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

Getty Images
September 22, 2017 | KHN · Although the government temporarily waived penalties for certain late enrollees to Medicare, the deal ends Sept. 30, which may not be enough time for many to comply.
 

AFP/Getty Images
September 22, 2017 | NPR · Social platforms such as Facebook and Twitter played a larger role than anyone first knew in Russia’s influence campaign against the 2016 U.S. presidential race — and Congress wants answers.
 

September 22, 2017 | NPR · Hurricanes have dominated weather news lately. When it snowed on Thursday in the Sierra Nevada, it not only added a new weather element to the news mix, it got resorts thinking about ski season.
 

Arts & Life

Focus Features
September 21, 2017 | NPR · Judi Dench returns to the role of Queen Victoria — this time in her dotage — for Stephen Frears’ film about the monarch’s eyebrow-raising friendship with a young Indian man (Ali Fazal).
 

Warner Bros. Pictures
September 21, 2017 | NPR · LEGO films have become their own genre, and despite stellar voice work from Justin Theroux as the evil Lord Garmadon, the genre is — surprisingly — already showing its age.
 

20th Century Fox
September 21, 2017 | NPR · The new film, starring Emma Stone and Steve Carell as the players facing off in one of the most famous tennis matches in history, shows how easy it is to paint a trailblazer into a corner.
 

Music

Courtesy of the artist
September 22, 2017 | NPR · The revered folk-rock songwriter returns with his third solo album in four years, which meditates on past mistakes and personal growth.
 

Getty Images for VH1/Viacom
September 21, 2017 | NPR · When one of the biggest hip-hop moguls of all time asks you, “What’s 5 percent of $100 million?” you’d better not stutter. He and son Romeo drop family jewels on their extended hip-hop hustle.
 

Library of Congress
September 21, 2017 | NPR · This episode explores selections from the American Folklife Center’s collection of about half a million sound recordings — including songs from Woody Guthrie, Bob Dylan and Carrie Grover.
 

Get the KRCC iPhone App

The Writer's Almanac

Radiolab