In a few short days the state’s landmark health reform law will reach another milestone – the requirement that each individual have health insurance. The Connector Authority, together with the health insurers, has developed 35 different insurance products to meet an individual’s needs. All of these plans are similar in that they offer coverage with low premiums but relatively high co-payments and deductibles.
Who is responsible for explaining and collecting the co-payments and deductibles? If you think it’s the insurers you are wrong. As it stands now, it’s mainly up to your local hospital to explain the plan’s coverage and to collect “out-of-pocket” expenses – an often difficult, costly and time-consuming effort.
I think that should change and so does state Senator Richard Moore, Senate Chair of the Joint Committee on Health Care Financing, who introduced a bill – SB690 – that shifts responsibility for collecting co-payments and deductibles to insurers who design the plans. The bill takes on heightened urgency with the new “high deductible” plans that are being aggressively marketed across the state and the growing trend of health plans to shift more of the financial burden for care on to its members.
Hospitals throughout Massachusetts spend a great deal of human and financial resources in trying to obtain payment for the services they provide. Unfortunately, even after significant investment of time and personnel, the co-payments and deductibles can be the hardest money to collect. Each year, the state’s 69 acute care hospitals provide tens of millions of dollars in patient care that cannot be recovered and end up as “bad debt,” which places additional challenges to their mission of building healthier communities.
Massachusetts’ hospitals are committed to providing services to all patients regardless of their ability to pay. However, without some shift of responsibility, we will have to invest even more administrative dollars to offset the increasing complexity and variety of health insurance products; this additional cost will pose significant financial risks to hospitals.
In Rhode Island, the House of Representatives addressed a similar issue by passing a compromise bill that spreads responsibility among hospitals and insurers. The approach echoes the principle of “shared responsibility” that is the underpinning of the Massachusetts Health Reform Law.
I believe that SB690 is a step in the right direction and should be given serious consideration by the Senate and ultimately the entire Legislature.
Let’s let hospitals do what they do best – provide care to the sick and injured – and insurers do what they do best – handle the financial responsibilities of providing that care.
Michael V. Sack is the President and CEO of Hallmark Health
I understand the difficulty posed when hospitals must collect the co-pays and deductible. But, it’s not so much different when auto repair shops must collect the deductible from the insured after an insured collision repair.
If you believe–and I do–that one cause of rising health prices is that people are insulated from the cost of their health, then this Bill adds one more step toward insulation. i.e. expectations that when I walk into a Dr. office or hospital, everything’s free regardless of services received, because I have insurance.
(1)”If you believe–and I do–that one cause of rising health prices is that people are insulated from the cost of their health”
Oh please….that worn-out false canard that people would not choose to get care for cancer, diabetes, a broken leg, torn ligaments, pneumonia and bronchitis, eye infections or a host of other illnesses and injuries if “they just knew how much it cost” their insurer.
People who are uninsured DO know how much it costs and the result is this:
(1) 18,000 people a yer die from treatable conditions because they lack health coverage
(2) the uninsured can not get an appontment with a GP or specialist unless they have the $100 – 500 cash in hand so they do not go there.
(3) Because they can not see a GP/specialist, they end in the ER for routine care – and that is causing a collapse of the ER system
(4) the vast majority of the uninsured do not fill prescriptions
(5) the vast majority of the uninsured do not get necessary tests or follow-up visits
(6) when the uninsured finally do seek care for an illness, they are far sicker and need more care
All the research data shows that when households have a total healthcare cost of premiums, deductibles and copays that exceeds 8% of income, they do exactly as the uninsured do and forego NECESSARY care.
All the research data shows that for the households below 120% of median income, when the deductible is more than $500 or so, they do exactly as the uninsured do and forego care.
(2) Then there is the problem of extracting info from an insurer. I just went round and round with mine over that issue. They have a cap on certain services, and require a 20% copay. Now since any idiot knows that the sticker price of provider is not the same as the price charged and insurer, I called the insurer to find out what the price really is. I wanted to know how much they pay per visit so I could ration out the service (multiple, repeat visit kind of thing.) I wanted to know how much they set as the price so I would know what 20% translated into as $$$.
From their behavior, you would have thought that I had ask for national secrets entrusted solely to NSA. They said they could not tell me (the insured) what they set as the price they will pay for that service. They told me that first the provider has to provide the service, then bill them and then they will decide what amount is paid for that service – and finally they will send me a bill for 20% of whatever they work out.
Getting extremely annoyed, I replied that they had a book listing what they paid for different subsets in that type of service; and to just give me the most $$ they allowed to be charged for 1 hour of that service. (Sorry – should have said we were talking about Physical Therapy here not cardiac surgery.) They flat refuse to disclose their payment rates on the grounds that those were “secret” and “not public information even to memebers”; and I would find out how much they paid and how much I owed AFTER I had gone to the appointments and then got my share of the bill in 2 or 3 months!!!
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As for Mr. Sack and his complaint that hospitals have to collect the deductible and co-pays which often turn into bad debts, ah gee…..
Making insurers pay the deductiblle and copays and then try to collect from their insured after the fact will simply result in one thing. Insurers will only offer 1st $ and no co-pay plans and jack the premiums through the roof.
What Mr. Sack wants is exactly the same thing – 1st $$/no copay coverage but done after the fact (premiums paid and then costs incurred) with the insurer sueing their insured for the retroactive ‘premiums’ to cover the deductible/copays and then dropping their coverage because they owe the insurer money.
It becomes a way for insurers to dump enrollees who actually have healthcare costs without violating state law that they can not refuse coverage becaue the person has medical problems or has had healthcare costs. They won’t be cancelling them because they had a health problem or because they had healthcare bills – they will e dumping them for the time honored reason called “breach of contract” by not paying the insurer the money which they agreed to pay……
Has to be one of the stupidest ideas around.
If hospitals so hate these high deductible/high copay plans, then REFUSE to do business with them and go off their list of providers. If the insurer can’t sign up any facilities to take their plan, then consumers will stop buying the plan and the insurer will stop offerring it.