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.
Many years ago, we started a Health Savings Account (HSA). Now that my wife and I are older, and have kids with their share of athletic injuries, we’ve been using the money we saved in the HSA to cover the high deductibles that the author refers to. Our household income is above average, but receiving the sorts of bills the author refers to would still be fiscally painful to pay out. Thankfully the HSA covers them.
I can imagine the financial hardships people who are below average in income must endure when faced with these sorts of bills. Is it any wonder why these “medicare for all” plans are rising in popularity? The alternative would seem to be to get lower deductibles without increased premiums, a dip into profits that I’m sure the health insurance companies will fight.
The author’s recommendation is apparently that insurance companies pay deductibles and then obtain reimbursement from the patient. That’s changing the definition of a deductible.
Given that the result of this change would be higher costs to the insurance companies, premiums can be expected to increase, especially because deductibles would shrink. Co-pays would likely also increase.
People who don’t require treatment would be paying significantly more, and that would be unpopular. So the current situation is unlikely to change.
Medical treatment is expensive. Insurance companies have an incentive to hold down costs. Governments hold down their costs by law, and insurance companies help defray the resulting losses to medical service providers. A system in which the success of lobbyists determines payments to providers would likely be much more expensive.
So at least the current system saves money.
The author is underestimating the intelligence of people who buy health insurance.
Also, the main point made by the author is a tiny slice of the overall problem.
In addition, the ACA forced out high deductible insurance plans in favor of coverage-for-everything plans which are so unaffordable, people now must chose between health insurance or things like housing or college education. I haven’t bought health insurance in over five years now due the costs and the low coverage. Before the ACA I had a high deductible plan for many years that I loved. The deductible was $20K and then coverage kicked in at an 80/20 split — insurance covered 80% and the insured covered 20%. The ACA outlawed such plans and now the coverage costs more and covers less. For example, last year when I reviewed the plans available to me, the plan with the lowest monthly fee was 31% of my gross income (I’m self employed and make just enough money to not qualify for a subsidy but not enough to afford health insurance) and the insured would pay out of pocket just under $23K before insurance covered costs at a 20/80 split — insurance covered 20% and insured covers 80%. That’s a legalized ponzi scheme if you ask me.
At the end of the day, let’s all remember that insurance is NOT healthcare. Until there is a non-profit system in place that focuses on healthcare, this problem will not be solved.
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