JustCare

Tag: Out-of-network care

  • How to avoid medical debt

    How to avoid medical debt

    A recent Kaiser Family Foundation report reveals the many ways the healthcare marketplace for people under 65 is designed to promote medical debt. People with insurance as well as those without insurance struggle to pay bills. Health care affordability remains a big issue. But, there are ways to avoid medical debt or at least reduce your likelihood of going into medical debt.

    More than one in four U.S. households with people under 65 report struggling to pay a medical bill or being unable to pay the bill in the last year.  While people without insurance struggle most, people with employer coverage, Medicaid, and people who buy their own coverage also experience problems. What’s worse, more than 30 percent of people who struggle with these bills report delaying or foregoing needed care. And more than a third could not pay for heat, housing, food or other basic necessities because of their medical bills.

    If at all possible, you should have health insurance. Obamacare made it easier and less expensive for most people–without employer coverage and not yet eligible for Medicare–to get insurance; unfortunately, not everyone is eligible for Obamacare.  If you are eligible, you should be able to get free help understanding your health insurance options and applying for coverage in your state’s health insurance exchange. Get covered if you can. More than half of people without insurance reported household problems with medical bills in the last 12 months.

    If you have insurance, you can keep costs down my making sure you use in-network doctors and choose a health plan with a low deductible. About one in five people with insurance–employer, Medicaid or individually purchased–reported problems paying medical bills.  About a third of the problems stem from getting out-of-network care, usually without being aware that the provider was out of network. And, often the insurance deductible keeps people from affording their care.  People with high deductibles have to pay a lot out of pocket before their coverage begins, and they struggled about sixty percent more often (26 percent) than people with lower deductibles (15 percent).

    Find out about free community resources if your income is low or you need a lot of costly care.  For example, Federally Qualified Health Centers provide primary care health services on a sliding scale in rural and underserved communities. To find a health center near you, click here.  If you’re a Veteran, the VA is also a good source for free or low-cost care.

    People with lower incomes and in poorer health or with greater health needs struggle with medical bills more than others.  Almost four in ten people (37 percent) with incomes under $50,000  have household medical bill issues. And, nearly half (47 percent) of people who struggle with activities of daily living report problems.

    More than forty percent of those struggling to pay bills (44 percent) say the bills have had a major impact on them, Almost sixty percent of people with household medical bill problems say they used all their savings paying their bills. And, 26 percent report dipping into their retirement, education or long-term savings accounts.

    Medical debt is a problem in need of a smart solution. 

  • Out-of-network coverage harder to come by

    Out-of-network coverage harder to come by

    If you’re shopping for health insurance in a state health exchange, you may be hard-pressed to find a plan that covers your out-of-network care. And, that could mean huge out-of-pocket costs for some people. A new Robert Wood Johnson Foundation report shows that in 2016 fewer people will have access to Preferred Provider Organizations (PPOs)–the plans that tend to offer out-of-network coverage.

    Why should you consider out-of-network coverage?  Even if you’re healthy, you may need it. If you travel, live in a different location for a part of the year or have family who live in another location, out-of-network coverage helps ensure you can get the care you need wherever you are. Or, you may be diagnosed with a costly or complex condition for which you want to see a doctor who is out of network. Part of the cost of your doctors’ and hospital care will be covered, both in your community and in other parts of the country as well.

    Moreover, you may end up using out-of-network doctors for reasons outside your control–the anesthesiologist or radiologist in your network hospital, for example, may be out of network. Out-of-network coverage should give you some protection if a non-network physician treats you while you are in hospital. Click here to learn about how to protect yourself against unexpected bills when you are in the hospital.

    For people without good out-of-network coverage, costs can be off the charts. A new report from America’s Health Insurance Plans documents the excessive prices doctors and hospitals often charge for out-of-network care.  In New York City, you can spend a day in the emergency room to treat a dizzy spell and the bill can total over $10,000. But, if your care is in-network, the hospital’s negotiated rate with your insurer could be $900, 90 percent less.

    Today, there’s no limit on the amount hospitals and doctors can charge for out-of-network care. In most states, they do not even have to disclose their rates.  So, if you do get out-of-network coverage, find out what percentage of the cost your health plan will pay for and whether there is a limit on your out-of-pocket costs for out-of-network care.

    In 2014, only about 35 percent of health insurance exchange plans were PPOs offering out-of-network coverage.  In 2016. people in 37 states will have far fewer PPO choices. Washington D.C., New York and New Jersey offer no PPO options in their state health insurance exchanges.

    If you’re eligible for Medicare, keep in mind that traditional Medicare affords you the most comprehensive coverage, since you have very low or no out-of-pocket costs no matter which doctors you see or hospitals you use anywhere in the country, so long as you have supplemental insurance.

  • Many Americans billed for care they thought was covered

    Many Americans billed for care they thought was covered

    A new survey of Americans by Consumer Reports National Research Center reveals that nearly one in three insured Americans (30 percent) are billed for care they thought was covered; they receive bills for services they expected their health plans to pay for. Almost a quarter of them received a doctor’s bill they did not expect. Of those who received these bills, more than a third took no action. And only a small fraction (28 percent) understood their right to appeal these bills and how to do so.

    Most of the people who receive these bills are not happy with the way the payment issue is resolved.  Survey results suggest that the majority of Americans pay these bills. Only 28 percent of people surveyed were satisfied with the outcome.

    The problem is that even when insured Americans use network hospitals, their health plan does not guarantee that the doctors who provide their care are also in the network.  It’s often hard for a patient to avoid getting care from out-of-network doctors, particularly radiologists, anesthesiologists and pathologists. And, it is especially difficult to avoid receiving out-of-network care in emergency situations. Click here for more information on how to protect yourself.

    Consumer Reports is advocating for consumer protections that would prevent patients from receiving these unexpected bills in emergency situations and ensure consumers had notice before out-of-network doctors treated them.  New York recently passed a law to this effect.  And, several other states are now considering similar laws.

    If you receive a medical bill that you don’t think you should pay, it’s always smart to appeal. Consumer Reports has launched a web site to help consumers figure out where to go to fight medical bills they believe their health plan should be paying for. People with Medicare have appeal rights that are very simple. And, most people who appeal win.

  • Two questions you should answer during the Medicare Open Enrollment Period

    Two questions you should answer during the Medicare Open Enrollment Period

    For anyone on Medicare and many caregivers, Medicare’s Open Enrollment Period is a time to reconsider coverage options. The open enrollment period runs between October 15th and December 7th this year. Here are two questions you should answer during the Medicare Open Enrollment Period:
    1. Is your Medicare doctor and hospital coverage meeting your needs?
    • If you’re in traditional Medicare and have supplemental coverage, you might be paying a little more than if you are in a private Medicare Advantage plan, but you have the widest choice of hospitals and doctors. And, you have good protection against health and financial risk.
    • If you’re in a private Medicare plan, you might save some money upfront, but you have a limited group of doctors and hospitals you can use. If you end up needing a lot of health care, it’s hard to know whether the doctors or hospitals in the health plan’s network will meet your needs. If you use out-of-network doctors and hospitals, you will likely spend a lot out of pocket for that care, more than your costs in traditional Medicare with a Medicare supplemental plan. Also, if you will be traveling out of area and you need care, it’s not likely your care will be covered, except in emergencies or urgent care situations.

    2. Is your Medicare (Part D) drug coverage meeting your needs? If you have Part D drug coverage, you should consider your options and not assume that the plan you have is still the one that you want or will cover the same drugs with the same cost sharing next year. The Part D plans often change the drugs they cover and the terms under which they cover drugs from one year to the next, as well as midyear sometimes. What makes sense this year may not make much sense at all next year. In 2015, the average monthly premium nationally is $32.

    To compare Medicare plan benefits and cost, visit the Open Enrollment Center page on the Medicare website.