Health Insurance as it Should Be

According to a 2019 Commonwealth study, 85% of insured Americans are satisfied with their health insurance. But when these same Americans use their health insurance, a different story emerges.

According to a 2019 study by the Kaiser Family Foundation half of all Americans stated that they or a family member skipped needed medical care because of cost. Of those who skipped care, one out of eight people stated that their condition worsened as a result. In addition, three out of ten respondents stated that they did not take their medications as required because of cost. Another 26% of U.S. households have had problems paying their medical bills with half of those people stating that medical bills had a major impact on their family.

One of the challenges that has taken center stage in the last year has been the issue of “surprise medical bills.” Twenty percent of Americans have had to deal with a surprise medical bill. Surprise medical bills arise when an individual gets care from an “in-network provider” who then uses the services of an out-of-network provider to provide care. As a result, the individual receives a bill that is either not covered at all (in the case of an HMO) or not covered well in the case of a Preferred Provider Organization. The situation has gotten so bad that the government is now looking at legislative fixes.

This in turn has led to a call for “transparent pricing” which would allow the member to know exactly what is being charged. And make no mistake transparent pricing is incredibly important! Healthcare is the only industry where the American consumer has no idea what the cost of services is. Worse, they may believe that they are only liable for their copay or deductible, only to receive a bill after the fact for a service that was handled by an out of network provider. To illustrate this problem, I want to share my own recent story. In 2017 I went to my in-network dermatologist to have a growth removed from the left side of my face. I paid my $50 specialist copay and believed that everything was taken care of. Imagine my surprise when six weeks later I received a bill for$173.50 for lab services. It turns out that my in-network dermatologist sent the removed growth to a lab that was not in my network. I have been a health insurance agent since 1985 and it never occurred to me to ask if the…