White House Moves to Fix 2 Key Consumer Complaints About Health Care Law

[n2doc]

The White House is moving to address two of the most common consumer complaints about the sale of health insurance under the Affordable Care Act: that doctor directories are inaccurate, and that patients are hit with unexpected bills for costs not covered by insurance.

Federal health officials said this week that they would require insurers to update and correct “provider directories” at least once a month, with financial penalties for insurers that failed to do so. In addition, they hope to provide an “out-of-pocket cost calculator” to estimate the total annual cost under a given health insurance plan. The calculator would take account of premiums, subsidies, co-payments, deductibles and other out-of-pocket costs, as well as a person’s age and medical needs.

Since insurers began selling coverage through public marketplaces 19 months ago, many consumers and doctors have complained that the physician directories are full of inaccuracies. “These directories are almost out of date as soon as they are printed,” said Kevin J. Counihan, the chief executive of the federal insurance marketplace.

Medicare and Medicaid officials have found similar problems in the directories of insurance companies that manage care for beneficiaries of those programs. In December, federal investigators said that more than a third of doctors listed as participating in Medicaid plans could not be found at the locations listed.

more
http://www.nytimes.com/2015/05/09/us/politics/health-care-law-consumer-complaints-to-get-addressed-by-white-house.html

[dixiegrrrrl]

1. I am shocked at how many people never ask the cost of a medical service before they decide.

Obviously I am NOT talking about ER visits and other emergencies.
( altho one could and perhaps should get those prices just in case an emgency decision does come up)

but I have had pretty good experience with "consuming" outpatient tests and being referred to docs, and the first thing I alway ask is
"what is your normal and customary charge for that service"?
so I can figure the co-pay and any deductible.

What has become clear is that most places are totally not used to being asked, esp. our local hospital which provides many outpatient tests..
x-rays, scans, etc.

Wouldn't buy a car without doing my homework...why aren't medical services seen the same way?

[Merlot]

2. Homework on costs rarely works out.

I recently had a procedure and the costs above and beyond insurance were almost $2k. Before the procedure I called the insurance company and asked what my share of the bills would be and they couldn't tell me, just gave some estimates (and no one included the hospital bill which was the biggest one). And even if I did know that the cost was, what choice did I have? I can't tell the doctor to change hospitals.

One bill was $275 and insurance paid $40. I asked why it was so high and was told that my doctor choose an out of network lab to send the test to. I had requested my doctor use all in network providers but they didn't.

Shopping for medical procedures is not like calling around for car repairs. Everyone has a different answer, a different diagnosis. You have to meet with more doctors to get these second opinions. Takes time and more money. I blame the for profit medical industry. It's disguising.

Oh, and just for fun - my first visit to the doctor got classified as "out of network" and the insurance company sent me EOB's showing that I was responsible for all costs. I called them and told them that I had found the doctor through their directory and they were like "oops - sorry!" Ya, thanks for the panic attack.

[dixiegrrrrl]

3. I see you called the insurer...

I called the hospital which was providing the service.

Interestingly, I had to tell them whether I was paying cash, or insurance or Medicare.
They transfer the call to the specific billing dept.
So I had to talk with Medicare billing. And SHE had to actually go to the outpatient clinic one floor down to talk to someone there and call me back with a price.

I wish everyone had Medicare.
When one doc overcharged me, Medicare promptly sent me a refund check and then went after the doc.

[Exilednight]

5. I've heard similar stories before. It still baffles me that

We are the only post industrialized country without a universal health care system.

[Unvanguard]

4. They need to take action on discriminatory drug tiering, too.

One of the most important issues for people with chronic health conditions.