Teh One Who Knocks
12-10-2013, 03:45 PM
By Michael Booth - The Denver Post
http://i.imgur.com/6ax5nBX.jpg
Tamie and Matthew Lang were saddened to confirm during a visit to the emergency room last March that their dream of a pregnancy had ended in miscarriage.
But melancholy turned to fury when they got the bill from Castle Rock Adventist Hospital: More than $11,000 for a visit totaling less than three hours. Of that, more than $6,000 was for use of an ER room for a few minutes with a doctor — who billed separately — which they considered little more than a "pat on the back."
The bottom line for the couple is writing a check for $5,600 under a high-deductible plan — insurance coverage that's similar to what millions of Americans are shifting to under pressure of employer cost cuts and federal health reforms.
Many families, even those with employer-provided benefits they thought were generous, are set up for future shock with the relentless trend toward high deductibles, health care experts said.
"That's the trade-off you have to think about" when evaluating health insurance choices, said Christopher Watts, a Denver partner with Mercer benefits consultants. The premium might look reasonable, but a $3,000, $5,000 or even $7,500 deductible means families writing a big check for an accident or procedure.
"We counsel employers to make it very clear, 'Please don't be shocked,' " Watts said. "But we don't all read our enrollment materials like we should."
Controlling costs For employer-provided insurance, the number of large companies offering high cost-sharing plans rose to 23 percent in 2013, from 4 percent in 2005, according to the Kaiser Family Foundation.
Employers are moving toward high-deductible plans to head off double-digit premium inflation from insurance companies. Agreeing to higher deductibles — meaning employees pay more upfront health costs themselves — or modifying benefits can keep a premium increase to 3 or 4 percent, rather than 10 or 12 percent.
The insurance shopping exchanges set up by the new health care law also emphasize high deductibles, by directly comparing prices of different "bronze, silver or gold" plans. High-deductible bronze plans look like a much cheaper monthly premium to the individual consumer buying through the exchange.
Matthew Lang said his financial position as an independent professional is relatively lucky — "Could you imagine a family going into the ER for a broken arm, getting a $10,000 bill, and it's still under their deductible and maximum out-of-pocket costs?" he asked. "I think it would be a hardship, or break most family budgets."
Castle Rock Adventist would not respond to the particulars of the Lang case, but issued a statement saying the hospital system agrees that consumers need to be aware of the risks of high-deductible plans. Hospital spokeswoman Christine Alexander said Castle Rock and its Centura parent try to work with patients on flexible payments with zero interest, or charity care for those who qualify.
Lang has sought answers from his insurance company, Humana, which in its hospital contracts negotiated a discount of the original $11,198 emergency bill to $5,599. The couple must pay that remaining $5,599.
"It almost seems as if Humana gets together with the hospital and figures out the maximum amount that can be charged while still keeping the total under the patient's deductible," Lang wrote in a letter to Humana. "This way, the hospital gets as much revenue as possible and the insurance company isn't out any money."
Humana declined to comment on the bill.
Erin Norton is another high-salary policyholder who is nevertheless fighting the system over high deductibles and maddening medical bills. Norton has a $2,000 deductible and, when shopping for a better deal on the Connect for Health exchange, was dismayed to see comparably priced plans demanding a $5,000 deductible.
Norton's theoretical deductible became all too real earlier this year, when a 15-minute diagnostic test produced a bill for $1,838, and her share after the insurer's negotiated discount would be $1,011.
Norton called Rose Medical Center to see what she could do about that charge, a step few consumers ever take. Rose told her that if she had no insurance, a 90 percent discount would reduce her bill to $183.75. But since she had insurance, the best they could do was knock another 10 percent off her share "as a courtesy," to $910.
The sticker shock for both premiums and high-risk deductibles is one reason enrollment in the Affordable Care Act has been so slow, Norton believes. "The industry is a racket," she said. "To me, it's price-gouging. One thousand dollars is no joke."
A Rose spokeswoman said the hospital works with patients through insurance negotiations and other discounts.
"The move toward higher-deductible insurance plans has put a strain on many of our patients, but we understand their choice to pay a lower monthly premium, and we also understand their frustration with the larger out-of-pocket expenses they may experience as a result," said Stephanie Sullivan, director of media relations for Rose parent HealthOne.
The surge in high deductibles comes alongside growth in so-called "employee-directed" plans, which force consumers to make first-dollar spending decisions for their health. An employer might contribute some money to a pre-tax health savings account, and the employee can add more. The first few thousand dollars of health spending are made by the employee from that account, with the idea they will seek more cost-effective MRIs or other services through research and comparison.
Consumer choice Both styles of plan are prompting interest in a form of health-gap insurance that employees might buy separately to cover the high deductible for a one-time event, like knee surgery or hospitalization.
These supplemental policies often cost $10 to $45 a month, and can provide a $10,000 check paid directly to the consumer to do with as they wish.
"Now they make sense for a lot more people," said Mercer's Watts. "We're seeing a high level of interest," he said.
Some health reformers have endorsed the high-deductible plans, saying America's overpriced medical system won't truly change until consumers understand the real cost of their choices. Under that theory, patients such as the Langs might have chosen an urgent-care office rather than an ER, or waited to see their regular doctor on a weekday.
How the theory will play out is yet to be determined. Some patients make wise and cheaper choices, others put off care and have expensive complications later.
A Rand Corp. study in 2011 said the high-deductible and employee-directed plans appeared to cut costs in the first year of an employee joining. But it also found such cost-sharing "reduced both necessary and unnecessary care," and it was unclear what would happen with those employee costs in later years. Nor did the study try to assess the overall impact on that employee's health condition.
The Langs are still fighting their miscarriage bill, taking it public with a Facebook page they have dubbed "Castle Rock Hospital Warning" with a cover photo of the hospital welcome sign. A lawyer friend has traded letters with the billing department, but neither Castle Rock Adventist nor Humana has budged yet.
Lang, a financial adviser, said he is frustrated that every branch of business is subject to intense audits and public scrutiny except for medicine.
"With patient care, there is nowhere to go," he said. "Nobody seems to even look at this. They can set their own rules and bill whatever they want. Your only choice is to pay it, or go to collections."
http://i.imgur.com/6ax5nBX.jpg
Tamie and Matthew Lang were saddened to confirm during a visit to the emergency room last March that their dream of a pregnancy had ended in miscarriage.
But melancholy turned to fury when they got the bill from Castle Rock Adventist Hospital: More than $11,000 for a visit totaling less than three hours. Of that, more than $6,000 was for use of an ER room for a few minutes with a doctor — who billed separately — which they considered little more than a "pat on the back."
The bottom line for the couple is writing a check for $5,600 under a high-deductible plan — insurance coverage that's similar to what millions of Americans are shifting to under pressure of employer cost cuts and federal health reforms.
Many families, even those with employer-provided benefits they thought were generous, are set up for future shock with the relentless trend toward high deductibles, health care experts said.
"That's the trade-off you have to think about" when evaluating health insurance choices, said Christopher Watts, a Denver partner with Mercer benefits consultants. The premium might look reasonable, but a $3,000, $5,000 or even $7,500 deductible means families writing a big check for an accident or procedure.
"We counsel employers to make it very clear, 'Please don't be shocked,' " Watts said. "But we don't all read our enrollment materials like we should."
Controlling costs For employer-provided insurance, the number of large companies offering high cost-sharing plans rose to 23 percent in 2013, from 4 percent in 2005, according to the Kaiser Family Foundation.
Employers are moving toward high-deductible plans to head off double-digit premium inflation from insurance companies. Agreeing to higher deductibles — meaning employees pay more upfront health costs themselves — or modifying benefits can keep a premium increase to 3 or 4 percent, rather than 10 or 12 percent.
The insurance shopping exchanges set up by the new health care law also emphasize high deductibles, by directly comparing prices of different "bronze, silver or gold" plans. High-deductible bronze plans look like a much cheaper monthly premium to the individual consumer buying through the exchange.
Matthew Lang said his financial position as an independent professional is relatively lucky — "Could you imagine a family going into the ER for a broken arm, getting a $10,000 bill, and it's still under their deductible and maximum out-of-pocket costs?" he asked. "I think it would be a hardship, or break most family budgets."
Castle Rock Adventist would not respond to the particulars of the Lang case, but issued a statement saying the hospital system agrees that consumers need to be aware of the risks of high-deductible plans. Hospital spokeswoman Christine Alexander said Castle Rock and its Centura parent try to work with patients on flexible payments with zero interest, or charity care for those who qualify.
Lang has sought answers from his insurance company, Humana, which in its hospital contracts negotiated a discount of the original $11,198 emergency bill to $5,599. The couple must pay that remaining $5,599.
"It almost seems as if Humana gets together with the hospital and figures out the maximum amount that can be charged while still keeping the total under the patient's deductible," Lang wrote in a letter to Humana. "This way, the hospital gets as much revenue as possible and the insurance company isn't out any money."
Humana declined to comment on the bill.
Erin Norton is another high-salary policyholder who is nevertheless fighting the system over high deductibles and maddening medical bills. Norton has a $2,000 deductible and, when shopping for a better deal on the Connect for Health exchange, was dismayed to see comparably priced plans demanding a $5,000 deductible.
Norton's theoretical deductible became all too real earlier this year, when a 15-minute diagnostic test produced a bill for $1,838, and her share after the insurer's negotiated discount would be $1,011.
Norton called Rose Medical Center to see what she could do about that charge, a step few consumers ever take. Rose told her that if she had no insurance, a 90 percent discount would reduce her bill to $183.75. But since she had insurance, the best they could do was knock another 10 percent off her share "as a courtesy," to $910.
The sticker shock for both premiums and high-risk deductibles is one reason enrollment in the Affordable Care Act has been so slow, Norton believes. "The industry is a racket," she said. "To me, it's price-gouging. One thousand dollars is no joke."
A Rose spokeswoman said the hospital works with patients through insurance negotiations and other discounts.
"The move toward higher-deductible insurance plans has put a strain on many of our patients, but we understand their choice to pay a lower monthly premium, and we also understand their frustration with the larger out-of-pocket expenses they may experience as a result," said Stephanie Sullivan, director of media relations for Rose parent HealthOne.
The surge in high deductibles comes alongside growth in so-called "employee-directed" plans, which force consumers to make first-dollar spending decisions for their health. An employer might contribute some money to a pre-tax health savings account, and the employee can add more. The first few thousand dollars of health spending are made by the employee from that account, with the idea they will seek more cost-effective MRIs or other services through research and comparison.
Consumer choice Both styles of plan are prompting interest in a form of health-gap insurance that employees might buy separately to cover the high deductible for a one-time event, like knee surgery or hospitalization.
These supplemental policies often cost $10 to $45 a month, and can provide a $10,000 check paid directly to the consumer to do with as they wish.
"Now they make sense for a lot more people," said Mercer's Watts. "We're seeing a high level of interest," he said.
Some health reformers have endorsed the high-deductible plans, saying America's overpriced medical system won't truly change until consumers understand the real cost of their choices. Under that theory, patients such as the Langs might have chosen an urgent-care office rather than an ER, or waited to see their regular doctor on a weekday.
How the theory will play out is yet to be determined. Some patients make wise and cheaper choices, others put off care and have expensive complications later.
A Rand Corp. study in 2011 said the high-deductible and employee-directed plans appeared to cut costs in the first year of an employee joining. But it also found such cost-sharing "reduced both necessary and unnecessary care," and it was unclear what would happen with those employee costs in later years. Nor did the study try to assess the overall impact on that employee's health condition.
The Langs are still fighting their miscarriage bill, taking it public with a Facebook page they have dubbed "Castle Rock Hospital Warning" with a cover photo of the hospital welcome sign. A lawyer friend has traded letters with the billing department, but neither Castle Rock Adventist nor Humana has budged yet.
Lang, a financial adviser, said he is frustrated that every branch of business is subject to intense audits and public scrutiny except for medicine.
"With patient care, there is nowhere to go," he said. "Nobody seems to even look at this. They can set their own rules and bill whatever they want. Your only choice is to pay it, or go to collections."