The Plight of the Underinsured (Michael Moore was right!)

[groovedaddy]

It is well known, by now, that almost 50 million Americans lacked health insurance for all or part of last year. What is less well known is that 25 million Americans who did have health insurance often found it pitifully inadequate when a medical crisis hit. They were only marginally better off than those who had no coverage at all.

That is the disturbing finding of a survey by the Commonwealth Fund, a private foundation specializing in health policy research, that was published by the journal Health Affairs. The survey found that some 22 million adults with health coverage all year still spent a large chunk of their incomes — at least 10 percent for middle-class families — for out-of-pocket medical expenses. Another 3.4 million were saddled with high deductibles that would cause financial problems if they became ill.

Conservative health theorists and insurance industry leaders have long argued that the best way to slow soaring health care costs is to force people to pay a significant share of the bill so that they will buy medical services more judiciously, and sparingly. But as out-of-pocket expenses and deductibles have risen, many families are instead postponing or forgoing treatment.

Many of those surveyed had put off seeing a doctor when sick, failed to fill prescriptions or skipped tests, treatments and preventive care. About half had difficulty paying their bills; many took out loans, mortgages or credit card debt to pay them.

http://www.nytimes.com/2008/06/12/opinion/12thu2.html?th&emc=th

[ayeshahaqqiqa]

1. I've been aware of this for years

I sit on the Board of Directors of a non-profit health education foundation. One thing we offer is Laboratory Assistance Grants--we pay for the lab work for folks who are uninsured OR under insured. It is shocking how many insurance policies won't pay for all lab tests needed, even when the MDs say they need the test to figure out what exactly is wrong with a patient. It is not unusual for a lab test to cost from $400 to several thousands of dollars, depending upon what kind of test it is.

It seems to me when an insurance company dictates what lab tests/medicines/procedures they will pay for, they are really practicing medicine without a license. It is ridiculous when a patient is denied payment for an expensive medicine because the insurance company wants them to use a cheaper one, even though that cheaper medicine will interfere with other medications the patient is taking.

One of my greatest fears is to be forced to purchase health insurance and then have the company refuse to pay for anything. I know this has happened to other folks.

[groovedaddy]

2. "practicing medicine without a license"

I agree with your assessment. Insurance companies should not have the authority to make decisions like this. It's what happens when such decisions are profit driven rather than in the interest of the patient's health.

[leftyladyfrommo]

4. I'm caught in the under insured group

I pay $385 a month for insurance. My deductible is $1500. The tests and office visits cost so much that I just don't get them. Can't afford it. An office visit (maybe 10 minutes) costs me $67. If I didn't have insurance it would be $132.

My brother has insurance thru his employer. He still pays $600 a month for himself and his wife. Their dectible is $1,000 per person. He is supposed to get a colonoscopy every year. That test costs $1,000.

Another friend of mine just got a pap test at the hospital where her doctor works - $390.

My aunt goes to a pain clinic. They gave her steroid shots for her back pain. She got the invoice and the shots were $800 each.

Another friend of mine had bronchitis and his doctor put him in the hospital over nite for tests. Total cost - $13,000. For one nite.

Another friend had to get an MRI as part of her treatment - $1700 (and that was the cheap option. The hospital want over $6,000 - her portion of the bill was $1000.

No one is going to be able to afford medical care.

[Delphinus]

3. By the time I pay for my insurance,

I have no money left to use it. Can't afford prescriptions or visiting the doctor.

What with everything - except my wages - going up, I'll more than likely have to drop my insurance come January. It's a good thing I'm in relatively good health for my age.