If you live in America, you have been hearing about the cost of healthcare for decades now and politicians never seem to be able to come up with a solution to it. It’s almost as if they don’t want to solve the problem so that they will have something to complain about and blame the problem on their opponents.
But to everyday people, the problem is real and it can be costly. Unlike the majority of other developed nations, we here in the US are frequently in medical debt due to the cost of medications or previous medical treatments received.
Despite over 90% of the United States population having some form of health insurance, medical debt remains a persistent problem. For people and families with limited assets, even a relatively small unexpected medical expense can be unaffordable. For people with significant medical needs, medical debt may build up over time. People living with cancer, for example, have higher levels of debt than individuals who have never had cancer.
High deductibles and other forms of cost sharing can contribute to individuals receiving medical bills that they are unable to pay, despite being insured. People with medical debt report cutting spending on food, clothing, and other household items, spending down their savings to pay for medical bills, borrowing money from friends or family members, or taking on additional debts.
https://www.healthsystemtracker.org/brief/the-burden-of-medical-debt-in-the-united-states/
In many cases, providers and other clinicians are presented with the unenvious task of explaining to a patient or family caregiver that a service, treatment, or medication “isn’t covered by your insurance” and “you’ll have to pay out of pocket” is this is something that you really want (or sometimes really need).
I have talked to folks who’ve moved to the US from abroad and they visibly have a difficult time understanding that they have to pay for what may be a very simple procedure or consultation. But, it is what it is.
Dr. Peter Kongstvedt who has his own consulting agency as well as works for George Mason University, suggests that our health insurance system may have something to do with the soaring costs of American healthcare.
“It was when you get this third-party payer system where the patient doesn’t have to pay all of the cost of it directly, the insurer pays a chunk of it,” said. Dr. Peter Kongstvedt, a senior health policy faculty member at George Mason University. “That gives you relentless upward pressure on pricing, because if you’re going to get paid, why not get paid some more?”
https://www.cnbc.com/2023/01/08/how-health-insurance-may-have-made-health-care-more-expensive.html
He may be on to something and it’s probably out of your control, but it should be kept in mind while you’re navigating the healthcare system for you or a loved one. It can also be an incentive for families to have a better understanding of their own insurance plan and what it covers as it appears that some Medicare Advantage plans can change networks or drop providers at their discretion or when they want.
Can my plan’s provider network change?
https://www.medicare.gov/Pubs/pdf/11941-Understanding-Your-Medicare-Advantage-Plan.pdf
• Yes. Your Medicare Advantage Plan can add or remove providers from its
provider network at any time during the year.
• Even though your Medicare Advantage Plan can change its network at
any time, your plan must protect you from interruptions in medical care
and make sure you have adequate access to medically necessary covered
benefits.
It’s important to understand as much as possible about your insurance coverage to avoid any unexpected bills or know what you’re eligible for.