Many people have the impression that once they have health insurance coverage, their insurance company will be able to cover any costs associated with any future illnesses that they experience. The unfortunate truth is that this is often not the case regardless of whether you are insured or not. Even with health insurance, many Americans are discovering how unexpected health issues lead to medical debt and finding themselves struggling to pay their medical bills.
Every day we see another tragic story of a patient who did their best to be responsible and pay for health coverage, only to fall ill and find out that their insurance doesn’t cover what they thought it did. One such story was recently covered on NPR about a cancer researcher who is now writing about medical debt, after she and her late husband struggled with the debt that he accumulated from his battle with cancer. Their story highlights how anyone can be blindsided by the cost of healthcare, since both of them had health coverage and yet her husband’s plan still left them with thousands of dollars in medical bills.
How Unexpected Health Issues Lead to Medical Debt
Although major conditions such as cancer or diabetes can lead to large amounts of debt quickly, a survey conducted by the Kaiser Family Foundation and the New York times in 2016 found that bills for a one-time or short term expense, like a single hospital stay or treatment for an accident, were found to be the cause for 66% of those who reported having trouble with medical bills. This means that two-thirds of problematic health bills were caused by conditions or incidents that occurred unpredictably as opposed to those that build up over time.
One in Five Insured Americans Have Problems with Medical Debt
It’s sad to say that having issues with medical bills is an all too common occurrence in America, even after much of the progress that’s been made in recent years. According to the same study 20% of working-age Americans with health insurance had problems paying their medical bills, which caused serious financial challenges and changes in employment and lifestyle.
This highlights the ubiquity of the issue and also how having insurance does not guarantee a reprieve from medical debt, with nearly identical shares of those with insurance (44%) and those without insurance (45%) saying bills had a major impact on their families.
Unexpected Claim Denials and Out of Network Providers
Among those who have insurance and had problems with medical bills, the Kaiser Family and New York Times study found that one in four (26%) say they received unexpected claim denials; and about a third (32%) say they received care from an out-of-network provider that their insurance wouldn’t cover. These arise because of the confusing nature of the health insurance system. Claims are often denied in error and can be approved through an insurance claim appeal with the insurer. The best way to tell if a healthcare provider is in-network is to go directly to your carrier’s website and search for the provider in their provider directory.
A patient advocate can help with insurance claims or medical billing issues, contact us to learn more about how a The Patient Advocate Agency advocate can help you navigate your care today.
Alison Kodjak, Widowed Early, A Cancer Doctor Writes About The Harm Of Medical Debt (NPR.org, August 10, 2017). Link, accessed August 14, 2017.
Liz Hamel, Mira Norton, Karen Pollitz, Larry Levitt, Gary Claxton, and Mollyann Brodie, The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey (The Henry J. Kaiser Family Foundation, January 5th, 2016). Link, accessed August 14, 2017.
New Kaiser/New York Times Survey Finds One in Five Working-Age Americans With Health Insurance Report Problems Paying Medical Bills (The Henry J. Kaiser Family Foundation, January 5th, 2016). Link, accessed August 14, 2017.