payment amount, and the portion for which you are responsible. This is still not a final bill.
- The provider will then send you a revised bill that should reflect the same information you received on the EOB. It will say this is the final amount and that you are now responsible for paying the identified amount. That may or may not be true.
- First, everything in life is negotiable and medical bills are no exception. The larger the bill, the more room for negotiation. Do not be afraid to ask what can be done to reduce the bill when speaking with the provider’s office. If possible, cash payment almost always will further reduce the cost. One additional approach to ease the immediate impact of medical debt is to request a payment plan. This provides an expected timeframe and steady, projectable revenue for the provider and eases the burden for the consumer to have to come up with all of the money at once.
Should you be aware anyone being overwhelmed by the prospect of understanding and managing all of the components of dealing with medical bills and correspondence, please consider recommending the services of Personal Healthcare Advocates. We are here to help navigate the forest of healthcare finance.
-Lee Hyman is with Personal Health Care Advocates in Louisville, Kentucky.
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