Patients Pay Before Seeing Doctor as Deductibles Spread

[xchrom]

http://www.bloomberg.com/news/2013-10-14/patients-pay-before-seeing-doctor-as-deductibles-spread.html


Medical assistant Daniel Coca-Espinoza prepares a vaccine at a Community Clinic Inc. health center in Takoma Park, Maryland, U.S., on Tuesday, Oct. 1, 2013.

When Barbara Retkowski went to a Cape Coral, Florida, health clinic in August to treat a blood condition, she figured the center would bill her insurance company. Instead, it demanded payment upfront.

Earlier in the year, another clinic insisted she pay her entire remaining insurance deductible for the year -- more than $1,000 -- before the doctor would even see her.

“I was surprised and frustrated,” Retkowski, a 59-year-old retiree, said in an interview. “I had to pull money out of my savings.”

The practice of upfront payment for non-emergency care has been spreading in the U.S. as deductibles rise. Now, the advent of the Patient Protection and Affordable Care Act is likely to accelerate that trend.

[pipoman]

1. Not legal in emergency rooms,

time for an amendment to include all healthcare.

[Yo_Mama]

7. It is entirely legal in ERs

unless the situation is life-threatening or threatens loss of an eye or a limb or something like that.

[cbayer]

15. This is incorrect.

EMTALA prevents any discussion of finances or requests for payment until the presenting patient has been medically assessed and stabilized.

That's true whether they are presenting with a heart attack or the sniffles.

[SomethingFishy]

17. You are correct..

And in my experience we didn't get treated any worse because we didn't have insurance. Matter of fact we had to sign a release to get out of the hospital, because they wanted to keep my wife for "observation" but we didn't want to spend 10 grand for a night in the hospital..

[cbayer]

18. Emergency departments tend to understand this law very well.

They run huge risks if they violate it and, in general, all patients are treated the same regardless of ability to pay.

That doesn't mean they aren't going to bill you or attempt to collect later. It does mean that they have to evaluate you and stabilize your condition.

I hope everything worked out for you and your wife.

[enlightenment]

20. Years ago, my brother

had to go to the ER after he swallowed a removable dental partial. The wire that wrapped around the tooth got lodged in his throat. It was about 9:30 at night. He wasn't choking, so they made him wait about an hour. Then it took about 15 minutes to assess the situation, spray a topical anesthetic in his throat, and remove the offending device with a long forceps.

Then they made him sit for awhile, to "make sure he was okay" and could swallow and breathe without difficulty. They released him at 12:06 am.

And billed him for a 24-hour stay in the hospital. Took a lawyer to straighten that one out.

[Trillo]

2. This is a good thing

From the patients point of view it has been impossible to get prices from doctors and healthcare corporations before services are rendered. It was always, "We don't know how many services you will need, so we can't estimate the cost." Once, a doctors office didn't even believe I was shopping around for prices, and accused me of running a scam of some kind. The receptionist was very nasty.

[progressoid]

3. It's the opposite here.

Maybe it's a regional thing. The hospitals and even dentists here are upfront about the cost.

I'm scheduled for a couple procedures. They told me one was covered by my ins and the other would require $190.00 upfront Any unforeseen circumstances would be billed later. The same with my pulling my daughter's wisdom teeth. But in that case, they gave me the total - I had to pay half up front and the rest I'm still paying off.

[Nuclear Unicorn]

13. I'm all for up-front pricing but

the article says a clinic wanted the $1,000 deductible before they even assessed her.

[SoCalDem]

4. Kaiser:.. when my husband filled his first prescription with them, they charged $110.00

$10 co-pay and the $100 deductible..

When I needed my $15 eye drops, I called my OLD (non-Kaiser) ophthalmologist & had him call one in at Walgreens for me.. I used my "discount" card I have with them & paid $11.00.. NO WAY would I pay $115.00 for a bottle of eye drops (it's the ONLY rx I use)

[Autumn]

5. Well this certainly is interesting.

How is that affordable care to those who don't have the cash to pay their deductible laying around?

[Yo_Mama]

6. For the lower income families or persons, ACA limits cost-sharing

Those who get significant cost-sharing help will have their responsibility limited to 6% and 13%. Those people will get access to most health care services as needed. However the third tier of cost-sharing help still leaves the patients on the hook for 27% of costs, and cost-sharing help ends at 250% of FPL, leaving patients on the hook for their entire deductible and generally a 30% copay after that until the OOP maximum is reached.

The reality is that many people won't be able to get anything but emergency care, because the deductibles and copayments for ACA plans are quite high. ACA doesn't provide access to treatment unless you are low income. It does provide wellness exams, but if they find anything wrong treatment is not covered until you have met your deductible and can come up with the copayment. So you can get a free colonoscopy or mammogram or wellness exam, but if your doctor decides you need treatment for a tumor or a nuclear stress test, many will have to come up with thousands of dollars to get that.

For many, ACA plans will be the "shitty insurance" everyone thought they were getting away from.

[enlightenment]

8. Yo_Mama, that's interesting info on the cost-sharing.

Could you please link to the source so I can read more? I remember reading something about cost-sharing in the body of the law, but can't remember the details.

Thanks.

(and I agree with you, by the way)

[Yo_Mama]

16. The best article is probably Kaiser

http://www.kaiserhealthnews.org/features/insuring-your-health/2013/070913-michelle-andrews-on-cost-sharing-subsidies.aspx

A family of four whose income is between 100 and 150 percent of the federal poverty level ($23,550 to $35,325) will be responsible for paying 6 percent of covered expenses out-of-pocket compared with the 30 percent that a family not getting subsidized coverage would owe in a silver plan. A family with an income between 150 and 200 percent of the poverty level ($35,325 to $47,100) will be responsible for 13 percent of expenses, and one with an income between 200 and 250 percent of the poverty level will be responsible for 27 percent ($47,100 to $58,875).

In addition, people who earn 250 percent of the federal poverty level or less will also have their maximum out-of-pocket spending capped at lower levels than will be the case for others who buy plans on the exchange. In 2014, the out-of-pocket limits for most plans will be $6,350 for an individual and $12,700 for a family. But people who qualify for cost-sharing subsidies will see their maximum out-of-pocket spending capped at $2,250 or $4,500 for single or family coverage, respectively, if their incomes are less than 200 percent of the poverty level, and $5,200 or $10,400 if their incomes are between 200 and 250 percent of poverty.

This helps lower-income families a great deal, but leaves middle income families with the need for cash up front.

Note that cost-sharing reductions are for silver plans.

[enlightenment]

19. Interesting.

Really interesting.

This is creating a real "donut hole" of affordability, isn't it.

Thanks for the link and input.

[Yo_Mama]

22. Well, the good part is that if you get ill and your income falls off

you will still get insurance and have reduced copays. That takes care of one of the problems in the system currently, in which ill people can't afford to keep paying their insurance premiums because they're out of work!

But there really is going to be a problem for many who literally have insurance but can't come up with the cash for payment. For those people, it is going to be hard to gain access to all but emergency care.

I think the doughnut hole is the best description. Higher income people will almost all be forced into the catastrophic plans, but they will have some reasonable chance of coming up with the cash to get treated. Plus, it is relatively easier to save for a high income person.

A family of 3 wouldn't have any cost-sharing reduction with income of 50K, and having to come up with $3,000 or $4,000 for medical care would be difficult for many and impossible for quite a few. If it's a kid with a medical problem they will treat the kid and chase the parents later, but if it is a parent with a medical problem, unless they can borrow or have a local charity who can kick in they are up the creek without a paddle.

[enlightenment]

24. Yes.

I've said from the outset that the devil's in the details on this, and the higher deductibles and co-pays that the companies are demanding for the lower metal tier plans are designed to offset their perceived financial losses. But, as many have pointed out in this thread, the cost of meeting deductibles and co-pays has always been a problem for people on the margins - and that will not change much, I think.

[Autumn]

9. Obama was correct then when he called it insurance finance reform.

That is not health care. and it certainly isn't affordable.

[KG]

21. it wasn't meant to be affordable for the poor.

nobody really thought there would be law helping out the really poor in this country, did they?

[Autumn]

23. Well there was hope.

I dropped my insurance a few years ago, I go to the Dr. now probably every three months and I pay cash for my visits and prescriptions and it costs me a hell of a lot less than my insurance premium was costing me.

[nobodyspecial]

10. This is nothing new

I've had to pay my expected deductible upfront for several years. The only office that has offered payment plans is the dentist and will only do it if you have a clean credit history.

[ScreamingMeemie]

11. The reason I can't go to a doctor/ER is because they always demand payment up front.

this is not a change.

[xchrom]

12. kick

[L0oniX]

14. Same ol pay your premiums and get denied coverage until you go bankrupt from deductables.

Really ..you expected something better from the back room Max Bacus dealings?