Confusing Health Insurance Policies Drive Personal Debts Up

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Web resources:

• The Access Project

According to national studies, Americans are going into debt to pay for medical expenses.

The Commonwealth Fund has found that nearly 50% of those who pay deductibles over $500 dollars carry debt from medical expenses.

Analysts from the Access Project, a healthcare policy group at Brandeis University, wanted to find out why.

So they interviewed 45 people in seven states who owe money for past medical care.

Carol Pryor co-authored the report.
She says she’s discovered that many consumers can't afford the increasingly high combination of premiums, co-payments and deductibles.

“And even if they can pay their monthly premiums, these charges, if they get sick, often mean that care becomes unaffordable for them.”
And to make matters worse, says Pryor, those interviewed didn’t understand their policies.

“People have a very difficult time comparing products one to another or understanding what their particular policy is supposed to cover. And when they try to get clarification from insurers the information is often inconsistent or inaccurate.”

The level of understanding didn’t seem to increase if the consumer bought the insurance privately or got it through work.

But Pryor said that those who buy it directly seem to have more problems.
They generally pay much higher premiums for fewer covered services. And they don't have a Human Resources department to help them out.

Molly Gould - from Stratham - bought health coverage directly from an insurer to cover her family of six.

The 32-year-old works part-time at her husband's chiropractic office.

The Goulds agreed to a $5,000 dollar deductible to keep premiums at $400 per month.

And they expected the policy would cover emergency services at least.

“In December I had a miscarriage and had to go to the emergency room and had an exam and an ultrasound and blood work and that was it.”
After the bills started coming in, Gould was told by her insurer that the procedures and tests related to the miscarriage were not covered.

“On the explanation of benefits form it said that I did not have a pregnancy rider and they don't cover maternity services and that they only cover in case where there is a complication of pregnancy. Well, a miscarriage is certainly a complication of pregnancy I would think….so there's something wrong with that…”

And then she began receiving separate bills from each medical unit. The emergency room, the anesthesiologist, the radiologist, and four others.

“I had to create an extra file for myself. I had to take bills and explanation of benefits and organize them, staple them together, and try and keep track of all of them. I had to call every single one to talk about what the insurance covered if anything how then I would handle balance left by high deductible discuss a payment plan with each one."
Four months after the miscarriage, Gould is still negotiating her bills with the medical units. She thinks she may owe between $5000 and $8000 dollars.
Some of Gould’s bills included errors and should have been covered.

Carol Pryor with the Access Project says that’s a common problem.

“And so people end up owing bills sometimes they shouldn't owe because if it is for something the policy should have covered but mistakes in processing or sometimes they thought a bill was going to be covered and only find out after the fact that it isn't covered because of some fine print exclusion.”

Leslie Ludtke analyzes health policy at the state's insurance commission.
She agrees with Pryor's study that health policies are too complex - and says that her agency receives thousands of complaints a year and steps in to help with some of them.

“I think very few people really understand the choices and it's also exceedingly difficult to understand the choices because of the lack of information.”

The two largest insurance companies in the state tout new web technologies they say customers can use to find policy information easily.

Anthem boasts that it offers telephone advice to customers to help them manage costs.

Cigna offers similar services, but a company spokesman said that customers should study policy information before they get sick.

The Kaiser Foundation estimates that over 17 million people in this country are “under-insured.”

That means that although they are covered by an insurance policy - they are unlikely to be able to afford the out-of-pocket expenses without borrowing money.

For NHPR News, I'm Dianne Finch