Problem: People are seeing hospital bills far higher than they expected.
Solution: Hold insurance companies accountable for covering expenses fairly.
The mission of Obamacare—or the Affordable Care Act or the ACA—was to expand access to affordable health insurance. And it’s been wildly successful. According to a Rand Corp. study from earlier this year, about 17 million Americans signed up for insurance coverage as a result of this landmark national health care reform.
The problem, though, is that insurance companies are refusing to pay for some services that patients believed were clearly in the coverage that the insurance company had provided, thereby leaving the patient with a high out-of-pocket cost.
Here’s how it happens. You’re a responsible consumer. You signed up for health insurance, you pay your premiums, you know what your deductible is, and you know which hospital is “in-network” and which isn’t. But sometimes you get medical services and get the bill and—surprise!—it’s far higher than you expected with no explanation.
Wait, you say, I’m insured. I know my benefits, I went to an in-network provider, I was responsible and I did everything I was supposed to do.
So what happened? You were the victim of surprise medical bills and there are few things more outrageous than being slapped with extra charges for something that isn’t your fault.
Here’s what went wrong. You can go to a hospital that is in-network and yet find out that your doctor at that same hospital is treated as “out of network” by your insurance company. Or your medical test could be sent to a lab not in your insurance plan’s network. That little detail means that your deductible suddenly goes up a lot, and you’re left paying a giant bill. Consumer Reports estimates that nearly a third of privately insured patients have been hit by surprise medical bills far higher than expected.
Besides being faced with an unexpected high bill, the big problem is that you are left in the dark. There is no rule or law that says that you must be told when you are “out-of-network” or to not penalize you when going out of network isn’t your fault. If the in-network anesthesiologist is gone for the day of your medical procedure, and only an out-of-network anesthesiologist is on hand, you’re going to wake up to quite a surprising bill.
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States like New York have outlawed these surprise medical bills. Both California and Texas are working to do the same. Wisconsin needs to do follow their lead. Obamacare has provided more Americans with access to affordable insurance, but we can’t allow the health insurance companies to penalize unsuspecting patients for something that isn’t their fault.
Kevin Kane is the lead organizer at Citizen Action of Wisconsin and is one of the state’s noted experts on health care reform.
