by – Sheri de Grom
An irony of the Affordable Care Act (ACA) is that millions of people have gained access to insurance but their deductible is so high that it’s left them uninsured.
Providers are reporting the largest increase in bad medical debt for people with insurance since the great depression.
Insurance has always been purchased to cover loss. The Affordable Care Act turned healthcare upside down and we see the unfortunate results daily. Healthcare is no longer insurable.
The truth about the ACA is that a high percentage of enrollees have plans with elevated yearly deductibles. The amounts are so high, people report they are still uninsured because they can not meet the deductible.
The rise of high-deductible plans is driving the rise in medical debt. The average deductible for a single person enrolled in an employer-sponsored healthcare plan reached $1,217 in 2014, a 7% increase over the previous year. By 2019, providers could see a 50% decrease in the amount of revenue they will be collecting directly from patients. Thirty percent of that amount, or as much as $200 billion will be written off, according to industry forecast.
Healthcare providers once considered individuals with insurance to be low risk for bad debt. Today, those without insurance are being joined by individuals with high-deductible insurance and they now owe thousands of dollars in medical debt.
New patients are routinely asked if their policy was purchased through the ACA marketplace or if it is employer-backed. If the answer is ‘marketplace’, the patient is often turned away. The medical practice understands the marketplace insurance comes with high annual deductibles and high co-payments regularly leading to uncollectable debt.
Hospitals and physician groups alike are learning they must approach debt collection in a different way than in years past.
Small physician practices do not have as much room for give and take negotiating debt with their patients. They want to maintain the personal touch but the Affordable Care Act has taken away what were once physicians practicing medicine with that hometown touch.
Hospitals and large medical clinics are learning from retail about collecting bad debt:
- Keep bad debt in-house. Once a collection agency is involved it can cost as much as 33% of any unpaid balance for the agency to manage the debt even if collections are unsuccessful.
- Pre-screen patients with a short financial form for any service over $250. Reach a payment schedule before treatment and the first payment before the treatment.
- Try to establish a conversation with the patient regarding their bad debt. Studies have shown the patient will pay part of their bad debt when treated with kindness and understanding.
- Always when attempting to collect a bad debt, give your employee the power to negotiate the bad debt. It’s better to get $500 cash today than to never collect the $2,500 due.
Collection prospects decreases as medical debt increases. The shocking reality is healthcare providers today are collecting $0.18 to $0.34 on the dollar from patients with high-deductible plans. Once a bill exceeds 5% of household income, a patient’s propensity to pay drops to zero.
You, your families and loved ones have the right to appropriate healthcare. We all must meet our financial obligations but we all deserve to be treated with human dignity. When illness strikes, we all need that extra touch of kindness.
The latest fallout of the Affordable Care Act, on a personal level for me, is that my internist has decided to retire at the end of the year. In his words, “The Administration, Congress and the Supreme Court do not know my patients or how to care for them, medically. I’m the doctor and you are my responsibility. I can no longer care for you in the way I believe is best for your health.”
In the past 40 years I’ve only had one internist I liked as much as the one I’ll have until the close of 2015. They both saved my life with their excellent diagnostic skills. However, I understand the continuing frustration my current internist faces daily. It is indeed maddening. He was recently elected as the best internist in a 21-state region by his peers. I would have gladly added my affirmative vote.
Thank you for your support, friendship, love and the many prayers you bestow upon Tom and I daily.
Many of you have become like family to me and I cherish the notes that arrive by e-mail [even if I don’t answer immediately], the cards that arrive by mail, and telephone calls as if you know when I need them the most. You always ask about Tom and of course the story of how we’ve survived all these years with his bipolar disorder has been the primary focus of my blog from it’s inception. For years I asked psychiatrist for books, journal entries or anything I could read so I would know what to expect from his bipolar disorder as we entered the afternoons of our lives. Now I understand why nothing had been written all those years ago. THE DOCTORS ALL EXPECTED TOM WOULD BE DEAD.
An update on Tom’s health: He’s still bedridden many days due to any number of diagnoses playing havoc with his body. However, on the days he’s able to be up and about; he is able to do so by using the walker.
After 7 months of being mis-diagnosed and having such horrific pain on the bottoms of his feet, we have a new rheumatologist that correctly diagnosed psoriatic arthritis. Unfortunately the oral medications didn’t work and he’s now on a schedule of infusions. We recognize the risk involved but when he feels up to walking, he can do so as long as he has the energy.
The horrendous coughing I talked about in my blog of Aug 30, 2014 may have finally met its match in a new Pulmonologist who continues to work with us. He’s definitely a keeper for Tom’s medical team. The coughing hasn’t stopped but, we now know how to treat it and Tom doesn’t spend the night sleeping on the bathroom floor.
This doctor did much testing and by placing the pH probe for gastroesophageal reflux at the entryway where food leaves the mouth and starts the beginning of its journey to digestion, he was able to determine the initial cause of Tom’s coughing. Tom’s had dozens of pH probe tests in the past but they all read negative because the probe was placed much lower, as is normal for other patients. [Let’s face it, there’s nothing normal about Tom’s body].
Tom has never had any of the symptoms of Gerd or Reflux disease. This is the same as he’d never had chest pains but he was still on the edge of dying from a 100% left bundle blockage of the heart. For me, Tom’s caregiver, I have witnessed years of Diagnostic Overshadowing, which I talked about in my blog of Aug, 30, 2015. As a result of the coughing not being diagnosed and the Gerd not being tested properly and diagnosed, Tom’s trachea ‘(windpipe) the airway that leads from the larynx to the bronchi, which are airways that lead to the lungs’ don’t function. He has developed tracheal stenosis as his trachea is shredded from top to bottom. Twenty-five years of coughing and extreme acid causes Tom’s trachea to collapse without warning and when it does, he must have immediate help. HE CANNOT BREATHE.
This new development has caused a complete shift in my caregiving and I’m learning as I go. Every day I thank God that I can help.
His daily intolerable migraines have become severe and include projectile vomiting, sensitivity to light and all that most of us with migraines know as the major symptoms. His heart problems complicate his migraines and their treatment. We are trying some herbal remedies and I’m open to any non-narcotic suggestions.
I can honestly say Tom’s medical issues are no longer about being bipolar. The physical illnesses attacking his body are a direct result of diagnostic overshadowing. Bipolar disorder is one of his 32 diagnoses we worry the least about. However, we still keep occasional appointments with his masterful psychiatrist.
Until next time, love to all. My blogs have been further apart this year because my responsibilities at home have increased a thousand fold. I have massive amounts of paperwork to prepare both Tom and I for the next phase of our life. However, I hope to be around to pop in with a blog here and there. I’ll also do my best to keep up with reading and commenting with you. I do love our conversations.