By B. Bryan Jordan
Published 12:15 pm EDT, Friday, May 10, 2019
An anesthesiologist at work. Among those who get their insurance on a state health care exchange, 87 percent have these plans, which in Connecticut means the minimal deductible is $1,300 per individual or $2,600 per family before insurance even kicks in.
About half of all covered workers like me in the United States are now enrolled in high-deductible health plans. Among those who get their insurance on a state health care exchange, 87 percent have these plans, which in Connecticut means the minimal deductible is $1,300 per individual or $2,600 per family before insurance even kicks in. Certainly, there is a logic behind high-deductible plans: they discourage medical care by requiring the insured patient to cover more of his or her medical expenses in exchange for lower premiums.
There is an alarming downside to these plans. People go without care. Others may seek care, but struggle to cover the costs they’ve committed to pay — leaving their health care provider saddled with an unpaid debt.
These patients avoid important follow-up visits and delay potentially life-saving treatments in fear of incurring large costs owed to the medical providers that were previously paid by the health insurance companies. Their health and their relationship with their physician erodes. When insured patients are thousands of dollars in debt to their physician, they may be reluctant to seek treatment, until they are left with no other choice and turn to the emergency department at a local hospital. (By oath and by law, emergency physicians will treat any patient regardless of ability to pay.)
Studies show that even patients who need emergency care for a critical health issue will go without if they are in a high-deductible health insurance plan. This ultimately harms patients and burdens the health care system with patients seeking medical care after their condition has deteriorated.
This is why physicians across the state are advocating for insurers to serve as a single point of contact for medical billing and payments.
Take, for example, the concept of co-insurance — a variable cost related to the percentage of the cost of care associated with a physician visit. Co-insurance payments owed by the patient can only be calculated after the patient is seen or has had a procedure. They are among the “surprise bills” that become the responsibility of the patient. The fee cannot be estimated before consenting to the treatment. And to make matters worse, the health care insurance company requires physicians, hospitals and other providers to collect these fees from the patients they insure.
The solution is a simple one: Insurers should directly pay any coinsurance, copay or deductible for care to the health care providers and take the patient out of the insurance reimbursement equation. Health care insurance companies have the ability to collect payments from the patient. This ensures patients have a single point of contact for medical billing and payment.
There is currently a bill before the Connecticut Legislature that would change the system of high-deductible insurance policies that forces many patients to make health care decisions on cost rather than need. We urge state legislators and the people of Connecticut to support this bill.
I advocate for expanded patient protection that truly takes the patient out of the middle of billing issues that should be between insurance companies and health care providers. This includes:
Health care insurance companies ensure patients have a single point of contact for medical billing and payment, and will no longer receive or have to reconcile multiple, confusing bills and explanations of benefits;
Insurers should directly pay any coinsurance or copay deductible for care directly to the medical provider; and
Helping policyholders become better educated to understand the limits of their health insurance coverage and all potential out-of-pocket costs.
Next year, the portion of health care expenses that patients would be required to pay out of pocket could go as high as $14,000 per family. As Connecticut’s Health care Advocate Ted Doolittle has pointed out, “That’s a lot like having no insurance.”
It’s time for change. It’s time for insurers to take back responsibility for health insurance payments.
Dr. B. Bryan Jordan is president of the Connecticut College of Emergency Physicians