Health Insurance All But Useless with High Deductibles


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“High Deductibles in Health Insurance”

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Quoting from the New York Times today, a subject often encountered daily, so rarely discussed in the media. My own colleagues cannot afford health insurance deductibles, let alone the average person who is not a medical professional. Five compounding pharmacies have closed in the last few months! Compounded medications are no longer covered! My patients cannot afford the insurance denials for medications, and how are we practicing medicine when each visit must be taken up with prior authorizations? No wonder the cost of medical care has gone up. What do we do for chronic pain or treatment resistant depression when our people have failed all drugs? Research funding never seems to go toward pain or depression.

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To the Editor:

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Re “Many Say High Deductibles Make Their Health Law Insurance All but Useless” (news article, Nov. 15):

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My self-employed husband and I have found ourselves in this predicament: affordable health care premiums but a prohibitive $5,000 yearly deductible.
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Truly accessible health care cannot be achieved when insurance companies are the primary beneficiaries of policies and when those who are “insured” still cannot afford to see a doctor.

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SUSAN A. McGREGOR

North Kingstown, R.I.
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To the Editor:

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Your article does a good job of describing cost-shifting from insurance companies to medical consumers but doesn’t explore the issue of risk-shifting.

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People pay insurance companies premiums to take on risk. Insurance companies try to avoid as much risk as they can. High deductibles and co-payments are just part of the risk-shifting.
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Other strategies being used include narrow networks of doctors and hospitals, denial of access to high-quality and often high-cost specialists, questioning and limitation of access to expensive drugs, questioning and limiting high-cost testing, and even offering free health club memberships to screen out those with high-cost disabilities.
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At a health insurance fair in San Francisco earlier this month, participants selected from various plans offered through the Affordable Care Act. Credit Jim Wilson/The New York Times
This process is about a lot more than high deductibles. But the end result is that good people are not getting the care they thought that they paid for. And the political leaders of both major parties approve these hassle factors — as our courts do — in the name of preserving America’s global competitiveness.
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BRANT S. MITTLER

San Antonio

The writer is a cardiologist and a lawyer.
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To the Editor:
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So at the end of the day, health care is no more affordable than it was before Obamacare was enacted! Why should we be surprised?
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Several decades ago, in an effort to promote “wellness,” we saw an increasing trend to encourage people to visit their doctor more regularly and more often, by offering plans that covered basic health maintenance costs. State regulations demanded coverage of some services, and the Affordable Care Act only added to the list that must now be provided without cost to the user.
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Insurance in the traditional sense provides coverage for the unforeseen event. In health care, that would be serious injury and catastrophic disease. What we have today is what the insurance industry refers to as “trading dollars.”
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Imagine if car insurance covered all basic services to reduce the risk of future damage, like oil changes, new brakes and even periodic visits to the car wash. We would see huge increases in the cost of car insurance, although we would also see policies that are offered at low premiums but with high deductibles and high co-payments.
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MICHAEL A. SMITH

Wells, Me.

The writer is a retired equity research analyst who covered the insurance industry.
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To the Editor:
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Your article about high deductibles in health insurance was accurate as far as it went, but a complete discussion of the benefits of health insurance coverage would have included the fact that insurers negotiate substantially reduced payments for in-network medical services for the insured.
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I have a high-deductible policy, but the payments I have to make to an in-network provider are usually only 40 to 50 percent of what I would have paid if I had been uninsured.
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An emergency room physicians’ bill here on my desk lists $632 as the charge, for which the insurer’s negotiated rate was $273.27, a 57 percent discount.
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My high-deductible health insurance policy is a membership in a huge discount medical services program. This is an important consideration that should be discussed more openly. The uninsured, by paying full freight, are subsidizing health care for those of us who are insured.
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DAVID MAIER

Richmond, Va.”

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4 Responses to “Health Insurance All But Useless with High Deductibles”

  1. Jon Wheeler Says:

    Amen David Maier.
    I was self employed for 10 years and with 3 pre existing conditions I was uninsurable.
    I found myself paying more than double what the insurance giants were paying for the same procedures. When I attempted to negotiate a more affordable price, I was told I should have paid cash up front for these procedures. That sounds fair, unless those procedures involve an ER visit via ambulance.
    You are in no position to negotiate when strapped to a gurney, unconscious. When the bills started coming in and I did some research, I found out I was being charged 3-4 times what an insurance company would pay.
    After declaring bankruptcy (after trying to make payments for several years) I’ve learned that we all lose with this current system, and to find out I’m subsidizing the multi-billion dollar insurance and medical industries while going hungry?
    Something just isn’t right, and it’s not Obama trying to destroy our country, as one of my doctors so helpfully suggested.
    I am insured now and I pay close attention to the statements from my insurer. $1400 for a basic urinalysis every time I visit my pain management specialist? $495 for a 2 minute office visit?
    It’s simple greed based economics. If the insurance company is going to negotiate a 50% savings, then why not double or triple the cost of the procedure?
    In the end the patients pay more, insured or not.
    ‘Catastrophic Care’ by David Goldhill is a very insightful book about our current system of health care/ health insurance.

  2. Jeisea Says:

    Hi Dr Sajben, Thanks for the insight into how it is in other countries. In Australia I have top level private insurance. I pay about US$1400/year. I pay no hospital excess. Eg last year I had Cardiac Ablation to stop SVTs from an extra pathway and paid nothing out of pocket. My plan includes extras. Eg I bought prescription Maui Jim sunglasses in December of 2013 and prescription glasses in January of 2014 (two weeks apart). Out of pocket cost total was about US$300. I hope Australia doesn’t follow other countries in regard to private health care. We also have a free public hospital system. My retired neighbours have knee operations and rehab at no cost and multiple admissions foe cardiac and other problems. There are sometimes waiting lists for elective surgery but non e for emergencies.

    I appreciate your posts Regards, Jan Fisher (jeisea)

    Sent from my iPad

    >

  3. Jo Says:

    Kidney stone emergency led us to the closest ER that told us they took all insurance and when specifically asked if in network they said yes. Once bill came and they really were NOT in network they said they couldn’t tell us at the time they were out of network due to liability if something happened if we left and went elsewhere. Now trying to negotiate the 13K bill for 2 hours in ER which insurance company denied completely. Now $3.5K spent in insurance premiums worthless and we still owe 13K to hospital for a total of $16.5K wasted-affordable-thats a joke. In network bill would have been $3400. Now they want us to pay $9K for a CT insurance only pays $280 for. How deceitful…and they get away with this.

    • Nancy Sajben MD Says:

      American voters seem to vote for the benefit of the 1% and trillions for more wars rather than personal needs. Managed care has been here to stay since the late 1980’s. “In network” applies to ER’s and hospitals, not to MD’s who may be private out of network. It is important to clarify with each MD.


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