Worry about the costs of surprise medical bills - a Kaiser Family Foundation survey

This article is published in the newsletter PatientEngagementHIT and the author is Sara Heath

67% of Patients Worry About Surprise Medical Bills, Healthcare Costs

Rising patient concern about surprise medical bills and healthcare costs are calling into question healthcare price transparency practices.

September 10, 2018 - Unexpected medical bills are the biggest healthcare and financial concern on patients’ minds, according to a recent poll from the Kaiser Family Foundation.

The survey, which included responses from nearly 1,200 adult patients, found that 58 percent of healthcare consumers are concerned about general out-of-pocket patient cost increases across the healthcare spectrum.

Chief of those concerns was the concept of unexpected medical bills, or healthcare charges that patients believed would be covered by their healthcare payer.

Thirty-eight percent of respondents reported that they are very concerned and 29 percent saying they are somewhat concerned about surprise medical bills. Only 16 percent of patients said they are not at all worried about surprise medical bills.

Unexpected bills proved an even larger concern than high premiums (18 percent), high deductibles (24 percent), and rising drug costs (22 percent).

Worry about surprise medical bills also override financial worry about paying for other lifestyle needs such as rent or mortgage and grocery bills, the survey revealed.

Surprise medical bills are an increasingly prevalent issue in the healthcare industry, the survey noted. Forty percent of insured adults ages 18 to 65 said they have received a surprise medical bill in the past 12 months. Of those respondents, 10 percent said their bill stemmed from out-of-network care.

Out-of-network care can include visiting a hospital or clinic that is not within a patient’s insurance coverage network, or seeing a clinician who is not a part of the patient’s insurance plan but who practices in an in-network facility.

Most of these surprise bills totaled to less than $500 – 50 percent of all patients who received a surprise medical bill said as much.

But smaller cohorts of patients saw astronomical surprise bills. Sixteen percent of respondents reported unexpected bills reaching up to $999, 12 percent received a bill between $1,000 and $1,999, and 13 percent were billed over $2,000.

58 percent of respondents said they are very concerned about general healthcare costs.

Separate studies have likewise indicated that surprise medical bills are of utmost concern for patients.

A 2018 analysis from NORC at the University of Chicago found that 57 percent of patients have received a surprise medical bill, and 58 percent of patients perceive these unexpected charges to be their insurers’ faults.

Seventy-nine percent of the patients who received a surprise bill said it came from an encounter with a provider that was within the patient’s payer care network. The surprise bill may have come from a provider who was not within network but was practicing in a facility that was in network, or for healthcare services that are not a part of a patient’s coverage plan.

These issues point to a need for better patient education about their payer benefits designs, the NORC* researchers said.

“Most Americans have been surprised by medical bills that they expected would be covered by their insurance,” Caroline Pearson, senior fellow at NORC at the University of Chicago, said in a statement. “This suggests that consumers may have difficulty understanding their insurance benefits or knowing which providers are included in their plan’s network.”

Payers may consider being more transparent about healthcare services that are and are not covered under a specific plan, or the providers whose services would not be covered. Additionally, clinics and hospitals may consider being more transparent about the total cost the patient will incur prior to the care encounter. Price transparency should take into consideration the patient’s insurance benefits.

But the Kaiser Family Foundation poll suggested that the solution to surprise medical bills goes beyond more patient-centered billing practices. As noted above, 58 percent of patients believe there is a fundamental issue with rising healthcare costs.

Determining ways to cap out-of-pocket patient spending or make costs more transparent could reduce the “sticker shock” that comes with a surprise medical bill.

*NORC at the University of Chicago is one of the largest independent social research organizations in the United States

Maine physician's echo- fear of medical expenses

ABOUT THE AUTHOR (an "echo" re-blog op-ed from a physician who wrote from his experience being a patient- very informative!

March 6, 2017
Paul Averill Liebow, M.D., FACEP, is a resident of Bucksport.
"'Insurance' is not spending $5 to compensate someone from the vanishingly small risk that a $200 package is lost in the mail, and guarantee huge profits for someone. Insurance is meant to protect all American families from overwhelming fear of arbitrarily losing everything they have worked their whole lives for – to protect the American Dream we all grew up with."- Paul Liebow, M.D.

Americans who fall ill shouldn’t live in fear of crippling medical expenses

Health insurance is meant to prevent patients from the fear of losing everything due to unexpected medical expenses

Insurance is meant to be a safeguard when an arbitrary crisis threatens all a person has worked for.

BUCKSPORT Maine — As both physician and patient, and child of an academic physician who was deeply involved in American health care system planning, I have a long-term insider perspective. 

We have a miraculous, world-class, but flawed medical care system, particularly in insurance coverage. 

Many of the frustrating inefficiencies of our present system could easily be fixed with a little common sense.

But if Mr. So-Called trashes Medicare, and/or the Affordable Care Act, and triggers a “winner takes all” monopoly capitalism financial stampede in private health insurance, we will all experience a total community health care meltdown. 

It would affect most of our friends and neighbors, even if we personally can somehow scrape through our own emergencies. Lifetime health care payment caps and denial of coverage for pre-existing conditions will hurt the most vulnerable. Is breast cancer a pre-existing condition after decades of progressively abnormal mutations, when it finally evolves to become metastatic?

“Insurance” is not spending $5 to compensate someone from the vanishingly small risk that a $200 package is lost in the mail.

Rather, health insurance is meant to protect all American families from overwhelming fear of arbitrarily losing everything they have worked their whole lives for – to protect the American Dream we all grew up with.

That has happened many thousands of times as people all over America have exceeded arbitrary yearly and lifetime caps on their health insurance after they contracted an expensive or chronic medical condition, such as cancer, diabetes, heart disease or multiple sclerosis through no fault of their own. 

Thankfully, the Maine Legislature outlawed such behavior in this state in 2010, when it passed L.D. 1620, “An Act to Protect Health Care Consumers From Catastrophic Debt.”

I was terrified! It was Feb. 3, 2010, and I was officially testifying in favor of L.D. 1620 on behalf of the Maine Medical Association, and very confident that Maine Physicians for Social Responsibility and the Maine Chapter of the American College of Emergency Physicians also totally supported my testimony.

I told legislators that I’d undergone a heart transplant after catching a virus on the job in the Eastern Maine Medical Center ER, and had just spent a terrifying month trying to deal with my insurance company, which was telling me I might have reached such a lifetime maximum cap on my health care coverage.

I suddenly couldn’t get so-called “prior approval” for one of my life-saving miracle medications, though I had gotten many other reauthorizations with only one error. I couldn’t get through to anyone in “customer care” at my giant national “insurance” company who would tell me anything I needed to know to sort the problem out.

I couldn’t get a call back from my supposed hospital case manager, if I even had one. I got dumped from answering machine to answering machine with no return calls. I was told that I “did” and that I “did not” have insurance within five minutes, by two different people trying to put me off. I got the same inverted answers regarding my wife.

My pharmacist couldn’t get through for “prior authorization” for my life-saving medication, and my “benefits office” couldn’t get through to begin to get any answers. I could not get any help from the “practitioners” at Brigham and Women’s Hospital in Boston, who had assured me they had gotten “prior approval” for a $24,000 cardiac catheterization.

The procedure involved five or six people’s time for less than two hours, a few hundred dollars of medical supplies and a huge machine that took X-ray pictures of my heart. It was certainly worth a few thousand dollars, but I then got a full bill with a threatening invoice, obviously derived from the chargemaster.

I suspect that few reading this know what a “chargemaster” is. It is a secret book of fantasy “Medical Charges from Hell” that hospitals invent, official rates that are generally about three times the negotiated rates with insurance companies. It is secreted off campus and can be reviewed only with special permission. It is used to plea-bargain innocent Americans into paying financially lethal charges, while slowly bleeding out their families’ life savings.

No hardworking American, particularly our wounded or mentally disturbed combat veterans, should ever die homeless or without health care denied by “death panels.” I am sure I speak for most of the 100,000-plus patients I have been responsible for, many of them at the worst times of their lives, perhaps even for the majority of owners and executives of insurance companies – and their lawyers.

One thing is absolutely for sure: Americans should not be subject to arbitrary death by disease, death by neglect, death by bureaucracy or death by lawyer.

Corporations Supporting Obamacare - Thank you Starbucks

Shame on companies that cut employee hours and, thereby, their pay because the corporations won't comply with health care reform or the Affordable Care Act, aka "Obamacare".

Starbucks, thankfully, is a refreshingly ethical exception.

Corporate officers in big businesses continue to receive stock options for bonuses. Certainly, they must remember the people who earn the corporation's financial successes.  

Management earns very little of the money corporations pay their executives.  Rather, the big corporate salaries, bonuses and generous benefits, including executive health insurance, are earned by hard working hourly employees, for management to reap.  It's hard working personnel who earn the benefits the corporate executives see in their salaries.

Obviously, hourly workers deserve health insurance coverage, regardless of how many hours they work.

Employees certainly don't deserve to have hours and pay cut because of health care reform, especially when management keeps their bonuses and benefits. 

It's an understatement to accuse corporations that cut employee hours and, therefore, pay, because they won't comply with Obamacare, as acting selfishly.

Rather than cut employee hours, somebody should recommend cutting executive salaries for those in management who refuse to comply with health care reform.

Employers around the country, from fast-food franchises to colleges,  told NBC News they will be cut workers' hours below 30 a week because they can't afford to offer the health insurance mandated by the Affordable Care Act, also known as Obamacare.
But, Starbucks, the popular coffee dynasty, won't cut worker hours or benefits ahead of Obamacare says the CEO.

When Starbucks Corporation stands up in support of employee health insurance benefits under Obamacare, then other companies can do the same thing. 

NEW YORK (Reuters) - Starbucks Coffee Co will not follow the lead of some other companies (like Subway) that are cutting health insurance benefits or reducing hours for employees in anticipation of the U.S. Affordable Care Act, the coffee shop chain's CEO Howard Schultz told Reuters on Monday.

"Other companies have announced that they won't provide coverage for spouses; others are lobbying for the cut-off to be at 40 hours. But Starbucks will continue maintaining benefits for partners and won't use the new law as excuse to cut benefits or lower benefits for its workers," Schultz said in a telephone interview.

The 2010 healthcare reform law, often called Obamacare, requires companies with more than 50 employees to offer health insurance for employees who work 30 hours a week or more. Starbucks currently provides healthcare to part-timers who work 20 hours a week or more.

And, therefore, all other companies with 50 or more employees can and should follow the Starbucks lead. 

For my part, Starbucks is a now a preferred coffee company.