Forgotten Medical Expenses

Tuesday, September 15, 2015, PM | Leave Comment

While Washington continues to debate the Affordable Care Act, not only American consumers, but small business as well, are greatly affected with the forgotten medical expenses. Consumers who are relieved to finally have health insurance are finding, when a medical illness or emergency arises, their life savings can be wiped out in 3-6 months.

Co-pays, deductibles, coinsurance have become commonplace and rising fast.

  • Case scenario

    Joe American works for a small business of less than 25 employees and they offer no medical insurance, although pay a very good salary.

    Therefore, Joe is able to buy his own insurance through the Affordable Care Act. Viewing the three choices of Bronze, Silver and Gold, being in the 30-40 age category, chooses the Bronze plan, which is the lowest premium/monthly payment.

    This fits into his budget, he signs on the dotted line; admittedly not really reviewing the plan summary as it is confusing and hard to understand the in’s and out’s. He is a healthy man and takes no medications. Goes to the doctor or walk-in when he is sick.

    One day, he is riding his bike on a trail and as a woman cuts him off, he falls off his bike and seriously fractures his wrist. Going to the local orthopedic group, he has X-rays and is booked for surgery to repair the shattered wrist bones.

    He presents with his insurance, secretly thankful for signing on with the Affordable Care Act insurance. Proceeds two days later to an Ambulatory Surgery Center (ASC) where he has general anesthesia, and provided wonderful care by a surgical staff, and PACU (post anesthesia care unit).

    Discharged home the same day with the surgery considered successful. He is to follow up with the surgeon for ongoing care.

    Upon the completion of normal healing it is determined Joe will need hand therapy with a certified Hand Therapist at least 2-3 times per week. Joe makes and keeps all appointments and makes wonderful progress. He is very happy with the results of the surgery, and has recuperated with full use of his hand and wrist.

    He is shocked and frankly scared when bills arrive every day, from every provider. How is he possibly going to pay all of these bills? He has missed time from work and lost money for a few weeks during the painful recovery so his bank account is a little low.

    Doing the math, he sees the total he owes is over $2500. In addition, there could be more. He owes every provider of service and some he never even knew about! He is so confused he does not know where to turn; he puts aside his mail, thinking he’ll worry about that some other time.

    Most insurance companies process medical bills rather quickly, with electronic billing and payment. So within 30-45 days, most claims are complete, and patients will get a bill for their out of pocket responsibilities/cost share.

    A bill has been sent to Joe American for $1500, this is determined to be the balance applied to his deductible. Joe thinks to himself, “I don’t remember anyone saying anything about deductibles? I must have forgotten about that part of the medical expenses. And, what the heck is a coinsurance; what am I paying for every month?” He does not understand any of this insurance lingo.

    Unfortunately, Joe American does not call after getting two statements and the bill goes unpaid. The billing supervisor at the doctor’s billing office, receives a weekly report on delinquent accounts, and uploads all of these accounts to and outsourced collection agency with one mouse click. This agency will take a commission on these charges of up to 20%. There is still no guarantee this account will be paid in a timely fashion or ever. It could end up in court.

These case scenarios happen on a daily basis in America for many reasons and different medical conditions. The fact of the matter is there should be a way to help people pay their bills and help these medical offices, which are a small business in America, collect on accounts without spending money to collect what is owed.

What the market is lacking is a mediator for the average person with these medical expenses. There are special interest groups helping the poor.

Alternatively, in the case of a legal action incurred after personal injury, lawyers can mediate a reduction in a pay off. However, the average American has to dip into savings, or add to the already strained credit card debt to pay the out of pocket costs.

These are the forgotten expenses in our healthcare system. No one wants to talk about. Yes, more Americans are carrying insurance, but what is the real cost, in dollars and cents, out of their personal, household budgets.

After paying high premiums, these forgotten medical costs are not even considered a problem to the politicians designing affordable health care.

This is a guest post by Carolyn Babjak.

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