Reply #87: I use to work in the industry as well. [View All]

[dflprincess]

"underinsured" means you have a deductible and other out of pockets that are so high you still can't afford to see a doctor when you need to. Most the people who declare bankruptcy in this country do so because they had "coverage" but their insurance didn't pay the bills for necessary procedures.

This is becoming more common as employers move to "Consumer Driven Plans". Not only do people stop running to the doctor every time they sneeze (a good thing) but those with chronic conditions put off regular visits intended to monitor their conditions and cut back on their meds as, with many of these "Consumer Driven" scams, prescriptions are not covered until the deductible has been satisfied. These plans generally have deductibles between $1,000 & $2,000 + "coinsurance" payments of 80/20 or 90/10 until you've spent another two or three thousand out of pocket.

The bill passed by the House allows deductibles or $1,500 for singles with annual out of pockets of $5,000 (the Senate bill has higher limits). Deductibles this high are enough to keep people from seeking care.

Here are some links about the cost of these plans and their affect on a person's ability to access care.

http://www.ebri.org/publications/ib/index.cfm?fa=ibDisp...

• Higher out-of-pocket costs—Despite similar rates of health care use, individuals with CDHPs and HDHPs are significantly more likely to spend a large share of their income on out-of-pocket health care expenses than those in comprehensive health plans. Two-fifths (42 percent) of those in HDHPs and 31 percent of those in CDHPs spent 5 percent or more of their income on out-of pocket costs and premiums in the last year, compared with 12 percent of those in more comprehensive health plans.

• More missed health care—Individuals with CDHPs and HDHPs were significantly more likely to avoid, skip, or delay health care because of costs than were those with more comprehensive health insurance, with problems particularly pronounced among those with health problems or incomes under $50,000. About one-third of individuals in CHDPs (35 percent) and HDHPs (31 percent) reported delaying or avoiding care, compared with 17 percent of those in comprehensive health plans.

http://www.mn2020.org/index.asp?Type=B_BASIC&SEC=%7B0F5...

Myth: Consumer-driven health plans will encourage people to get the care that best suits their needs.

Fact: High deductibles and cost sharing shift benefits to the healthy but shift costs to the sick.

A survey from the Employee Benefit Research Institute found that, while people in such plans were more cost conscious, they were twice as likely to report delaying or avoiding care and about three times as likely to report paying a large fraction of their income on health costs as those in comprehensive insurance.

Although employers are allowed to make contributions to health savings accounts, a 2007 survey shows that employers contribute less to HSA-qualified plans compared with other types of plans, shifting higher out-of-pocket expenses to workers which could further deter workers from seeking care.

http://www.managedcaremag.com/archives/1001/1001.downst...

Research does show that CDHP enrollees clearly demonstrate cost-conscious behavior, according to the Employee Benefit Research Institute (EBRI). But several organizations, including the Center for Studying Health System Change (HSC), Families U.S.A., the Kaiser Family Foundation (KFF), the Commonwealth Fund, and even the EBRI, say that shifting costs to employees can delay needed treatment. That can mean that when beneficiaries receive care, they are sicker. Delays, then, may raise overall costs.

...However, patient satisfaction is greater among members of traditional plans, and that is related to out-of-pocket costs. And CDHP and HDHP enrollees do report delaying seeking medical care because of costs.”

And this from a physician who sees first hand what high out of pockets do

http://www.startribune.com/opinion/commentary/83682912.... <img src=

As our policymakers work on broad-scale health care reform from the halls of government, many physicians have joined patients in demanding change.

As a neurologist who sees multiple sclerosis (MS) patients every day, I am worried that without reform, our current system will kill preventive care and continue driving up the cost of care. I know this because patients too often tell me that they aren't taking their medications or aren't following my advice for maintaining their health because they can't afford skyrocketing copays.

Copays are the fixed, out-of-pocket costs required by health insurers to be paid by patients for services such as exams at a clinic, outpatient procedures, physical therapy and the filling of prescriptions. These services are often preventive in nature -- for instance, preventing paralysis that would otherwise need constant, long-term medical attention, or preventing hospital stays with visits to the clinic for doctor-recommended checkups.

The idea behind copays is to reduce wasteful treatments by patients and health care providers, thereby reducing costs. But some copays have gotten out of control. Preventive medications for MS patients fall into the "fourth payment tier," which are more expensive to produce because they are naturally, rather than chemically, derived. These treatments prevent MS attacks and lessen long-term disability.

Insurance companies recently introduced this highest-priced tier and are categorizing more medications into the fourth tier all the time. In many cases, the copay for an MS medication can jump from $25 to $200 for a one-month supply, effectively denying patients access to needed medicines and preventive care.

Rather than reducing costs, high copays increase total costs to the health care system. That's because a patient who is denied access to a needed medication has to see his or her doctor to come up with an alternative treatment. This results in lost time and productivity for the patient, and it wastes the time of the health care provider, who could be helping another patient.