Honorable Donna M. Christensen
We are in the midst of a national crisis affecting the lives of more than 100 million Americans, including Pennsylvanians. This crisis is worsening racial disparities in health and wealth. It’s stopping some Americans from saving for retirement and others from investing in their children’s education. It’s forcing patients who may have just months to live to spend their last days on earth fighting corporations over medical bills and coverage. This is the crisis of medical debt in America, and it’s crushing millions of hardworking families.
That’s why this October – Health Literacy Month – Consumers for Quality Care (CQC) is sharing information that Pennsylvanians can use to help keep their out-of-pocket health care costs low and avoid medical debt. The key tips are to avoid tricky health insurance plans and policies, to ask good questions about charity care options, and to know your consumer rights if you ever get stuck with a surprise medical bill.
Choosing the right health insurance has a huge impact on Americans’ finances. When choosing insurance for you and your family, it’s important to watch out for Short-Term Limited Duration Insurance plans, or STLDI plans. These so-called “junk plans” are insurance in name only, and are exempt from many of the consumer protections found in the Affordable Care Act (ACA). Although they may have lower monthly premium payments, STLDI plans often exclude pre-existing conditions, have dollar value limits on covered services, and aren’t required to cover preventative medical services at all. In fact, for every $1 you pay in premiums, STLDI plans often spend less than 10 cents on your health care – and out-of-pocket expenses can pile up quickly under these plans.
But it’s not just junk plans that lead to high out-of-pocket costs and medical debt. The rise of health insurance plans with high deductibles (the amount you are responsible for before your insurance begins covering treatment), high copays (the amount your insurance requires you to pay for a treatment), and high coinsurance (the percentage of costs of a covered service you pay even after you’ve met your deductible) means that insured Pennsylvanians seeking care are often left with large bills they are unable to pay.
Some of these plans also include copay accumulators that shift prescription medicine costs from the insurance companies to patients by blocking any financial assistance you receive – like a voucher or a coupon – from counting toward your deductible. It’s like paying for your groceries with a gift card, but when you swipe the gift card and the store takes all the money from it, they still won’t let you have your groceries until you pay again – for a second time – with cash from your own pocket. It’s insurance company double-dipping, and it has left many Americans mired in debt or unable to afford their lifesaving medication.
Although fourteen states have banned copay accumulators, legislators in Pennsylvania have taken no action to protect patients, highlighting the need for a national ban on this harmful practice that is leaving many patients in our state and across the country with medical bills they can’t afford to pay.
In addition to looking out for tricky insurance plans, you should also ask good questions about what your options are if you receive treatment at a nonprofit hospital. The truth is, while nonprofit hospitals are meant to provide more affordable care to the public in return for big tax breaks, the executives at nonprofit hospitals often focus on making big bucks instead. For example, IRS rules require nonprofit hospitals to provide financial assistance to patients who qualify, but fewer than half of these hospitals actually informed patients that they may qualify for charity care. Worse, 45% of nonprofit hospitals regularly send bills to patients who qualify for charity care.
To protect yourself, ask about your options if you are treated at a nonprofit hospital. If you feel that you’ve been unfairly and unlawfully denied charity care, file a complaint with the Pennsylvania Department of Health.
Finally, you need to know your rights if you ever receive a surprise bill from your medical provider. A law called the No Surprises Act went into effect earlier this year to help stop the unfair surprise billing practices that have put millions of Americans in debt. Unfortunately, about 1 in 5 Americans reported receiving a surprise medical bill since the law took effect. If you’ve received a surprise medical bill this year that you think violates the No Surprises Act, visit the Centers for Medicare and Medicaid Services website to learn more and file a complaint. Your community’s legal aid organizations may also be able to provide assistance.
It’s no secret we need major reforms in our health care system, reforms that stop hospitals and insurance companies from viewing sick people and their families as sources of profit and nothing more. Until then, CQC will work hard to make sure Pennsylvania are in the know by sharing the information they need to make sound health decisions.
The Honorable Donna M. Christensen is a member of the Consumers for Quality Care board. She retired in 2015 from the U.S. House of Representatives, where she served nine terms. She is the first female physician to serve as a member in the history of the U.S. Congress.