JustCare

Tag: Emergency care

  • Medical debt on the rise

    Medical debt on the rise

    New research from the Peterson Center on Health Care and the Kaiser Family Foundation finds that Americans are now holding at least $195 billion in medical debt. Nine in ten of them have health insurance. Emergency care, COVID-19 care and mental health care are the three biggest causes.

    Three million Americans owe more than $10,000 in medical debt, and 16 million Americans owe more than $1,000. Not surprisingly, the most vulnerable Americans face the greatest debt. Researchers say that “Medical debt can happen to almost anyone in the United States, but this debt is most pronounced among people who are already struggling with poor health, financial insecurity, or both,”

    In a separate survey of 1,250 people, researchers found that more than half (55 percent) say they have some medical debt. And, almost half of these people report not being able to purchase a home or put money aside for retirement as a result.

    Nearly seven in 10 people (69 percent) who purchase their own health insurance have medical debt and just over six in ten (61 percent) who have employer coverage have medical debt. Just under six in ten (59 percent) without health insurance report having medical debt.

    People with health insurance appear to have the same rate of medical debt as people without health insurance. But having health insurance limits the amount of debt people have. Health insurance deductibles have sky-rocketed over the last several years, presenting a barrier to care for many Americans. They are also a driver of medical debt.

    Employer plan deductibles average $1,669 in 2022 for people who work for large employers. People working in companies with fewer than 200 workers face even higher average deductibles, $2,379. And, individuals with state health insurance exchange plans and no subsidies faced average deductibles of $4,364 in 2020.

    Total average out-of-pocket costs for health care are now $12,530. That includes premiums, deductibles and copays. And, it represents about 20 percent of the typical person’s annual income, $67,521 in 2020.

    People not yet eligible for Medicare, with incomes between 100 and 400 percent of the federal poverty level, are entitled to subsidies on health insurance through the state health insurance exchanges, which can bring down their health care costs significantly. People with Medicare with low incomes are also eligible for government assistance paying premiums, deductibles and coinsurance, through Medicaid and Medicare Savings Programs.

    To minimize your costs, plan ahead. If you have Medicare, to save money, make sure you have the number of the local ambulance that takes Medicare on your phone and your refrigerator. If you’re in a Medicare Advantage plan, have the number of an in-network ambulance.

    Here’s more from Just Care:

  • Round up: Emergency care

    Round up: Emergency care

    As you know, health care costs can be sky high. Regardless of what you pay, your health outcomes depend heavily upon the quality of care you receive. Since emergencies are by definition unexpected, it’s important to think about what could be in store for you and to plan ahead for a medical emergency.

    Preparing yourself:

    Making sure Medicare covers your care:

    The importance of a good primary care doctor:

    Your hospital care:

    Thinking about costs:

    And, for the broader picture:

     

  • How to protect yourself from surprise medical bills?

    How to protect yourself from surprise medical bills?

    Watch out for huge medical bills if you visit the emergency room and are enrolled in a commercial health plan. They are common, and Kaiser Health News reports that these bills are often permissible. What should be done to end surprise medical bills? Medicare for All, of course. How can you protect yourself from surprise medical bills?

    In today’s commercial health care system, you want to avoid out-of-network emergency care if at all possible. Plan ahead and identify the emergency room in your health plan’s network and the in-network ambulance that will take you there. If not, here’s one example of what can happen: In the Spring of 2017, St. David’s Medical Center charged a teacher $108,951 for his four-day emergency stay after a heart attack. St. David’s, in Austin, Texas, is operated by HCA Healthcare, the nation’s largest for-profit hospital chain. The teacher’s insurance had paid $56,000 for his out-of-network care. But, the hospital billed the teacher for the difference.

    Fortunately, the story got a lot of media attention. And, shortly after Kaiser Health News and NPR reported it, St. David’s  cut its bill down first to $782.29 and then to $332.29. But, what about all the people with exorbitant medical bills that do not get major media attention?

    What’s particularly noteworthy is that the reduced bill does not reflect St. David’s acknowledgement of billing errors on its part. The hospital’s original bill was intentional. Indeed, the hospital claims it “did everything right in this particular situation.” How? The hospital had let the teacher know that he might be able to get a “discount” on his bill based on his income. 

    The issue, of course, is the legitimacy of St. David’s charges. It stretches credulity that the teacher’s four-day stay could have cost the hospital anything close to the amount it billed. The fact that it slashed the additional charge down to a few hundred dollars immediately after it came to public view also suggests the bill should not have been sent.

    But, in this case, the teacher had insurance through his employer’s self-funded health plan. And, according to Kaiser Health News, ERISA, the federal law concerning self-funded health plans, allows hospitals and doctors to charge patients receiving out-of-network care seemingly whatever they please on top of what their employer plan pays. About six in ten people with employer coverage are enrolled in an ERISA plan.

    Surprise hospital bills are pervasive, particularly when people are seeking emergency care. Some states have stepped in to protect their residents from surprise bills in a limited way. But, not enough. And, Congress has yet to address this serious issue. According to Congressman Lloyd Doggett, “This is a nationwide problem, and we need a nationwide solution.” 

    If your health care coverage is not from your employer through a self-funded ERISA plan, you should be protected from some of these exorbitant surprise bills. The Affordable Care Act permits out-of-network hospitals to bill patients only what they would have paid in an in-network hospital. That said, the ACA still allows out of network ambulances, doctors and hospitals to charge patients for whatever their health plans do not pay.

    If you get surprise medical bills, you should appeal to your health plan to pay them. And, if that does not work, contact your Congressman and Senators as well as your local newspaper and Kaiser Health News to report your story. It’s important to keep the pressure on Congress to address this issue.

    No one should be forced into extreme medical debt or bankruptcy because of a medical or hospital bill, or for that matter, a prescription drug bill. Medicare for All would put an end to these bills. Not surprisingly, the majority of Americans support Medicare for All and an ever increasing cohort of Democrats in Congress do as well.

    If you support Medicare for All, please let Congress know. Sign this petition.

    Here’s more from Just Care:

  • Choose your hospital emergency room carefully

    Choose your hospital emergency room carefully

    Who knows when a hospital emergency will strike, but it is more frequently than you would expect. In 2015, there were 433 emergency room visits for every 1,000 people. To the extent possible, it is wise to be prepared and choose your hospital emergency room. A little homework while you are feeling good, can ease stress, reduce costs and mean better care. Here are three things you can do now:

    1. Understand your hospital options and discuss them with your doctor. Different hospitals rank higher than others in the quality of care they deliver. Some hospitals are poor on patient safety. And, some offer better emergency care than others. A University of Michigan study linking emergency room care with patient outcomes shows a connection between the number of emergency room cases a hospital gets and patients’ survival, particularly for patients with life-threatening conditions. The busier the emergency room, the higher the survival rate. The study’s authors estimate that if all patients with serious conditions used the busiest emergency rooms, 24,000 fewer people would die each year. Do not rely exclusively on Medicare’s hospital compare tool; also check the Informed Patient Institute, which rates the usefulness of different online tools.
    2. Identify the hospital you would want to use in an emergency. Traditional Medicare covers care at virtually any hospital. If you are enrolled in a Medicare Advantage plan or other commercial health plan, make sure the hospital is in network to ensure continuity of care after the emergency passes. Commercial health plans, including Medicare Advantage plans, must cover emergency care no matter where you get treated. But, your health plan may only cover follow-up care in a network hospital, unless your health is endangered.
    3. Find the number of an ambulance in your health plan’s network that will take you to that hospital, share it with a health care buddy, a family member or friend, and keep it in a safe place. Traditional Medicare will cover any ambulance that complies with its rules. A commercial Medicare Advantage plan or other commercial health plan may only cover an in-network ambulance. Just Care offers tips for keeping your ambulance costs down here.

    Here’s more from Just Care:

  • Anthem penalizes patients who seek emergency room care

    Anthem penalizes patients who seek emergency room care

    Your heart is racing, your head is spinning, you have excruciating stomach pain. Should you go to the emergency room? Even with health insurance, you may end up paying the entire cost of your ER treatment, if it is later determined that you did not need emergency room care. Leslie Small reports for FierceHealthCare that, in select states, Anthem Blue Cross Blue Shield, the largest health insurer in America, does not cover ER care in these circumstances, penalizing patients who are afraid for their health and seek emergency room care.

    New Anthem policies now make some exceptions to Anthem’s general practice in Georgia, Missouri, Kentucky, New Hampshire, Indiana and Ohio of denying coverage to patients who seek emergency care when it turns out they did not need it. It will cover care for patients who are directed by their doctors to go to the ER, for patients under 15, for patients post-surgery or testing, and for patients traveling out of state.

    On its face, Anthem’s failure to cover emergency care when it turns out not to be needed is unconscionable, even with the new policy exceptions. Adults may not be able to distinguish between a heart attack and heartburn or hundreds of other symptoms that may or may not turn out to require emergency attention. Forcing people to absorb the full cost of their ER care if Anthem deems it unnecessary based on their diagnosis is tantamount to deterring people from using the emergency room when it might be critical.

    Most people visit the ER because they believe their condition is serious, but they usually cannot know for sure; they need trained professionals to make that determination. Even doctors in potentially emergency situations may not know whether ER care is needed. Moreover, the idea of needing to reach your doctor for permission to visit the ER, to ensure coverage, in the course of a perceived emergency, is preposterous.

    It is completely reasonable to encourage people to get needed care at the doctor’s office or a clinic, where appropriate, and not the ER. But, it is beyond unreasonable to deny people ER coverage altogether based on their ultimate diagnosis as a way to discourage ER use. It may deter them from getting necessary care or may put them at serious financial risk. As it is, through large deductibles and copays, insurers ration care based on people’s ability to pay, putting people’s health in jeopardy and lives on the line.

    As Michael Hiltzik writes for the Los Angeles Times, state regulators need to ban Anthem’s anti-consumer ER coverage policy swiftly.

    Here’s more from Just Care: 

  • Medicare should cover dental, vision and hearing services

    Medicare should cover dental, vision and hearing services

    A new paper in JAMA, by Amber Willink, Cathy Schoen and Karen Davis, explains why Medicare should cover dental, vision and hearing services. Right now, these three services, along with long-term care, are the biggest gaps in Medicare coverage. Lack of coverage for these services may lead to unnecessary hospitalizations and can push older adults into bankruptcy. Expanding Medicare to cover these services would benefit older adults, people with disabilities, health professionals and the Medicare program.

    A survey of people with Medicare in 2012 reveals that most people with Medicare end up going without needed vision, dental and hearing care. Three-quarters of people surveyed reported hearing difficulties and more than four out of five of them (84 percent) did not have a hearing aid.

    About 11 million people with Medicare (about 20 percent) said that they had trouble eating because of problems with their teeth, but seven in ten of them had not seen a dentist in the last year. (Here are some tips for getting free or low-cost dental care if you have Medicare.)

    Another 20.5 million people with Medicare reported problems with their eyesight, yet more than half of them (57 percent) had not had an eye exam in the past year. (Here are four things to do to protect your eyesight.)

    Cost is the primary reason people do not get these services. Hearing aids alone typically cost $4,700 for both ears. (That said, low-cost hearing aids may be available soon.) On average, people who received services spent $927 for dental services, $715 for vision services, and $1338 for hearing services.

    Not surprisingly, people with incomes under 100 percent of the federal poverty level were far less likely to get these critical services than people with incomes over 400 percent of the federal poverty level.  In most states, Medicaid does not pay for much if any vision, hearing or dental care.

    People who forego this care are far more likely to be hospitalized or to need emergency care than people who receive treatment for their vision, hearing and dental needs. There are currently two bills in Congress that would cover these services, but for now they appear to be going nowhere.

    Here’s more from Just Care:

  • Paramedics help people avoid emergency rooms

    Paramedics help people avoid emergency rooms

    A new initiative is underway around the country to use firefighter paramedics to keep people out of hospitals and direct them to appropriate primary care or other services. And, it’s working! With support from the California Health Foundation, firefighter paramedics in the Golden State are being trained to identify individuals who use hospital emergency rooms frequently for non-emergency situations and, instead, pay them regular visits. The goal is to get them needed care so that they don’t call 911 or need to use the emergency room. The paramedics call on them in their homes and connect them to regular doctors or other services that can keep their health on track.

    In California, with authorization from the State Emergency Services Medical Authority, 13 jurisdictions are participating in this pilot program. Some of the programs focus on people who have just been discharged from hospitals. Others treat “frequent flyers” who are thought to use emergency rooms more than necessary.

    Conventional paramedics typically spend about 20 minutes talking with the 911 callers in their homes and another 20 minutes taking them to the hospital. Instead, community paramedics partner with people in need of care and create a plan with them so they get access to the services they need most that can help them better care for themselves. Not surprisingly, their clients want this help and are willing participants.

    The paramedics drop by to visit patients and work with them to achieve their goals, including checking their blood pressure, ensuring they take their prescription drugs,  and undertaking bio-psycho-social assessments of their situations. If appropriate, the paramedics may refer them to a social worker, arrange for home-delivered meals, connect them to local agencies that treat substance abuse disorders.

    In short, these paramedics show they care. As a result, these patients have had fewer hospital visits and a better quality of life.  For more information, click here. To learn more about the high number of older adults living alone, elder orphans, for whom these services can be life-saving, click here.