Under health insurance exchanges, patients are bearing the burden of higher costs. More patients are now paying a higher percentage of their premiums than they have in earlier years. Many patients have only been responsible for a copay. However, most of the plans under the new exchanges require a patient to pay a yearly deductible. We have seen many irate people who don’t understand why they have to pay this. Most people understand the new rules but the ones that don’t are truly disillusioned. This is proving to be a significant burden for many to pay out money they were not expecting to be responsible for. Sometimes, they need to decide if the medical treatment they are seeking is truly worth spending money to obtain. Their medical well-being becomes a budgeted item, rather than a right.
How can patients’ expectations be brought to reality?
-when a person signs an insurance contract, they should understand the exact terms of what they are signing. This hold true for anything, not just insurance contracts. If someone is unaware that they have a deductible, it will not make it go away. They are liable to pay all deductibles and it would behoove everyone if both sides try to make sure this is clear.
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-Doctors need to inform the patient up front that they have a deductible. We do this prior to seeing the patient so they are aware that they will be responsible for paying a certain amount.
– Medical office staff needs to understand these rules and be able to explain them to patients. It is not enough just to tell the patient they owe a certain amount of money. The staff needs to be able to explain why.
-Insurance cards should have the deductible written on them along with the copay. Most patients pull out their cards and say that according to this, they are just responsible for the copay. This is in fact not always true. The benefits and responsibilities should be clearly written on the card so there is no confusion.
-Insurance companies should have support staff available to answer patient questions about coverage. We hear all too often that the patient did try to call their insurance company and were unable to speak to a live person.
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The new insurance exchanges that have been rolled out have been fraught with many problems that we are all aware from media outlets. However, we are now starting to see some of the impact it is playing in our daily lives. Patients are unhappy because they are responsible for subsidizing a larger part of their healthcare costs. And for many of them, their expectations were not set at an appropriate level to start with. This has led to some bitter exchanges with the office staff, who are not happy for this reason. Additionally, physicians are not happy because all too often this means getting paid in a less than timely fashion, if at all, for work that we are fully entitled to receive payment. The new deductibles are indeed placing a burden on many and something needs to be done before more chaos ensues.
Dr. Linda Girgis MD, FAAFP is a family physician in South River, New Jersey. She has been in private practice since 2001. She holds board certification from the American Board of Family Medicine and is affiliated with St. Peter's University Hospital and Raritan Bay Hospital. She teaches medical students and residents from Drexel University and other institutions. Dr. Girgis earned her medical degree from St. George's University School of Medicine. She completed her internship and residency at Sacred Heart Hospital, through Temple University where she was recognized as intern of the year. She is a blogger for Physician's Weekly and MedicalPractice Insider as well as a guest columnist for HIT Outcomes. She has had articles published in several other media outlets. She is on the medical advisory board of SERMO. Recently, she has authored the book, “Inside Our Broken Healthcare System” and "The War on Doctors". She has been interviewed in US News and on NBC Nightly News.
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