HomeLatest ThreadsGreatest ThreadsForums & GroupsMy SubscriptionsMy Posts
DU Home » Latest Threads » Forums & Groups » Main » General Discussion (Forum) » Does the Affordable Care ...

Sun Nov 10, 2013, 10:36 AM

Does the Affordable Care Act make it illegal for hospitals to demand entire deductibles up front?

I'm glad the health care law is helping so many people get health insurance, but I hope it can be improved to help more. Unfortunately, the way the law is written is leaving many poor American families ineligible for the subsidies they need because their low paying employers offer high deductible family health insurance. I've read that if a patient needs surgery or expensive cancer treatment, hospitals can demand the entire deductible up front. What if the low income family member needing treatment doesn't have good enough credit to get a $5,000+ loan to pay for the deductible or doesn't know anyone who can come up with it? Does anyone know if the health care law makes demanding entire deductibles upfront illegal starting in 2014?

37 replies, 21885 views

Reply to this thread

Back to top Alert abuse

Always highlight: 10 newest replies | Replies posted after I mark a forum
Replies to this discussion thread
Arrow 37 replies Author Time Post
Reply Does the Affordable Care Act make it illegal for hospitals to demand entire deductibles up front? (Original post)
MrsKirkley Nov 2013 OP
Le Taz Hot Nov 2013 #1
Hugin Nov 2013 #4
loudsue Nov 2013 #10
Hugin Nov 2013 #26
rhett o rick Nov 2013 #14
Hugin Nov 2013 #29
enlightenment Nov 2013 #9
Hugin Nov 2013 #2
SoCalDem Nov 2013 #7
xmas74 Nov 2013 #8
Laelth Nov 2013 #3
Hugin Nov 2013 #6
rhett o rick Nov 2013 #15
Laelth Nov 2013 #17
rhett o rick Nov 2013 #18
Yo_Mama Nov 2013 #37
dipsydoodle Nov 2013 #5
enlightenment Nov 2013 #11
StrayKat Nov 2013 #13
StrayKat Nov 2013 #12
L0oniX Nov 2013 #16
Name removed Nov 2013 #19
In_The_Wind Nov 2013 #20
JNinWB Nov 2013 #21
MrsKirkley Nov 2013 #22
JNinWB Nov 2013 #23
Humanist_Activist Nov 2013 #25
JNinWB Nov 2013 #28
Humanist_Activist Nov 2013 #31
Keefer Nov 2013 #33
Yo_Mama Nov 2013 #36
lumberjack_jeff Nov 2013 #24
dionysus Nov 2013 #27
Yo_Mama Nov 2013 #35
JNinWB Nov 2013 #30
TheKentuckian Nov 2013 #32
Yo_Mama Nov 2013 #34

Response to MrsKirkley (Original post)

Sun Nov 10, 2013, 10:39 AM

1. First, it might be helpful

if you included a cite for your claims. Did you read this somewhere? Hear it? What/Where?

Reply to this post

Back to top Alert abuse Link here Permalink


Response to Le Taz Hot (Reply #1)

Sun Nov 10, 2013, 10:49 AM

4. A relative of mine went in for a kidney procedure and...

Had to cough up $2500.00 (the entire deductible) before they would even touch him. He is a stock man at a large retailer and does not have that kind of money laying around nor does he qualify for a loan.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to Hugin (Reply #4)

Sun Nov 10, 2013, 11:24 AM

10. The affordable care act begins in ernest in January, so this payment

the hospital is asking for isn't related to the ACA, I feel certain. I've had procedures where I was not required to come up with all of it at once, but I did have to put down $100 or so. They ALWAYS ASK for the deductible, but all he has to do is work it out with the business office at most hospitals.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to loudsue (Reply #10)

Sun Nov 10, 2013, 03:13 PM

26. Their reply was "they are not a bank" when he asked about financing the co-pay.

He had little choice but to come up with the money. He's lucky to have some resources (his relations) which some others I've heard of did not.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to Hugin (Reply #4)

Sun Nov 10, 2013, 12:24 PM

14. So what did he do? nm

 

Reply to this post

Back to top Alert abuse Link here Permalink


Response to rhett o rick (Reply #14)

Sun Nov 10, 2013, 03:21 PM

29. He hit me and other family up for some "loans".

Which, I'm pretty sure won't be re payed and we could ill afford either.

But, he had to have something done asap and it was only going to get worse and more expensive if he put it off longer. As, he was unable to work until he received treatment.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to Le Taz Hot (Reply #1)

Sun Nov 10, 2013, 11:23 AM

9. Here are a few:

I chose older articles because the question is not about the ACA but about whether or not hospitals demand payment up front:

http://www.northjersey.com/news/137872133_More_hospitals_demand_payment_on_the_spot.html?page=all

http://health.usnews.com/health-news/best-hospitals/articles/2010/07/23/patients-beware-hospitals-are-increasingly-requiring-cash-up-front
This article discusses both uninsured and insured patients

http://www.modernhealthcare.com/article/20121013/MAGAZINE/310139953


There is, apparently, a report from mid-October that suggests that the ACA is causing this and if you Google "hospital charging deductible up-front" you'll see page after page where it has been repeated. I deliberately ignored it because it looks like fear-mongering, but I suspect that it plays off these earlier reports and the fact that yes, hospitals admit that they want the bills paid up-front. I think anyone who has dealt with hospital care in the last five years or so can attest to the increasingly strong-arm tactics that some use; it's something that I lay at the feet of the increased privatization of hospitals - profits come before care.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to MrsKirkley (Original post)

Sun Nov 10, 2013, 10:43 AM

2. kick

I know several people who have had to do this deductible up front stuff before necessary procedures and it is IMHO discriminatory.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to Hugin (Reply #2)

Sun Nov 10, 2013, 11:09 AM

7. Kaiser was going to charge me $115 for a $15 prescription..

(our drug plan has a $100 deductible).. I said Keep the eye drops..went to Walgreens & paid less than $15 (because of their funky little card the guy filled out for me)..

Reply to this post

Back to top Alert abuse Link here Permalink


Response to SoCalDem (Reply #7)

Sun Nov 10, 2013, 11:14 AM

8. I have a kidney stone right now.

I was given a prescription for flomax. My insurance company charged a higher amount than Walgreen's. The clerk saw the total, waved over the pharmacist and he said there was no reason to pay that amount and brought it down to about $7.50. Insurance? Wanted $50.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to MrsKirkley (Original post)

Sun Nov 10, 2013, 10:46 AM

3. Good question. I, too, would like to know the answer. n/t



-Laelth

Reply to this post

Back to top Alert abuse Link here Permalink


Response to Laelth (Reply #3)

Sun Nov 10, 2013, 11:03 AM

6. ...

Sadly, I don't think we're gonna get an answer to this question. :/

Reply to this post

Back to top Alert abuse Link here Permalink


Response to Laelth (Reply #3)

Sun Nov 10, 2013, 12:27 PM

15. I think a better question would be, "Does the ACA change the current practice of requiring

 

the deductible up front?" The way the question is written implies that the ACA may be responsible for this.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to rhett o rick (Reply #15)

Sun Nov 10, 2013, 12:46 PM

17. That's certainly possible.

I simply do not know the answer to this question.



-Laelth

Reply to this post

Back to top Alert abuse Link here Permalink


Response to Laelth (Reply #17)

Sun Nov 10, 2013, 12:50 PM

18. I dont either and would. I just didnt like the implications of the question.

 

DU should have a pinned thread somewhere to track discussion of the ACA.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to rhett o rick (Reply #15)

Sun Nov 10, 2013, 07:37 PM

37. ACA is not responsible and ACA makes it worse

Many buying insurance on the exchanges have no option but high deductible plans and most small employers are going to have to shift their employees to exchanges.

ACA provides subsidies on a 70/30 actuarial payout. This requires either high deductibles or high copays. If you have a high copay the hospital will require cash up front also.

Same with outpatient care. If free preventive treatment finds a problem, some people are going to be shit out of luck seeking treatment.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to MrsKirkley (Original post)

Sun Nov 10, 2013, 10:57 AM

5. Surely there's a copy of the actual law somewhere or other ,

probably as a PDF , and the contents should answer your question.

Try here : http://www.hhs.gov/healthcare/rights/law/

Reply to this post

Back to top Alert abuse Link here Permalink


Response to dipsydoodle (Reply #5)

Sun Nov 10, 2013, 11:38 AM

11. The answer is "no"

Searching the entire 2,409 page document using "deductible" (looking at each incident of the word) and "hospital" (again looking at each incident of the word).

Nothing in the legal language that suggests the law prohibits hospitals (or doctors) from demanding the full deductible up-front. It might have been added to another, existing law. That's part of the problem with the ACA - to really get a sense of what it does and doesn't do, you have to have several federal statutes open in front of you.

There is federal law from 1986 (EMTALA) that prohibits emergency rooms from denying emergency care, though that has nothing to do with the question posed. It is possible that is where they made changes, but I doubt it . . . and I don't feel like digging it up to see!

Reply to this post

Back to top Alert abuse Link here Permalink


Response to enlightenment (Reply #11)

Sun Nov 10, 2013, 11:48 AM

13. I sort of did.

I searched the GPO one. I saw nothing about this.

I used "dedu" as the search and there seemed to be more hits for tax deductions than mentions of deductibles. The ACA is not very protective.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to MrsKirkley (Original post)

Sun Nov 10, 2013, 11:43 AM

12. I hadn't heard of this trend.

But, reading about it, I'm reminded of the old days when hospitals always checked your insurance first when you came into an emergency room and then decided IF and how they were going to treat you.

"Large majorities of hospitals have organized their admission process where they want to see a check or credit card before they take you to your room," says Ron Luke, a consultant to healthcare providers in more than 25 states. Among them are Inova Fairfax in Northern Virginia and North Shore in Manhasset, N.Y. Insured workers, too, are feeling the pain, as many are choosing high-deductible plans, and copays and coinsurance charges just keep going up.- US News & World Report



Reply to this post

Back to top Alert abuse Link here Permalink


Response to MrsKirkley (Original post)

Sun Nov 10, 2013, 12:40 PM

16. There's a whole shit load of cracks to fall through.

 

Reply to this post

Back to top Alert abuse Link here Permalink


Response to MrsKirkley (Original post)


Response to Name removed (Reply #19)

Sun Nov 10, 2013, 12:56 PM

20. Hello ~ Alice B. TokeLess.

[img][/img] What do you think?

Reply to this post

Back to top Alert abuse Link here Permalink


Response to MrsKirkley (Original post)

Sun Nov 10, 2013, 01:22 PM

21. Hospitals are not lending institutions.

We would not consider going to Bank of America, or Citibank, for a hip replacement; why expect hospitals to finance health services? Hospitals should be assured of full payment from the insured patients, not the taxpayers.

Individuals, who select high deductible policies must realize that a hospitalization will cost the full deductible and make prior arrangements for payment. Credit cards, equity lines, borrowing from dad and savings accounts can be used. Anyone going in for elective surgery should make financial arrangements in advance of the procedure.

I'm sure that hospitals already have arrangements with lenders to work with those who need financial assistance to pay their hospital bills. Hospitals can not refuse to provide emergency services, but they need to be paid.

I'm in favor of Single Payer, but that's not what we have.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to JNinWB (Reply #21)

Sun Nov 10, 2013, 01:46 PM

22. How can one choose a low deductible policy if their employer only offers a high deductible policy

and the fact that their employer offers health insurance makes them ineligible for subsidies they need purchase a lower deductible plan?

Reply to this post

Back to top Alert abuse Link here Permalink


Response to MrsKirkley (Reply #22)

Sun Nov 10, 2013, 02:40 PM

23. I have been involved in selecting small group coverage for many years.

It is more challenging now, but it has (almost) always been an unappreciated chore. Providing health ins. for a small group has been difficult---balancing the affordability of the premiums against the needs of the employees. The workers are rarely happy with their coverage and the employer is almost always the one to "blame".

It is very hard to provide insurance for lower-income employees, who would (with/ACA) be qualified for subsidies on the exchanges. Employer provided insurance is based on age and number of family members, not the employees salary. I predict that most small employers will stop offering coverage and increase salaries, somewhat, to encourage purchases from the exchanges.

This transition to the ACA (Covered CA) will be pretty bumpy for all employers. Our current group policy extends until next November with a somewhat better provider network than similar ACA plans. But, I can see small groups soon discontinuing coverage for all employees who will then need to purchase from the market

As employer-provided plans become indistinguishable from the exchange plans, the annual deductibles will become the same at @ $6500.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to JNinWB (Reply #21)

Sun Nov 10, 2013, 02:52 PM

25. Many people select high deductible plans because they can't afford the premiums on low...

deductible plans. That's perhaps the most egregious thing about our private healthcare system, its set up to cost the poor everything, so they can never have assets of any sort, and are lucky to hold onto a (crappy, old)car for primary transportation.

Even worse for poor people with chronic conditions, who would love to be able to have a low deductible, but can't afford the premiums, and basically just do without health care all together because they can't use what insurance they can afford.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to Humanist_Activist (Reply #25)

Sun Nov 10, 2013, 03:17 PM

28. For many, a $6300 deductible plan might as well be $50,000.

People selecting plans need to understand that the deductible or annual out-of-pocket, do not always begin unless there are out-patient or hospital charges. The new plans, even the Bronze cover an annual, complete physical exam and comprehensive testing. Many chronic conditions can be diagnosed at the time of this exam.

Some plans cover additional office visits and prescription drugs with co-pays that do not require deductibles. This is why exchange consumers will need to carefully analyze their current annual costs to be able to select the appropriate plan. Sometimes, paying a higher, monthly premium will be cheaper than paying deductibles.

What consumers will have examine closely is the individual deductibles, Rx co-pays (and formularies) and provider networks. This will be very difficult---here in CA, some plans have not yet decided on, and published, their provider networks. Insurance companies are offering different providers for their group plans and their exchange offerings.

Deductibles, restrictive formularies and provider networks are ways that exchange plans can provide low premiums.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to JNinWB (Reply #28)

Sun Nov 10, 2013, 03:52 PM

31. They aren't consumers, they are patients who need medical care...

you seem to be under the erroneous assumption that many people have a choice, when they don't.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to Humanist_Activist (Reply #31)

Sun Nov 10, 2013, 06:44 PM

33. They are consumers...

They are purchasing health insurance, not health care.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to JNinWB (Reply #28)

Sun Nov 10, 2013, 07:30 PM

36. Many of us have no choice whatsoever

The only plans offered in many counties have these high deductibles. If you don't qualify for cost-sharing, you are up the creek without a paddle.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to MrsKirkley (Original post)

Sun Nov 10, 2013, 02:44 PM

24. I've never experienced a hospital that demanded payment up front.

 

Not to say that they don't exist, but I've never seen it.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to lumberjack_jeff (Reply #24)

Sun Nov 10, 2013, 03:17 PM

27. i was hospitalized for a few days a couple years ago. the bill came six weeks later.

took a year to pay them off.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to lumberjack_jeff (Reply #24)

Sun Nov 10, 2013, 07:29 PM

35. ACA institutionalized this growing trend

Reply to this post

Back to top Alert abuse Link here Permalink


Response to MrsKirkley (Original post)

Sun Nov 10, 2013, 03:39 PM

30. Several other interesting bits of info:

Hospitals can check your policy information, finding out how much is left on your deductible and request payment at the time of admission.

Do not accept COBRA until you check the exchanges to see if you are entitled to a subsidy; if you take even one day of COBRA, you cannot qualify for the subsidy that year. (You have a 62 day window to accept COBRA. If you decline COBRA and have a medical emergency within that window, you can still sign up.)

If you do not qualify for a subsidy on the exchange, you can purchase your policy through a broker, who can compare all the various exchange plans for you. (A broker told me this, so.....)

California exchange subsidies are based on the Federal Poverty Limit not California's, which is higher. This will really hurt low-income Californians.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to MrsKirkley (Original post)

Sun Nov 10, 2013, 04:10 PM

32. Of course not and if they did the phony penalty would involve a wag of the finger

and publication of the wrongdoing, at most.

Enforcement is pretty weak all the way around but stronger on the individual than any "stakeholders" at any time. The ultimate sanction is not being able to sell on the exchanges, which is not even a credible threat in many markets and where it is credible, it probably doesn't mean much in the way of profits.

On the other hand, they will definitely hold our refunds if nothing else.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to MrsKirkley (Original post)

Sun Nov 10, 2013, 07:22 PM

34. No, it does not

As for the ACA Silver deductibles, for really low income people who buy on the exchange (up to 200% of FPL), there is significant reduction for policies bought on the exchange. There is a small reduction for 200-250% of FPL.

Everyone else is up the creek, and yes it is a problem if you need a test or procedure for something that's not an immediate emergency, because yes, to get that MRI or biopsy or whatever you may have to come up with thousands of dollars. And many moderate income people don't have it.

This trend has been increasing for years.

Reply to this post

Back to top Alert abuse Link here Permalink

Reply to this thread