Monday, November 02, 2015

Musings on ACA Open Enrollment Day

I’ve paid you enough
This is an actual sentence uttered to me by a patient who was resisting coming back in for an appointment to see the physician regarding treatment of a severe infection. The physician wanted to monitor her during her run of medications, but due to her high co-pay and astronomical deductible, she “felt” that she had already paid enough.

I need to cancel this test for now.  My insurance will not pay because it will go straight to the deductible which is $5500 and my family has not even met it yet.  I CAN NOT AFFORD A LARGE MEDICAL BILL. I will just have to wait until next year, maybe August 2016 before i can have the test.”

This is a message another patient left on the portal, canceling a rather important test due to her high deductible.

Then from my medical practice list serve was this quote regarding patients paying their co-payment and out of pocket expenses:

We are looking to strengthen the policy about collection of deductibles but sometimes the amounts are just too darn high that folks don't come in because they are not able to pay for them.

Classic example:  The patient's deductible is literally $5.000.00 who is not coming in the door with this kind of money even with enough balance on their credit limit to pay for it even if having one.  Meaning that if we verify coverage before they come in it's still not helping.”

Now, correct me if I am wrong, but wasn’t the ACA supposed to LOWER medical costs to encourage patients to INCREASE their visits to the physicians? What I and my colleagues across the country are experiencing is that patients are not coming in for their visits, citing costs as the most common reason for cancelling their appointment or putting off treatment.

I noted several years ago that more patients had plans with high deductibles and that our bad debt by patients was rising, I instituted a payment plan to help my patients pay their large medical bills. I became more proactive in contacting the patients regarding high out-of-pocket expenses and then setting them up on a payment plan, anywhere from two to six monthly payments, to handle their expenses.  For some patients, even payment plans do not work because they do not have any extra money. It is becoming more difficult to collect monies owed by patients and I do not see it becoming any easier in the near future.

So, as Americans go to the Marketplace today and in the next few weeks and are enticed to buy a bronze plan because the premiums are lower, please remember to look at the deductible and calculate if you can “afford” to have such “inexpensive” health insurance.
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