Donna M. Christensen
We are in the midst of a national crisis affecting the lives of more than 100 million Americans, including residents of New Jersey. This crisis is worsening racial disparities in health and wealth. This prevents some Americans from saving for retirement and others from investing in their children’s education. It forces patients who may only have a few months to live to spend their last days on earth battling corporations for medical bills and coverage. It’s America’s medical debt crisis, and it’s crushing millions of hard-working families.
That’s why this October—Health Literacy Month—Consumers for Quality Care is sharing information New Jerseyans can use to help lower their healthcare costs and avoid medical debt. Key advice is to avoid tricky health insurance plans and policies, ask good questions about charity care options, and know your rights as a consumer if you’re ever 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 is important to pay attention to short-term limited duration insurance plans, or STLDI plans. These so-called “junk plans” have insurance in name only and are exempt from most consumer protections under the Affordable Care Act. Although they may have lower monthly premium payments, STLDI plans often exclude pre-existing conditions, have dollar value limits on covered services, and are not required to cover preventive medical services at all. In fact, for every dollar you pay in premiums, STLDI plans often spend less than 10 cents on your healthcare — and out-of-pocket expenses can add up quickly on these plans.
But it’s not just junk plans that lead to high out-of-pocket expenses and medical debt. The rise of health insurance plans with high deductibles (the amount you are responsible for before your insurance begins to cover treatment), high copayments (the amount your insurance requires you to pay for a treatment) and high coinsurance (the percentage of the cost of a covered treatment service that you pay even after reaching your deductible) means that insured New Jersey claimants often end up with large bills that they are unable to pay.
Some of these plans also include co-pay accumulators that shift prescription drug costs from insurance companies to patients by blocking any financial assistance you receive — such as a voucher or 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 out of it, they still won’t let you shop until you pay Again – for the second time – with money from your pocket. It’s the double deduction of insurance companies, and it has left many Americans in debt or unable to pay for their life-saving drugs.
Although fourteen states have banned copay hoarders, New Jersey lawmakers have taken no action to protect patients, emphasizing the need for a nationwide ban on this harmful practice that leaves many patients in our state and across the country with medical bills they cannot afford. pay.
In addition to researching tricky insurance plans, you should also ask good questions about your options if you’re receiving treatment at a nonprofit hospital. The truth is, while nonprofit hospitals are supposed to provide more affordable care to the public in return for big tax breaks, nonprofit hospital leaders are often focused on making big bucks. For example, IRS rules require nonprofit hospitals to provide financial assistance to eligible patients, but less than half of those hospitals actually told patients they were eligible for charitable care. Worse still, 45% of nonprofit hospitals routinely bill patients eligible for charity care.
To protect yourself, learn about your options if you are being treated at a nonprofit hospital. If you believe you have been wrongfully and unlawfully denied charitable care, file a complaint with the New Jersey Department of Health.
Finally, you need to know your rights if you receive a surprise bill from your medical provider. A law called the No Surprises Act came into effect earlier this year to help end the unfair surprise billing practices that have put millions of Americans in debt. Sadly, about 1 in 5 Americans said they had received a surprise medical bill since the law took effect. If you received a surprise medical bill this year that you think unsurprisingly breaks the law, visit the Centers for Medicare and Medicaid Services website to learn more and file a complaint. Legal aid organizations in your community may also be able to help you.
It’s no secret that we need major reforms to our health care system, reforms that prevent hospitals and insurance companies from viewing patients and their families as sources of profit and nothing more. Until then, the CQC will work hard to ensure New Jerseyans are in the know by sharing the information they need to make informed health care decisions.
The Honorable Donna M. Christensen is a member of the Consumers for Quality Care Council. She retired in 2015 from the United States House of Representatives, where she served nine terms. Born in Teaneck, New Jersey, Christensen is the first female physician to be a member of the United States Congress in history.