Medical Debt

[Christine]

Some may have gone up but some have not. I know that ours is exactly what it has been for at least the last 20 years, maybe longer. The ACA has become an easy target to blame everything health/insurance related on. Where do you place the blame for the people in debt for medical expenses prior?

My deductible has also remained steady. It did go up back in 2005. The health insurance made some changes to certain things and they were able to get it back down to the rate it had been for 20 years. To be fair, my plan is through my husband's union and they are self-insured although they used a big PPO to administer claims. They are not grandfathered either. It is $150 per person and $300 per family. If the cost of plan increases considerably, then they raise the deductible but they have been managing well so it's been okay.

 

[mom2rtk]

My deductible has also remained steady. It did go up back in 2005. The health insurance made some changes to certain things and they were able to get it back down to the rate it had been for 20 years. To be fair, my plan is through my husband's union and they are self-insured although they used a big PPO to administer claims. They are not grandfathered either. It is $150 per person and $300 per family. If the cost of plan increases considerably, then they raise the deductible but they have been managing well so it's been okay.

I'm sure you'll admit that everyone's experience is different? Because your experience has been good does not mean everyone else's has been. As I said upthread, all that happened is they chose different winners and losers. Some who had no insurance now have insurance. Some of us who had decent insurance now don't (which is how I classify it when a deductible rises 6 fold).

My biggest gripe about the ACA is that it took everyone's eye off the ball. Regardless of whether the effects are good, bad or indifferent, it did zero to bend the cost curve of health care downward. Costs continue to spiral out of control. Small and medium size employers are subject to wide swings in cost based on a small number of claims. Meanwhile, those crazy high claims continue to get more and more expensive because nobody did a thing to try and address those rising costs.

I suppose my husband could leave a job he loves to find a company with better benefits. But I thought one of the benefits of the ACA was to disentangle insurance from employment. It has had the opposite effect for us, pushing us to need to consider different employment BECAUSE of the insurance.

 

[Art 1]

This is incorrect...they are billed at the highest, non discounted rate and hospitals DO send them to collection.Most hospitals will require a deposit on that bill at the check in time for a non emergency admission or testing. Emergencies are a different story, we are still a country who doesn't let people die in the street. I see more US citizens not paying their bills than immigrants, contrary to the popular, inaccurate sentiment.

They might be billed, but they don't have to pay. They have nothing to take and just don't pay. There is no deposit asked for at the hospital. They are seen, surgery whatever and do not pay. How would they pay a $30,000 bill? I would have to pay it, they don't.

 

[daughtersrus]

Most have gone up, not just some. My wife has been in the medical field for almost 20 years and I know that is a fact for the insurance companies that are dealt with around our area. The blame for previous medical debt if you want to call it blame is on them. However, if someone has a bill for open heart surgery at $100,000 I don't expect that to be paid off by them in a few months or years even though their insurance probably covered 80-90% of the bill. There is a direct correlation between the higher insurance deductibles and the inception of the AHCA. It isn't the only one but it is part of the reason.

Yours has not gone up in 20 years? You might be the only person with the only company in the country that hasn't gone up in 20 years. I'd consider myself very lucky. 20 years ago my parents paid $1 a month for family insurance, $100 or $250 deductible, and full coverage with no 80/20 or 90/10 split as did quite a few people. That is almost gone by the wayside.

Our insurance is through DH's union. (Private sector ). They are self-funded and use a major PPO to administer the plan. Our deductible ($250/$500 family) has not changed in at least 20 years. Coverage is 80/20 or 90/10 (in patient). Our benefits have increased over the last few years to cover things like well check ups, immunizations...that weren't covered in the past.

We have a DD with a rare genetic disease so we are grateful that the lifetime max has been removed and that they will allow her to remain on the insurance for her lifetime due to her disability.

My opinion is that medical providers over inflate the cost of goods and service. Example is a bill for DD earlier this year. Hospital bill was $73,467.97. PPO discount was $49,884.74. Leaving elibgble charges of $23,583.23. Someone without insurance is liable for almost $3/4 of a million dollars. Insurance paid all of it since we had already met our out of pocket of $2,500 for her this year.

 

[mom2rtk]

Do you guys with the nice Union plans know if your plans are subject to the ACA, just out of curiosity. I seem to recall that a number of unions were given exemptions.

 

[piccolopat]

And just to add, I believe in the Affordable Care Act. Having people insured, getting regular care is cheaper, in the long run, than what was done previously.

I think you are assuming that people with insurance will use the health care system. For many people, having a very high deductible only means most or all of their health care costs will be out of pocket AND they have the privilege of paying a premium to do so. When the cost of care is out of pocket, many people will only use it when they have no other option and regular preventative care is a casualty.

 

[manning]

I'm sorry OP. I feel your pain. I'm sick to death of hearing how we fixed the health care cost crisis in this country. No, we didn't. They just moved some deck chairs around. The iceberg is still there. All they did was shuffle around who the winners and losers are.

We had to move from our lower deductible plan this year when the monthly premiums got as high as our mortgage. We are now in the lovely world of $6K deductibles and hoping for the best.

And they are going higher, way higher, when full ACA kicks in in 2016

Yes your premium might go down but your deductibles will go up. WAY UP!!!

 

[manning]

I think you are assuming that people with insurance will use the health care system. For many people, having a very high deductible only means most or all of their health care costs will be out of pocket AND they have the privilege of paying a premium to do so. When the cost of care is out of pocket, many people will only use it when they have no other option and regular preventative care is a casualty.

Dream land will be crashing down soon.

 

[gwynne]

I think you are assuming that people with insurance will use the health care system. For many people, having a very high deductible only means most or all of their health care costs will be out of pocket AND they have the privilege of paying a premium to do so. When the cost of care is out of pocket, many people will only use it when they have no other option and regular preventative care is a casualty.

You left out the sentence before the one you quoted. This is what I said, and this is my opinion:

I think in the short term, it's challenging with insurance. Making sure to purchase the right coverage, right deductible for each family isn't easy. Long term? I'm not doom and gloom. I think it will settle out.

And just to add, I believe in the Affordable Care Act. Having people insured, getting regular care is cheaper, in the long run, than what was done previously.

And yes, I do "assume" people with insurance will use the health care system. It's a learning curve to choose the right coverage, right deductible and so on.
Regular preventive care use has gone up, and I expect it will continue.
I'm not saying it's easy, I'm saying we're all learning.

 

[mom2rtk]

You left out the sentence before the one you quoted. This is what I said, and this is my opinion:

I think in the short term, it's challenging with insurance. Making sure to purchase the right coverage, right deductible for each family isn't easy. Long term? I'm not doom and gloom. I think it will settle out.

And just to add, I believe in the Affordable Care Act. Having people insured, getting regular care is cheaper, in the long run, than what was done previously.

And yes, I do "assume" people with insurance will use the health care system. It's a learning curve to choose the right coverage, right deductible and so on.
Regular preventive care use has gone up, and I expect it will continue.
I'm not saying it's easy, I'm saying we're all learning.

But I used to get regular care and now I probably won't. All of us with high deductibles will be paying out of pocket for any routine care we want to receive. Many of us will choose to just pass on routine screenings. This can only lead to slower later diagnosis of serious chronic diseases, making them even more expensive to treat down the road.

Having coverage is not the same as having medical care.

 

[minnie56]

I cannot imagine ..

 

[Christine]

I'm sure you'll admit that everyone's experience is different? Because your experience has been good does not mean everyone else's has been. As I said upthread, all that happened is they chose different winners and losers. Some who had no insurance now have insurance. Some of us who had decent insurance now don't (which is how I classify it when a deductible rises 6 fold).

My biggest gripe about the ACA is that it took everyone's eye off the ball. Regardless of whether the effects are good, bad or indifferent, it did zero to bend the cost curve of health care downward. Costs continue to spiral out of control. Small and medium size employers are subject to wide swings in cost based on a small number of claims. Meanwhile, those crazy high claims continue to get more and more expensive because nobody did a thing to try and address those rising costs.

I suppose my husband could leave a job he loves to find a company with better benefits. But I thought one of the benefits of the ACA was to disentangle insurance from employment. It has had the opposite effect for us, pushing us to need to consider different employment BECAUSE of the insurance.

I absolutely agree/admit that everyone's experience is different. I chimed in on my experience because I wanted to show exacctly that every experience is different.

I wonder how some places keep things under control and costs down (seems to be the self-insured) while these corporations that are providing insurance keep skyrocketing?

I believe that with or without the ACA, you were going to see these type of high deductible plans being more prevalent. They were there before the ACA (they were new prior to the ACA) and I think they've just caught on in popularity. It is a way for people to get insurance and keep costs down. Personally, I think those plans stink. I think they would have exploded even without the ACA. Smaller companies (even larger ones) are forced to offer them as they look for ways to hang on to their money and pay less and less premiums for their employees.

The ACA's original intent was to disentangle from employment, but some of the best parts of the ACA were dropped out because they were unpalatable and too much of a change for our profit-driven health system.

The biggest fault was not going far enough with the Act. It should have been all or none. Midway is problematic. I'm sure many will disagree; it's just my opinion. I think the whole health care situation is a disgrace and embarrassment and it has been for quite some time.

I really don't know what the answer is as the path we were on wasn't good either. Well, I do know what I think would work but that's another discussion.

 

[Christine]

Do you guys with the nice Union plans know if your plans are subject to the ACA, just out of curiosity. I seem to recall that a number of unions were given exemptions.

Mine is.

 

[daughtersrus]

Do you guys with the nice Union plans know if your plans are subject to the ACA, just out of curiosity. I seem to recall that a number of unions were given exemptions.

According to the letter we received in Dec 2010, as of Jan 1, 2011 our plan had to comply with the requirements of the ACA. This is also the time that our benefits increased to eliminate a life-time max for medical bills, yearly max for things like PT, OT and ST, substance abuse treatment, chiropractic care and to include coverage for well/preventative care. Prior to that, well care for children including all immunizations were only covered for well care until 24 months with a limit of $150. Adults were allowed $600/year for a physical exam

Since this went into effect, a new contract has been negotiated and coverage did not change.

Our plan has always been self-funded and is managed by BC/BS PPO

 

[Pea-n-Me]

I have to agree. I think in the long term, the ACA will reduce health care spending. Ultimately, providers will be a little more cognizant of costs when making recommendations because users will push back more. For instance, we have been pushing back on my dad's doctors for requiring him to have repeat visits that are simply updates. To get him there, one of the three of us has to take a day off of work. With 4 or 5 doctors wanting to see him every three months or so, plus the various emergencies that have come up, it adds up. (And I do believe that they only bring him in because Medicare will pay. Not as much as they want, so why not make them come more often. Its no money out of his pocket, so the general patient wouldn't push back. But every time we see if we can extend the next visit, they have no problem with it.)

I don't know what your dad's medical issues are. But I'd like to offer a view from the "other side". Patients and families aren't the only one's who are scrambling - care providers are as well. Why? Because in 2013 as a direct result of the ACA, Medicare began instituting penalties against hospitals pretty severely in the form of "fines", or reduced Medicare reimbursements, if patients with certain conditions had any hospital readmissions within a 30 day period of discharge. If anyone has any familiarity with how often some people are readmitted to the hospital (for a variety of reasons, including those that are self-driven), they'd know this is a huge problem for hospitals. Hospitals had to then figure out how to deal with this problem, and the answer obviously had to involve follow up in the outpatient setting. Hence, we saw more "clinics" being set up, and more follow up in doctor's offices, and other minute details like making sure patients had follow up appointments scheduled before they left the hospital as opposed to them making them themselves (which was often not done) and winding back up in the hospital, etc. Nobody likes it. But it isn't just "because Medicare will pay" - they are likely just working very hard on follow up so as to keep him out of the hospital via tight oversight of his medical care in the community.

https://www.advisory.com/daily-brie...als-will-pay-readmissions-penalties-next-year

And BTW this isn't the only way Medicare has instituted penalties on hospitals.

 

[Kathryn Merteuil]

Sorry to hear, I fear DH's situation is going to get us there too.

 

[Pea-n-Me]

Perhaps people with union plans have seen less play in their costs because unions fight hard to keep costs of their medical plans low.

For those who do not have union plans, or have plans that have mostly stayed the same, more power to you. It hasn't been the case for many of the rest of us - our costs have gone up substantially. I think mom2rtk has it right, it just got shuffled around.

As I mentioned earlier, I've never had as many medical bills as I've had in the past few years. I should probably knock on wood, but I have two more bills to pay off and that will finally be it for a while. But some of the bills were crazy, like getting billed separately by anesthesia groups, and pathology tests, as well as generaly co-pays for one proecdure - this was not something I'd ever seen before. I had so many bills I actually sort of lost track of what we owed so I had to make charts. And no, no hospitals were willing to discount at all, the most they would do was set up payment plans.

Compare this to 11 years ago when I underwent almost a year's worth of cancer care (surgery, chemo, radiation) and never paid one bill out of pockety beside my copays. (And yes, I kept a tough job with a tough commute in part because of the good medical insurance plan.)

 

[Pea-n-Me]

In my FIL's case, that proved to be a moot point. FIL had to be flown via life flight 100 miles. Twice MIL has called with a substantial amount in hand and offered to pay that amount on the bill if they were willing to zero the balance. No such luck.

They are now paying life flight $25 a month for the next 35 years and they are in their 70's both retired.

Granted they could pay a little more, but FIL views it as, they won't budge, I'm not budging.

I'm curious about this. Is it a hardship case, or that they just don't want to pay the full amount?

Just wondering what would happen to the Life Flight program if everyone did this.

 

[Ceila]

I guess this a vent about health insurance. My deductible is $5,500 after that it is a 80/20 max $11,000. We are a family that uses our insurance. That being said I have been paying off medical bills for the last 10yrs. I am medically bankrupt. I am a nurse and make a decent living, but I could just cry b/c so much of my check goes to those bills. We live paycheck to paycheck and I have not been able to put anything away for upcoming bdays,holidays and fall things we like to do. I am going to apply for financial assistance from 2 hospitals to see if they could help. I do have the money to pay a little every month,but I see no end in sight. Such hard working middle class people who are poor b/c of medical care.

I have 11 years left on my mortgage. At that time I will be 55. Otherwise I am debt free at 41 raising 2 girls. When the house is paid off that money will be used for DD#2 college education. I max out my Roth Ira every year and have an excellent retirement fund growing. I just accepted a new job and my employer yearly will put in 15% of my annual income into retirement. I will then add another 10% so that is not too shabby. This is my forever home so ay 65 I am hopeful to retire very comfortably.

I'm a bit confused. Are you medically bankrupt and living paycheck-to-paycheck, or are you debt free except for your mortgage and setting aside a nice sum for retirement?

 

[mnrose]

I'm a bit confused. Are you medically bankrupt and living paycheck-to-paycheck, or are you debt free except for your mortgage and setting aside a nice sum for retirement?

Hmmmm.