The Affordable Care Act was signed into law on March 23, 2010, with the majority of the implementation taking effect through 2015. Through the ACA, millions of Americans have been able to receive more affordable health insurance. In fact, 1 in 6 Americans are eligible for a health insurance plan through the Federal Marketplace for less than $100 per month. Young adults may be eligible to remain on their parents’ health insurance plan until age 26. Pre-existing conditions and your current health status can no longer have any effect on determining your eligibility for a health insurance policy. For many Americans, the ACA has helped them to secure health insurance at a rate that previously had not been affordable for them.
All of the changes implemented in these new laws were desperately needed. However, although the new healthcare reform changes have had an obvious positive impact on many U.S. citizens, numerous issues exist that hinder some of its potential progress. Some imperative points need to be addressed and fixed in order for the U.S. healthcare system to start down the road to proper recovery.
The billing method within the American healthcare system is broken. Facilities are not billing according to compliance regulations and guidelines. Rules and regulations are in place in an effort to help guarantee that patients’ medical bills only contain true and accurate charges, but healthcare facilities are not adhering to these rules. With little threat of a reprimand, they have no reason to do so. Some benefits that have become law under the ACA are not being fully implemented, leaving U.S. citizens holding surprise medical bills.
As part of the new healthcare reform regulations, preventative or “wellness” visits are often covered at 100%. These visits are designed to help you avoid illnesses and to help prevent certain ailments by discovering them in their earliest stages. Some preventative services for adults may include:
- Blood pressure screening
- Cholesterol tests
- Diabetes testing
If you are covered by Medicare, you may be eligible for even more preventative services. Wellness services are also available for children, and might include vaccinations for some illnesses and counselling services.
However, more and more Americans are seeing their physician for a wellness visit and being charged. Why is this happening? Patients are expecting a free preventative visit, but often, other items are brought up during the visit, allowing the doctor to charge the patient.
Sometimes these items are brought up in conversation by the patient in an effort to understand a previously diagnosed issue. Other times, things that concern the doctor are discovered during the visit. The patient is under the misconception that items discussed during the wellness visit are still under the umbrella of the free preventative visit. However, the doctor is able to bill the patient for a separate visit because items were discussed that are outside of the scope of a preventative or wellness visit.
In a perfect world, this scenario would be fixed by the doctor scheduling a follow-up visit to address these new concerns or, at the very least, would communicate to the patient that discussing these items would make the visit billable.
However, in most scenarios, the patient is surprised to find that they were charged for something that occurred within a “free” visit. Not only is this an area of concern for the patient, but also for the doctor who is often unsure of how to bill for large amounts of time spent discussing previously diagnosed conditions during the preventative visit.
Another area of concern is the availability of pricing transparency. Having the average cost of certain healthcare procedures readily available to the public sounds like an excellent practice, on the surface. However, this is becoming financially dangerous to consumers.
A consumer might look up the average price for an upcoming procedure and feel a sense of relief if they see that the average price is reasonable. They might not even check with the facility that will be performing the procedure to find out how much that procedure will cost them. However, many times, the average cost of a service or procedure that is published on a website is based on Medicare reimbursement.
Sometimes other items or services may not be factored into the procedure cost. The amount of time spent in the hospital, medications and potential follow-up services and treatments are usually not included in the price. The combination of these items might result in a bill for double the cost of the actual procedure.
As a responsible, cost-conscientious consumer, you should contact the facility directly and negotiate a rate which includes the cost of the procedure, time spent in the hospital, medications and any follow-up treatments and services.
When you have agreed on a negotiated amount, have someone in a position of authority (a manager in the billing department or a member of administrative or executive staff) give you a statement in writing with the negotiated amount and what all would be covered – which should be everything pertaining to the procedure and hospital stay – and make sure that the authoritative figure signs the document. Simply having someone tell you that they will perform the procedure for a certain amount is not sufficient – it must be in writing and that document must be signed by an appropriate staff member.
There’s no doubt that the ACA is attempting to benefit Americans who previously had not been able to obtain affordable health insurance and give them the opportunity to enjoy a longer, healthier life. But attempting to build on an already broken system in which healthcare facilities seek to charge unfair and unreasonable prices to make a large profit is not nearly as helpful as it could potentially be.
Until the abusive billing methods found in our current healthcare system are acknowledged and fixed, Americans will not be able to reap the rewards of the many good intentions offered under the Affordable Care Act.