With so many people on high-deductible health plans, insurers — not patients — should be responsible for reimbursing health care providers for services and for seeking collection of the patient-owed portions directly from their insureds, the author writes. (Fotolia / TNS)
I’m a practicing emergency physician at Hartford Hospital, as well as a past president of the Connecticut College of Emergency Physicians. Like the majority of people today, my family and I have a high-deductible health plan.
Patients with high-deductible health plans are frequently stuck in the middle of billing issues that arise around insurance coverage. It’s time for change. It’s time to streamline the process to ensure patients have a single point of contact for emergency billing and payment. This means insurers — not patients — are responsible for reimbursing healthcare providers for services and for seeking collection of the patient-owed portions directly from their insureds.
Planned amendments to Senate Bill 902 will do just this.
High-deductible health plans are commonplace in 2019. This means more than half of the people covered by workplace insurance plans, and nine out of 10 who get their health insurance on the state exchange, are on the hook for paying up to $10,000 in up-front health insurance costs before any insurance payments will be made by their insurer.
The point of insurance is that bills are paid and care is covered, especially in the case of emergency or urgent medical need. Many people are comforted by the fact they have health insurance coverage. Their insurance card grants them access and affordability, protecting them from the financial burden of a health crisis. Or so they think.
What I’ve seen in my line of work is to the contrary. Most people with a high-deductible plan do not understand the financial ramifications of seeking care or the out-of-pocket expenses they must shoulder for a medical emergency. In the end, high-deductible health insurance plans frequently leave patients struggling to pay their medical bills, forcing them to make health care decisions based on money instead of need.
When an insurance policy requires the patient to pay all or a large portion of his or her healthcare — as is the case with high-deductible plans — and when the insurance company dictates the patient pay the healthcare provider directly, the insurance company shifts the financial risk to the patient and health care provider. More specifically, the insurance company and provider agree upon a negotiated rate for services, but the insurance company then transfers that negotiated price and payment responsibility to the patient. This risks placing a great financial strain between the doctor and patient.
There is a better solution.
Insurance companies should honor their contracts with physicians and hospitals by directly paying their negotiated rates. This also gives patients a single point of contact for billing (the insurance company) and eliminates the labyrinth of bills, statements, and explanations of benefits patients are currently left trying to understand and reconcile.
When the insurer collects the patient’s portion of payments, rather than the physician or hospital, it protects the doctor-patient relationship by eliminating the financial strain of unpaid or overdue bills.
The way things are now, many patients are going to the emergency department and stating they cannot or will not return to their primary care or specialty physicians due to unpaid bills. In a recent survey, more than 50 percent of patients with high-deductible health plans said they had delayed or avoided needed or recommended medical care due to costs or unpaid bills.
Patients are avoiding appropriate healthcare services. This ultimately makes the cost of healthcare more expensive and puts an undue burden on emergency departments that become the health care provider of last resort for many patients.
Daniel Freess lives in West Hartford.