MTT #111: Why are patients paying more before they get care?

Jeremy, the answer is that her experience increasingly is the rule, not the exception.

As the cost of coverage soars, not only are workers being required to pay more, but as a percentage, their out-of-pocket requirements are going up faster than their wages and and at a higher rate than total medical inflation.

Already total cost per employee, and we're including both the premium and the out-of-pocket expectations.

On the average, it's over $20,000 a year, with about a quarter of that being the obligation of the individual.

And with projections for next year indicating a rise of between 9% and 11%, you can see the magnitude of the added burden workers are likely to pay.

But higher out-of-pocket costs aren't the only new and worrisome burden enrollers are carrying in response to these ever greater costs.

In addition, providers, both doctors and hospitals, are now demanding payment of the out-of-pocket deductibles in advance for all but emergency admissions and procedures.

As hard as it would have been to imagine a few years ago, 92% of U.S. health care providers either strongly encouraged patients to pay in advance or are now requiring it.

One year ago, that number, 81%.

Let's say you need a hernia repair or your gallbladder removed due to chronic pain.

If your deductible is $3,000, it's likely that the doctor in the hospital would expect you to pay that before you could have your procedure scheduled since performing the surgery wouldn't be an emergency.

And the fact that you are limited in your activities and suffering discomfort, that wouldn't make a difference.

Depending upon your circumstances, paying that much might require you to take out a loan or a second mortgage on your home.

The reason providers are doing this reflects the reality that many individuals default on their payments.

And when doctors try to collect the dollars that are owed, increasingly patients are declaring bankruptcy with the physician left unable to collect anything.

According to a survey from Java Forum last year, half of all doctor bills that patients were expected to pay under their insurance plan remained unpaid after one year.

Similarly, hospitals are requiring prepayment before patients can schedule a surgery or procedure.

Under HIPAA, They are prohibited from requiring payment for emergency care.

But the definition of an emergency? That's very subjective.

Most people wouldn't consider heart surgery for mild chest pain that wasn't a heart attack or repair of a torn ACL with knee instability elective.

But that's how both doctors and hospitals are increasingly defining each.

For providers demanding prepayment, it's not a patissier.

In fact, from a purely financial perspective, it often backfires.

Since faced with this demand, patients are deciding not to have the procedure at all.

This means that the provider never gets to bill the insurance.

Jeremy, the answer is that her experience increasingly is the rule, not the exception.

As the cost of coverage soars, not only are workers being required to pay more, but as a percentage, their out-of-pocket requirements are going up faster than their wages and and at a higher rate than total medical inflation.

Already total cost per employee, and we're including both the premium and the out-of-pocket expectations.

On the average, it's over $20,000 a year, with about a quarter of that being the obligation of the individual.

And with projections for next year indicating a rise of between 9% and 11%, you can see the magnitude of the added burden workers are likely to pay.

But higher out-of-pocket costs aren't the only new and worrisome burden enrollers are carrying in response to these ever greater costs.

In addition, providers, both doctors and hospitals, are now demanding payment of the out-of-pocket deductibles in advance for all but emergency admissions and procedures.

As hard as it would have been to imagine a few years ago, 92% of U.S. health care providers either strongly encouraged patients to pay in advance or are now requiring it.

One year ago, that number, 81%.

Let's say you need a hernia repair or your gallbladder removed due to chronic pain.

If your deductible is $3,000, it's likely that the doctor in the hospital would expect you to pay that before you could have your procedure scheduled since performing the surgery wouldn't be an emergency.

And the fact that you are limited in your activities and suffering discomfort, that wouldn't make a difference.

Depending upon your circumstances, paying that much might require you to take out a loan or a second mortgage on your home.

The reason providers are doing this reflects the reality that many individuals default on their payments.

And when doctors try to collect the dollars that are owed, increasingly patients are declaring bankruptcy with the physician left unable to collect anything.

According to a survey from Java Forum last year, half of all doctor bills that patients were expected to pay under their insurance plan remained unpaid after one year.

Similarly, hospitals are requiring prepayment before patients can schedule a surgery or procedure.

Under HIPAA, They are prohibited from requiring payment for emergency care.

But the definition of an emergency? That's very subjective.

Most people wouldn't consider heart surgery for mild chest pain that wasn't a heart attack or repair of a torn ACL with knee instability elective.

But that's how both doctors and hospitals are increasingly defining each.

For providers demanding prepayment, it's not a patissier.

In fact, from a purely financial perspective, it often backfires.

Since faced with this demand, patients are deciding not to have the procedure at all.

This means that the provider never gets to bill the insurance.