WBUR

Patients Confused, Angry About Health Insurance Changes

BOSTON — Do you shop for health care? Well pretty soon you may. More employers across Massachusetts are switching to health plans that ask patients to start comparing prices and quality before they decide where to get care. These are plans with high deductibles, that limit where you can go for care, or charge you more for care at “high-cost” hospitals.

Sandy Reynolds, with the state’s largest employer group, Associated Industries of Massachusetts, said the goal is to “have the purchase of health care services work the same way that it works when we purchase almost everything else in our lives. For many years, the purchase of health care has not worked the way anything else works in our lives.”

I reported on this changes this morning, and have been gathering patient reactions today:

Steve Brown: Most of the patients we heard from have a high-deductible plan. That means they pay up to $2,000 for an individual or $4,000 for family before their insurance takes effect. What’s happening with these patients?

Martha Bebinger: We had lots of comments on Facebook about high-deductible plans.

Kerri Calistri said she spent $900 on tests for stomach trouble, but can’t afford any more, so now she’s hoping the problem justs gets better. Bev Melo said she needs carpal tunnel surgery, but has put it off for a second year now because she doesnt have the $2,000 she’d have to pay before her insurance coverage kicks in. And Kari Whitney also has a $2,000 deductible and is furious about having to pay that, on top of a substantial monthly premium.

Your story this morning focused on tiered plans. With this coverage, patients can go wherever they want, but they have to pay more — sometimes a lot more — for care. You spoke to a patient whose co-pay for her kids’ pediatrician is now $50 every time she takes them to the doctor. Is she just not going as often?

That’s right, she’s taking her three children as little as possible. She has one child with asthma and even when the doctor asks her to come back for a follow-up, Maria thinks twice. Some patients in this situation are switching doctors so that they will have a lower co-pay, but Maria said: “I don’t want to change doctors. I met her in the hospital after I had my first child; I’m really happy with her. That’s my last option; I’ll do anything not to have to switch. But if I have another winter like this past one with my daughter I might have to.”

Maria’s pediatrician is letting her bring two children in at the same time and providing some follow-up care over the phone or in emails to reduce the number of times Maria has to spend that $50.

A common reaction to many of these insurance changes is that when patients pay more of the bill upfront, they avoid care. They’re saving money, both for themselves and all of us, but they could be putting themselves at great risk.

Some patients are very worried about the high charges of going to, say, Dana Farber or Brigham and Women’s. These are high-cost hospitals but they’re also specialized hospitals. You spoke to Donna from Waltham, a former cancer patient who wants to keep going to these higher-cost hospitals.

Yes, because all her records are at Dana Farber and the Brigham, all of her relationships are with the doctors at those hospitals. Donna says she realizes the quality might be as good elsewhere but it’s those relationships that she really wants to maintain. She said it seems like tiered health plans are “all about the price tag and not necessarily about the quality of the care or the relationships that you’ve established. I’ve been going to the same primary care doctor for 20 years.”

Many health care experts will say that there’s a lot of value in doctors who know you. So deciding to change doctors can be a big deal, but we are seeing many patients do that because they want a lower co-pay.

And we heard from patients who are stunned as they pay more attention to costs. Joe Blumenfeld wrote in about a major emergency surgery he had for which the first 40 hours of his hospital stay, before the surgery, cost $202,000. Does Joe feel like a smarter health care shopper after scrutinizing some of his bills?

Joe said: “It’s making me a more jaded consumer. It’s fascinating when you cut this apart and look at how much things cost and why. The odd thing is that I don’t pay that cost, so in that regard, no, it hasn’t made me a smarter consumer at all.”

Joe has a $1,000 deductible, so he pays attention to costs while he’s spending that $1,000. But then once his bill grows into the hundreds of thousands of dollars he’s off the hook and in fact he says he can’t understand his bills.

Of course there are some families in Massachusetts that can afford a $2,000 deductible and many for whom care at a high-cost hospital is just out of the question if they are in one of these plans. Are we seeing a growing gap for higher- and lower-income patients as employers switch to these plans?

We don’t have evidence of that yet, but it is a concern for many consumer advocates. I have not heard health insurers talk about a remedy for this potential problem yet.

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  • http://profile.yahoo.com/QL3G7AA3WQ2XMQATVNRKFZECHI Deanna

    If you have MassHealth there are no deductibles and no co-pays. It pays to be low income when it comes to health insurance!

    • Linnie

      My daughter was on Mass Health for one year – the only thing it was good for was cheap meds (soma-land anyone?) – otherwise not so much – our dentist would not take Mass Health because they don’t pay what his costs are, and are always late – out of pocket that episode cost me $847 –
      I pay $825 monthly for a 60% subsidised plan as a retiree from my company – which for years mandated that us mgmt types compare plans – because my husband has chronic heart disease, has had a heart attack and has a pacemaker, plus even with insurance $500 worth of drugs every three months, and one hospitalisation would bankrupt us- this covers my daughter so long as she is a student (the Obamacare ACA only covers kids under 26 for medical, not dental) – and me and my husband
      pitch for HR1322 – this bill has languished for two years now, it covers what is missing from ERISA, eg, protects retirees who might actually have some sort of health insurance subsidy –
      In concept I support Medicare for all – why I think Obamacare/ACA that the white house had already predecided would NOT have a public option is a bad bill.
      As for rights of doctors re obese patients:  it was my impression that the decision that inspired this story was after patients did not change behaviours – I get that, but given that often MDs have to turn new patients away, why shouldn’t this doctor manage her or his business in a way that best serves the most patients?

  • Lynne Weiss

    When I had a plan like this a couple of years ago, I found it very difficult to get providers to tell me how much various procedures or services would cost. Doctors and providers generally have no idea what things will cost, and even administrators have a range of “prices” depending on the type of coverage. I was often told they could not tell me the cost until they submitted to my insurance. This is NOT the way people normally shop for other products.

  • Anne DiNoto

    Thank you so much for shining a light on the impact tiered networks has on consumers!

  • Circusmcgurkus

    What is hysterical is the moronic notion of a “market” for medical care.  How do we know what we need?  By cost?  By expertise?  If the cheapo doctor says we need a test (maybe because s/he does not know enough to realize it it futile) but the expensive doctor says we don’t (maybe because s/he cannot get referral reimbursement), who should we believe?  If a less expensive provider also lacks skills and does a poor job missing a problem (which already happens right here in Boston at big time medical institutions because people are human and make mistakes but then no one can admit it or correct it because of the competitive environment), who suffers?  Is the ides of second and even third opinion now over when that might just save someone’s life OR the cost of an unnecessary procedure?

    Medical care is not a market like, say toilet paper where we can shop around for a brand we like, maybe trying a few out, and then budgeting it in based on softness and price and maybe environmental factors.  This is why a percentage of hospital fees go to advertising.  It is insane!  You’re sick, you go to a doctor – a decent human being would let you know if s/he is unsure of what is going on and would consult with others to help the patient.  That does not happen because there is competition!  How on Earth does anyone know whom to trust?  Better yet, how can anyone trust anyone involved in this nutty system where the patient is utterly lost in the equation?

    If we are sick, we want help, not a sales pitch.  At one very famous Boston hospital, surgeons give out CD-Roms of them performing the surgery they are recommending for the patient like a screen test!  They do not even know why that is preposterous and a sure fire bet that a sane patient will go elsewhere, even if s/he needs the surgery.   If we are well, we want to be left alone, not badgered to take some unneeded test or try some new pill that might keep us healthy when lifestyle is working just fine, thank you.  Yet, when that test is indicated or that pill is warranted, we do not want to shop around for the best price because that should be built into the system.

    It is absurd that anyone thinks this is a good idea.  Medical care is not a business, there is no market.  It is a service that is required to be provided in every humanitarian society on the planet.

    Single payer – salary only medical care coverage.  No market.  No insurance companies.  Ethical providers.  It is not rocket science.

    • http://pulse.yahoo.com/_LLH7SFRBBDZ54YLFVP6POB6XAI ANNA

       I agree.  We need single-payer Medicare for All. Maintaining our health is not a product. We need to disinvite the health insurance industry from finding solutions  to this problem because they ARE the problem. Medicare for All, like every other industrialized country has, will save us $400 billion a year.  Coverage is not care. We need Medicare for All and we need it now.

  • X-Ray

    “Patients Confused, Angry About Health Insurance Changes” Wait until the
    full effect of the health insurance changes take effect; the level of confusion
    and anger will be an order of magnitude higher.

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