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Thread: Pay now, care later

  1. #1
    Veteran Member bajisima's Avatar
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    Pay now, care later

    Found out our local hospital is doing this now...


    Last year, the Henry County Health Center in Iowa started providing patients with a cost estimate along with pre-surgery medical advice. The 25-bed rural hospital in the southwest corner of the state implemented the protocol because of mounting unpaid bills from insured patients, a group that had previously not raised red flags.

    Henry County is one of hundreds of U.S. hospitals trying to cope with an unexpected consequence of the Affordable Care Act of 2010, known as Obamacare: millions more Americans have health insurance, but it requires them to spend thousands of dollars before their insurer kicks in a dime. Since U.S. hospitals do not want to end up footing the bill, they are now experimenting with pre-payment strategies for patients, with a growing number requiring payment before scheduled care and offering no interest loans, according to interviews with more than two dozen hospitals, doctors, patients, lenders and healthcare experts.

    “Most patients are appreciative that we’re telling them up front,” said David Muhs, chief financial officer for the Henry County hospital, which provides a discount for early payment. The discussion leads some patients to skip care, others to delay it or use a no interest loans available through the hospital, he said. The ACA extended insurance to 20 million Americans, which initially helped hospitals begin to shrink debt from uninsured patients who could not pay their medical bills. But more and more, people in Obamacare plans or in employer-based health plans are choosing insurance that features low monthly payments. The trade-off is high out of pocket costs when they need care.

    The trend is expected to accelerate this year because unpaid bills are creating massive bad debt for even the most prestigious medical centers. U.S. hospitals had nearly $36 billion in uncompensated care costs in 2015, according to the industry’s largest trade group, a figure that is largely made up of unpaid patient bills. Almost half of Americans – 45 percent - polled by the Kaiser Family Foundation said they would have difficulty paying an unexpected $500 medical bill. The average deductible this year for the least expensive of the widely used Obamacare health plans is $6,000 for an individual - an 18 percent spike since 2014 - and more than double that for a family, according to government data.

    Insight: Ballooning bills - More U.S. hospitals pushing patients to pay before care | Reuters

  2. #2
    Bizarroland Observer Thx1138's Avatar
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    "but it requires them to spend thousands of dollars before their insurer kicks in a dime."

    Yes, and Trumpcare would have been even more so.

    Just one of many reasons we need UHC...

    Cut out the middle-men, the big insurers, provide HC to everyone and see how many more people employers can hire!

    Thx
    Thanks from Friday13, bajisima and Madeline

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    When I was uninsured (couldn't afford the cost of insurance because of preexisting conditions, and to well off for Medicaid) the county hospital where I went for medical care offered a 50% discount for bills paid when presented. That made me wonder what the true cost of medical care was. It also meant that people who couldn't afford to pay the whole amount upfront, paid double what I did.
    Thanks from Friday13, Madeline, Amelia and 4 others

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    Veteran Member bajisima's Avatar
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    Quote Originally Posted by labrea View Post
    When I was uninsured (couldn't afford the cost of insurance because of preexisting conditions, and to well off for Medicaid) the county hospital where I went for medical care offered a 50% discount for bills paid when presented. That made me wonder what the true cost of medical care was. It also meant that people who couldn't afford to pay the whole amount upfront, paid double what I did.
    Our doctors and hospitals offer an immediate 35% discount if you pay your bill in full at the time of service. So you bet the profit is indeed much higher.

    Our dentist has been doing this forever in regards to payment. "Full payment when services are rendered" is on the desk. So if you have a deductible or copay, they require it be paid when the work is done, then insurance is billed. My medical deductible currently is $10,000 so that would definitely delay me seeking anything that wasn't urgent. Its almost like some horrific Charles Dickens story where you go in to have a baby but cant afford the deductible so they hold the baby for payment...
    Thanks from HCProf, pragmatic, Madeline and 3 others

  5. #5
    Established Member NeoVsMatrix's Avatar
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    funny thread title you picked to describe this " obscurity (which seems to be common in a lot of places though, as per the repsonds).

    Funny, because it's also the general principal of ANY health insurance. you pay NOW, and receive care later, when you need it.

    Most people have accepted and embraced this principle now when it comes t retirement, saving today for an event that will only happen decades / years from now.
    But for some reason, when it comes to health care, people still feel someone is trying to "trick them" out of their money.

    Retirement is a FACT.. except you die before you reach your retirement age. That you will need money to support yourself, when you have no more steady income, is also a fact. and people adapt to it.

    Getting sick, with age, is a FACT.. except you die before you get sick. That you will need money to pay for treatment when you're sick is also a fact. Yet people still don't want to adapt to it in this country.

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    Thought Provocateur NightSwimmer's Avatar
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    Quote Originally Posted by bajisima View Post
    Henry County is one of hundreds of U.S. hospitals trying to cope with an unexpected consequence of the Affordable Care Act of 2010, known as Obamacare: millions more Americans have health insurance, but it requires them to spend thousands of dollars before their insurer kicks in a dime.
    I don't know about you, but my health-care insurance has always featured both co-pays and deductibles. Those didn't start with PPACA. While the premiums, co-pays and deductibles have also had a tendency to increase over time, this too was taking place long before I had ever even heard the name "Barack Obama".
    Thanks from Friday13, labrea and NeoVsMatrix

  7. #7
    Veteran Member bajisima's Avatar
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    Quote Originally Posted by NightSwimmer View Post
    I don't know about you, but my health-care insurance has always featured both co-pays and deductibles. Those didn't start with PPACA. While the premiums, co-pays and deductibles have also had a tendency to increase over time, this too was taking place long before I had ever even heard the name "Barack Obama".
    Well when I first began working I paid premiums via my company, we had 100% coverage after that. No deductibles or copays. About 5 years later they added deductibles. But they are very high today. It was rare that people couldn't afford a deductible or copay in the 1970s, 80s or 90s. It wasn't until the early 2000s that healthcare costs began to skyrocket after many HMOs failed. Now with a 10K deductible (for COVERED expenses) that makes it hard for working class people to afford. Insurers are afraid they will be left without payment so are making these new rules.
    Thanks from Madeline

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    Moderator HCProf's Avatar
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    Quote Originally Posted by bajisima View Post
    Well when I first began working I paid premiums via my company, we had 100% coverage after that. No deductibles or copays. About 5 years later they added deductibles. But they are very high today. It was rare that people couldn't afford a deductible or copay in the 1970s, 80s or 90s. It wasn't until the early 2000s that healthcare costs began to skyrocket after many HMOs failed. Now with a 10K deductible (for COVERED expenses) that makes it hard for working class people to afford. Insurers are afraid they will be left without payment so are making these new rules.
    My husband works for a large company and we had wonderful insurance until 3 years ago. Our deductible was 250.00 each, today it is 3K each. His payroll contribution increased gradually over the last 3 years from 120.00 every two weeks to 225.00 every two weeks. I think insurance companies are making up for the preventative care that now must be covered at 100% by raising the deductibles for care with a definitive diagnosis. This is one of the reasons I will not go for many of my screenings such as the colonoscopy...one polyp and with the diagnosis of diverticulitis and my deductible kicks in. I can afford it, but it is a matter of principle to me...I don't want every dime of my disposable income to go into healthcare and taxes since I am in my early 50's now. How can you sustain the economy when your big expenses are healthcare and taxes? I told my Doctor on my last physical when she was pressuring me to get the colonoscopy because of the diverticulitis....sometimes you have to roll the dice and see what happens, we have no control over our healthcare expenses and I refuse to put our life together in debt over it. The way I see it clearly now...whatever happens, I had a nice run the first 50-60 years, all good things will eventually end. Our healthcare will eventually become so expensive we will all have to make life or death decisions to sustain our families. I don't see any relief in from this in my lifetime.
    Thanks from bajisima and labrea

  9. #9
    Veteran Member bajisima's Avatar
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    Quote Originally Posted by HCProf View Post
    My husband works for a large company and we had wonderful insurance until 3 years ago. Our deductible was 250.00 each, today it is 3K each. His payroll contribution increased gradually over the last 3 years from 120.00 every two weeks to 225.00 every two weeks. I think insurance companies are making up for the preventative care that now must be covered at 100% by raising the deductibles for care with a definitive diagnosis. This is one of the reasons I will not go for many of my screenings such as the colonoscopy...one polyp and with the diagnosis of diverticulitis and my deductible kicks in. I can afford it, but it is a matter of principle to me...I don't want every dime of my disposable income to go into healthcare and taxes since I am in my early 50's now. How can you sustain the economy when your big expenses are healthcare and taxes? I told my Doctor on my last physical when she was pressuring me to get the colonoscopy because of the diverticulitis....sometimes you have to roll the dice and see what happens, we have no control over our healthcare expenses and I refuse to put our life together in debt over it. The way I see it clearly now...whatever happens, I had a nice run the first 50-60 years, all good things will eventually end. Our healthcare will eventually become so expensive we will all have to make life or death decisions to sustain our families. I don't see any relief in from this in my lifetime.
    My doctor told me that she is now far more careful telling patients what to expect if there are positives in their tests now. She said so many go in for a colonoscopy or mammogram but then decline anything further when it comes back questionable. They are afraid it will cost too much. She said she tries to find out what everyones deductibles are and administer healthcare based on that. She knows at least if she tries to keep costs down they might still come, otherwise they wont bother to come at all. You can wake up from a colonoscopy and find out it costs thousands due to what they found and the extra anesthesia involved.
    Thanks from Amelia and HCProf

  10. #10
    Little Old Lady Madeline's Avatar
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    Quote Originally Posted by NeoVsMatrix View Post
    funny thread title you picked to describe this " obscurity (which seems to be common in a lot of places though, as per the repsonds).

    Funny, because it's also the general principal of ANY health insurance. you pay NOW, and receive care later, when you need it.

    Most people have accepted and embraced this principle now when it comes t retirement, saving today for an event that will only happen decades / years from now.
    But for some reason, when it comes to health care, people still feel someone is trying to "trick them" out of their money.

    Retirement is a FACT.. except you die before you reach your retirement age. That you will need money to support yourself, when you have no more steady income, is also a fact. and people adapt to it.

    Getting sick, with age, is a FACT.. except you die before you get sick. That you will need money to pay for treatment when you're sick is also a fact. Yet people still don't want to adapt to it in this country.
    I had an HMO most of my working life. But I recall the bad, old days of copays and deductibles. As a new mom, worrying that if I take the baby in for her fever, it will mean we can't afford her baby food the rest of the month.

    There needs to be some disincentive to patients abusing any level of care. Doubtless, most GPs have treated a hypochondriac or two. We ALL know people without insurance use the ER for routine matters. And not every procedure anyone could have can be offered to all patients.

    But if you set the level of self-funding too high, people will delay care. This can easily lead to more expensive care on down the road. The serious illnesses that are preventable with a vaccine, for example.

    I'm not sure what the ideal solution is. A sliding scale might tweak the personal responsibility share more appropriately, but in the elderly, income is typically very low as compared to total wealth.

    Sadly, the UK's ongoing experience with trying to starve its NHS to death offers a lot of data that we can use in designing a sustainable universal health care system.
    Thanks from bajisima

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