As president of the CT Retail Merchants Association, Tim Phelan recently called on Congress to address surprise medical billing, calling it one of the most pressing issues facing Connecticut citizens. The Connecticut College of Emergency Physicians agrees that this issue is urgent and requires a solution. The solution proposed currently by Tim Phelan of capping payments and forcing even more physicians out of network, would in fact, make the problem worse.
Despite the mischaracterization, virtually all physicians prefer to be in-network if possible and do not avoid contracting with insurers. Unfortunately, this whole discussion misses the larger issue and the root of the problem.
The real issue is high deductible health plans. Patients purchase these plans because of the lower premiums and up-front costs, only to be “surprised,” perhaps even shocked and outraged, by large, yet correct medical bills on the back end. Often confused for “surprise” medical bills, these bills are instead a surprise lack of coverage. It is these plans that are undermining the patient – physician relationship and creating an untenable situation for providers and patients alike.
Under these plans, patients are responsible for $5,000, $10,000 or even higher amounts of out-of-pocket costs before their insurance payments kick in. While there is nothing inherently illegal or nefarious about this situation, these plans are generally misrepresented to consumers who do not understand the financial implications of seeking care or the out-of-pocket expenses of a medical emergency.
In effect, most of the “surprise medical bills,” are in fact bills that are a “surprise” to patients due to these high deductible insurance plans. To make matters worse, these medical bills that are sent to patients must be collected by their physicians, rather than the very insurance companies that have created the plans and contracted with the patients. Unfortunately, the physicians and patients are caught in the middle as the providers are forced to become bill collectors and the patients avoid necessary treatments for chronic illnesses. In essence, high-deductible plans have shifted the financial risk from the insurance companies to the patients and their providers. When physicians and hospitals are in charge of collecting large copayments and deductibles, it creates a financial barrier between the doctor and the patient, straining the crucial doctor-patient relationship. This is the true crisis and it’s getting worse, not better.
With the current high-deductible plan structure, almost any emergency visit will leave the patient personally responsible for thousands of dollars in expense before the insurer pays any portion of the bill. Unfortunately, today, insurance doesn’t necessarily mean coverage.
In a recent patient survey, over 50% of patients with high-deductible plans stated they had delayed and/or avoided needed or recommended medical care due to cost or unpaid bills. Isn’t this the true crisis facing Connecticut patients? Similarly, many patients are now presenting to the Emergency Department stating they cannot or will not return to their physician because of their existing unpaid medical bills. Isn’t this the true crisis?
In essence, insurance companies have shifted the financial risk to doctors and patients by issuing high-deductible plans without regard for a patient’s ability to pay. The truth must be known about the risks associated with these plans and the negative impact they are having on the patient-physician relationship. Insurance companies shouldn’t be allowed to dodge their financial responsibilities any longer.
B. Bryan Jordan, D.O., is President of the Connecticut College of Emergency Physicians.