Our Moth-Eaten Health Insurance Security Blanket

January 31, 2016 8:49 pm Published by Leave your thoughts
Health insurance claim form with money and stethoscope for insurance concept

CDC: 13% of people with private health coverage having problems paying medical bills. Source: Centers for Disease Control and Prevention, December 2015

The security blanket of health insurance has holes.  Insured people should not have problems paying bills, but clearly they do.  And just as clearly insured families remain at risk for the ravages of medical costs.

How can that be?  Insurance is supposed to provide protection from such risks of life. But, a not so funny thing has happened to health insurance.  Often under the guise of making insurance premiums more affordable, coverage has gotten skimpier. If not skimpier, more traps have been laid to shift the cost from the insurance company to the patient.

By slipping some “devil in the details” before your insurance carrier will pay the claim, patient financial accountability is growing.

Deductibles, which are no more than a ransom to be paid before health insurance benefits kick in, are growing in size. . Most polices offered in the workplace now carry material deductibles, deductibles of $1000 and up are common.  This means that carriers shoulder less of the burden and move that instead to the patient.

Often employers will set in place deductibles that mirror health plans being sold on the Health Exchanged created by Health Reform where the majority of enrollees have chosen the Bronze Plan. This plan features deductibles and coinsurance starting ate $3000 and capped annually at over $6000.

Injustices, continued

Another industry gambit has been the creation of “Narrow Networks” comprised of physicians and hospitals chosen solely by the carrier. This not only eliminates access to a large pool of physicians and hospitals, and will result in a patient unnecessarily being exposed to claims from out-of-network providers.

The problem there? These providers have no limit on what they can charge, such charges not eligible for reimbursement from the patient’s health plan. Guess who shoulders that cost?

Patients can be faced with not only having to travel further to obtain care, but the care recommended to them by their physicians may only be found out-of-network.

A vicious trap, compliments of your insurance companies. Wait, there’s more!

Health plans have added referral/authorization requirements that must be obtained before care can be eligible for coverage and the rules are fuzzy as to who is supposed to be the responsible party to secure that referral.  Discovering these limits may not be known until after services have been provided. Further, the insurance company is free to contract with some nameless third party to administer authorizations and referrals. In essence, a clear attempt to absolve themselves of the responsibility when the patient runs into a problem.

So while health insurance premiums have become more affordable (?) or more stable (?), the cost of accessing health benefits has become more expensive.

You won’t find these details in any of those colorful industry brochures.

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This post was written by Robert Goff

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