Health Care and the Insurance Bind

According to a recent Kaiser poll taken in April, 2008, over 28% of those surveyed report problems paying for health industry and health care. As health care costs increase, more of those expenses are being shifted to individuals and families in the form of large deductibles or other requirements that patients pay out of pocket for a greater portion of health care costs. The Wall Street Journal reported results from the survey this month. The economy may be a contributing factor, and there may also be a "tipping point" that has been reached for Americans to afford medical care in an ever increasing rise of health care expenditures. Uninsured people surveyed reported at the highest rate of 38% of delaying or going without medical care. However, insured Americans were the biggest increase of those not able to pay for health care, including medical imaging, specialty pharmacy, and surgery.

As reported by MCOL, according to a new report released by the Center for Studying Health System Change, more than 20% of the U.S. population in 2007—one in five people—reported not getting or delaying needed medical care in the previous 12 months, up significantly from 14%—one in seven people—in 2003. Among study findings:
--Access to care deteriorated the most for insured people in poor or fair health—14.2 percent reported going without needed care in 2007, up from 9 percent in 2003.
--Overall, people in poor or fair health with an unmet need increased by 5.1 percentage points between 2003 and 2007 (11.9% vs. 17.0%), compared with an increase of 2.1 percentage points for people in good, very good or excellent health (4.1% vs. 6.2%).
--Uninsured people in poor or fair health reported the greatest problems getting needed care in 2007, with one in four (25%) reporting they went without needed care.
--For people reporting an access problem, cost was the most frequently cited—and a growing—obstacle to care. In 2007, 69 percent of people who went without or delayed needed care cited worries about cost, a 3.8 percentage point increase from 2003.
--Between 2003 and 2007, the frequency with which insured people cited a health plan-related reason for going without or delaying care increased 8.5 percentage points to 39 percent in 2007. Most of the increase was attributable to people reporting more problems getting their health plan to pay for treatment or that their doctor or hospital would not accept their insurance.

There are several ways to manage expenses with health care providers:
1.) Ask for an itemized statement in advance to avoid any surprises.
2.) Work with your insurance company and the medical provider to negotiate better rates.
3.) Seek help from a medical financial counselor to focus on managing health care expenses.
4.) Consult your insurance company to find out if certain procedures and medical providers aere covered under your plan.
5.) Find out what your exposure is for deductibles and co-payments, annual maximums and out-of-pocket expenses, providers located in or out of network, and any other concerns related to your medical needs.
6.) Seek out reputable discount medical plans that offer significant savings.

According to the Dallas Morning News, paying for medical costs can be very stressful and expensive. Although not every situation will not work out in the patient's favor, the medical provider knows that it is in his best interest to negotiate with you to get paid. Be honest with your ability to pay and make any payment that has been promised. Be open and communicative with the health care provider, and be fair and realistic about your options and abilities. Medical debt can drain your bank account, stretch your emotions, and destroy your credit if you cannot meet your obligations for unpaid medical bills.

Financial problems can cause considerable concern and add to the burdens of dealing with illness, especially catastrophic care. People are often embarrassed when they have financial problems and so don't seek the help they need or else they wait until their financial problems are overwhelming before seeking help-which makes them even more difficult to solve. BlueCross BlueShield reports that 50% of adults with incomes of less than $50,000 have experienced problems paying insurance in the past two years. It is common for families to have large expenses, especially if their insurance is limited. If you are worried about paying your medical bills, you are not unusual. However, there are important options for you to know about. Don't wait until you are overwhelmed.

The American Cancer Society (ACS) suggests the following ways to help manage insurance. The following are suggestions to help you and your family better understand your medical coverage:
--Locate all insurance information referring to the current medical problem.
--Read and review carefully any booklets explaining the plan under which you or your family is covered.
--Request written information on benefits if you do not have it.
--Talk with your employee benefits person at your job if you have questions or do not understand any of the terms in the printed materials.
--Make a list of any questions on benefits, deductibles, and coverage.
--Get answers directly from the insurer or managed care group that provides coverage.
--Be sure you understand your tasks in making sure that services are covered.
--Identify one contact person (if possible) in customer service with whom you can discuss claims and request services who will become familiar with your situation. This person may be a case manager.
--Meet with a hospital or clinic financial counselor or person from the patient accounts office to learn about billing procedures.
--Discuss any concerns about your insurance with your team social worker. He or she can help you understand how the system works and where to get help.
--Ask for help from a trusted friend if you feel overwhelmed in dealing with these matters.
--Develop a system for keeping records. For example, you may keep records according to each visit or under each health provider or under each week, whatever makes most sense to you.

The ACS also recommends that records should be kept of the following:
1.) Medical bills from all health care providers.
2.) Claims filed.
3.) Reimbursements (payments from insurance companies) received and explanations of benefits.
4.) Dates, names, and outcomes of contacts made with insurers and others.
5.) Non-reimbursed or outstanding medical and related costs.
6.) Meals and lodging expenses.
7.) Travel (including gas and parking).
8.) Long-distance telephone calls related to medical or other types of care, including psychosocial care.
9.) Admissions, clinic visits, lab work, diagnostic tests, procedures, treatments
drugs given and prescriptions ordered.

Insurance can be difficult to understand and expensive to maintain. Costs can be prohibitive for some health care needs, and many medical costs are unforseen which really wreak havoc on your budget. Even small businesses surveyed show that the cost of health insurance is the Number One issue facing them today as reported this month by the National Federation of Independent Businesses. The National Coalition on Health Care reports that national surveys show that the primary reason people are uninsured is the high cost of health insurance coverage. Economists have found that rising health care costs correlate to drops in health insurance coverage. In a Wall Street Journal-NBC Survey almost 50% of the American public say the cost of health care is their number one economic concern.

Health insurance does not always protect a family from medical bill problems. But insured families—all members have coverage—comprise the majority (68%) of families with medical bill problems. Even with insurance coverage, many families face higher out-of-pocket medical expenses because of rising deductibles, copayments and coinsurance, where patients pay a percentage of the total bill as reported by the Center for Studying Health System Change. The bottom line: Americans must do a better job of managing health care costs.

Until next time. Let me know what you think.