Wendell Potter. Credit: Ann Imse/Colorado Public News

(Jump to text)

The Colorado Health Access Survey finds more than 600,000 Coloradans have insurance they know won’t pay enough. When an unexpected illness hits, the coverage falls short. Carol McKinley of Colorado Public News found one health care advocate who has taken to the road to warn even more Americans to be sure they understand exactly what their policies won’t cover.

Audio clip: Adobe Flash Player (version 9 or above) is required to play this audio clip. Download the latest version here. You also need to have JavaScript enabled in your browser.

More health insurance doesn’t pay what consumers need
Experts’ advice: Read the fine print, save for surgeries

By Ann Imse
Colorado Public News

More consumers are falling into health insurance policies that won’t cover their bills when they get sick.

That’s according to Wendell Potter, a nationally known author and former insurance PR executive-turned-industry critic who has visited Colorado twice in recent weeks, speaking in Colorado Springs and Pueblo.

“People look at the cost of premiums, and don’t realize that’s not nearly the entire amount that they are going to be paying for coverage,” Potter said in an interview with Colorado Public News before one of his speeches. Consumers, he said, also need to consider:

– High deductibles
– Procedures and other items not covered
– Payments beyond the so-called “out-of-pocket maximum”
– Surprise out-of-network expenses at in-network hospitals

Potter is not alone. Insurance companies are also issuing similar warnings – though less dire – telling the public not to assume their policies will cover everything. Many advise consumers to be certain they understand what’s covered, what’s not, and to set aside money to pay the medical bills that today’s policies will leave to them.

Then, “when you do need coverage, you have sufficient savings,” said Will Shanley, spokesman for United Healthcare.

Customers should calculate their share of costs of a major surgery or injury, and ask themselves: “Would I be able to afford that?” said Jeff Sepich, large group sales director for Anthem Blue Cross in Colorado.

A recent Colorado Health Access Survey found that 671,000 Coloradans are underinsured – that is, they have insurance but know it doesn’t cover enough. As policies become more obscure, more people are ending up underinsured – and increasingly don’t know it.

Potter was brought to Colorado Springs by Republican and former Colorado insurance commissioner Marcy Morrison, where he spoke to a group of about 200 in late April. He appeared in Pueblo on Tuesday, May 8, drawing a crowd of about 175.

The problem, he says, starts with deductibles – the amount people must pay before the insurance company does.

“More and more employers and insurers are moving people into high-deductible plans,” he said. “People are now finding themselves in family policies that have $50,000 deductibles every year.”

“My worry is that even if the Affordable Care Act is fully implemented, and more people are in coverage, a lot of people will be opting to enroll in plans with high deductibles – and they shouldn’t,” he continued. “They’re still going to be vulnerable to losing their homes and having to file for bankruptcy if they get seriously ill.”

Another issue: Many policies have good coverage for doctors inside the network of preferred providers – but require customers to pay as much as 50 percent for services outside the network. Consumers may think they will never use an out-of-network provider, so they don’t have to worry about this. But it’s actually possible to have surgery at an in-network hospital, and be billed by out-of-network doctors who work there.

“Who would ever stop to think – particularly if you are ill – if the physicians who are going to treat you in a hospital are included in your network? It’s an insane situation,” Potter said.
Shanley agreed that consumers need to be aware of this possibility. He advised asking detailed questions of hospitals and doctors about whether all their bills will be in-network.

Many insurers have websites where it is easy to determine whether the surgeon and hospital are in-network. But it’s nearly impossible to pre-check certain hospital staff doctors, like anesthesiologists, pathologists and radiologists, Sepich said. Colorado law does require such services to be billed at in-network rates. “It’s a nice consumer protection,” he said.

Consumers also need to ask whether out-of-network fees are included in the out-of-pocket maximum, Sepich said. On some policies, that maximum isn’t a maximum, because some bills just aren’t counted.

In addition, patients can get a bill for a service not covered by the policy.

Potter also warned consumers to read carefully, especially on “plans of limited benefits” or “consumer-directed” plans.

“That’s another thing that has become increasingly popular and is marketed heavily by insurance companies – plans with benefits that are so limited, they often don’t cover, in many cases, hospitalizations!” Potter said.

Purchasers also “need to make sure there are no annual or lifetime limits,” he said. “The average hospital stay in this country is now more than $20,000. And some of these plans have annual limits that are less than that.”

“You can really find yourself on the hook for a lot of money,” he said.

Customers also need to be prepared to pay a 10 or 20 percent share on many policies.

“Ten percent of a major medical procedure can still be a significant amount,” Sepich warned. On a $100,000 list of charges, that’s $10,000 from the patient.

Potter has been speaking in Colorado in favor of the federal health care law now under review by the Supreme Court. He sees it as containing major consumer protections and extending care to more people. But, he says, the law has many flaws, as special interests had too much influence on it.

 

Comments are closed.

News

September 24, 2016 | NPR · The National Museum of African-American History and Culture opens on the National Mall on Saturday. NPR’s Sam Sanders talks to visitors and tells us what it was like on the first day.
 

September 24, 2016 | NPR · Michel Martin talks to KUOW reporter Ross Reynolds on the latest on the manhunt for a gunman who killed five people Friday night in a shopping mall in Burlington, Wash.
 

Courtesy of Judea and Samaria Fire and Rescue Department
September 24, 2016 | NPR · When an Israeli family was ambushed in their car in the West Bank, two Palestinians came to their aid. One is paying a price now, seen as aiding the enemy.
 

Arts & Life

AP
September 24, 2016 | NPR · More than 100 years after it was originally proposed, the Smithsonian National Museum of African American History and Culture is opening its doors in Washington, D.C.
 

September 24, 2016 | NPR · In the late 1980s, Curtis filed a patent for a diaper/baby wipe combo, so we’ve invited her to play a game called “Eureka!” Three questions about inventors and their inventions.
 

Getty Images
September 24, 2016 | NPR · The chain restaurant that catered to women helped redefine how Americans eat, according to a new book. For NPR’s Lynn Neary, it also defined how she did and didn’t fit with the counterculture.
 

Music

Courtesy of the artist
September 24, 2016 | NPR · The international ambassador for Louisiana roots music died early Saturday morning of lung cancer.
 

Courtesy of the artist
September 24, 2016 | NPR · Social media isn’t Jillian Banks’ style, so she told her fans to text her instead. “Something that I’m still learning and have had to learn is how to put boundaries up,” she says.
 

Opera Philadelphia
September 24, 2016 | NPR · Composer Missy Mazzoli wouldn’t call Lars von Trier’s film Breaking the Waves, a feminist project. But its portrayal of a woman’s experience was part of what drew her to help reimagine it onstage.
 

Get the KRCC iPhone App

The Writer's Almanac

Radiolab