The most recent one to hit the media’s attention is that of 31 year-old Arijit Gurha, a graduate student at the University of Arizona who was recently diagnosed with stage 4 colon cancer.
Unfortunately for him, his Aetna student health plan had a $300,000 lifetime benefit limit. Needless to say, the plan offered little protection to him once his cancer was discovered.
Arijit’s story has a happy ending, thanks to three very different aspects of the ACA: (1) a new provision that says that student health plans can no longer have lifetime benefit limits or unreasonable annual limits, (2) the new pre-existing condition insurance plan, and (3) the new scrutiny that the ACA has brought onto both health insurer profits and spending through the new MLR rules, and on consumer protections.
See, Arijit was eventually given the option of securing coverage through a newly renegotiated student health plan or the PCIP. However, his six months spent undergoing lifesaving cancer treatments with no health insurance benefits left him with over $100,000 of debt.
His fundraising blog, aptly titled poopstrong.org, helped him raise some money, but it wasn’t enough. So, Arijit decided to put Aenta’s feet to the fire by utilizing his Twitter account. The New York Times’ Well Blog has a great account of the conversation that ensued, which you can read here. But the amazing thing is that IT WORKED. Yes, that’s right, in the end, Aetna agreed to pay the over $100,000 debt he had accrued since hitting his lifetime max.
How was this possible, you ask? Well basically, it had to do with what I’d like to refer to as the PoopStrong Effect. Basically, because of the new consumer protections written into the ACA, health insurance profits and spending have begun receiving a whole lot of attention from the mainstream media. Pair this with a young person with an incredibly compelling story and the power of the internet behind him, and a forthcoming law that will change the rules in his favor, and you’ve got yourself the perfect conditions to bring forth some serious health plan PR damage control.
Two years ago, before the ACA became law, the PoopStrong Effect would have never been possible. Remember the 2007 Michael Moore film “Sicko”? A great conversation starter, but it didn’t do much to help the folks profiled in the film who had suffered from insurance industry abuses. Yet today, a young guy with cancer and a twitter account is able to move a mountain.
The landscape has certainly changed, hasn’t it? And for that, we can thank the ACA.
Debt collectors! In the hospital! Posing as normal people – like you and me!
In case you missed it, the NY Times broke a story last week out of Minnesota about a practice that is becoming more and more common around the country: Hospitals that are embedding debt collectors as employees to try and get patients to make good on their debts – sometimes even before they are treated.
Now, we know that with so many folks walking around with no insurance many hospitals are in a pickle. After all, lack of insurance – or lack of good insurance for that matter – has never stopped anyone from getting hit by a bus. Then again, most hospitals do receive millions each year to compensate them for unpaid medical bills and to provide financial assistance.
But, regardless of how you look at it, the whole practice just seems extremely underhanded. Often patients – who are vulnerable, either recovering from or still in need of medical care – don’t even realize that they are talking to a debt collector.
Thankfully, there may be some changes coming down the line that may put the kibosh on these types of sketchy hospital practices. A recent guest blog on Community Catalyst’s Health Policy Hub points out that the Affordable Care Act now requires non-profit hospitals to screen patients to see if they are eligible for financial assistance before engaging in “extraordinary collections practices.” Of course, how this all plays out will remain to be seen. At any rate – it’s definitely an issue to watch!
Earlier this month, we covered a new report on hospital financial assistance released by the Community Service Society. This report has been making waves since its release, so anyone who is interested in learning more on the topic now has a few more options to do so.
Elisabeth Benjamin, one of the report’s authors, recently appeared on Democracy Now! with one of the patient’s profiled in the New York Times article and Jessica Curtis of Community Catalyst to explain the issue a bit more. You can check out the video above.
Also, in case you were wondering if there had been any response from the hospitals, Ken Raske – President of the Greater NY Hospital Association – did post a letter to the editor to the NY Times in response to this report. While he doesn’t challenge the contents of the report, he does point out that, financial aid flaws aside, hospitals are an important safety net for the uninsured and many continue to lose money. Click here to read Ken’s letter.
Jessica Curtis also covered the issue on Health Policy Hub, the Community Catalyst blog. Click here to read Jessica’s blog post.
Lastly, the story was picked up by Modern Healthcare, which you can read by clicking here.
We’ve all been there.
You try and pop a wheelie to impress your girlfriend and instead fall off your bike and bust your head. Or, perhaps you wake up in the middle of the night with a sharp pain in your side and a raging fever. A dull knife and a slippery onion. Black ice. Sometimes, you don’t even remember what happened – only that you’ve woken up in the emergency room.
This is one of the reasons why people have insurance – to protect them from the unknown, and the crippling costs associated with it. But, it seems that more and more that protection that insurance offers seems to be riddled with holes. Or rather, fine print.
The Daily News has been covering a series of stories about New Yorkers just like you and me who have been hit with unexpected medical bills, despite having full coverage insurance. The culprit? Misinformation about who and what is considered “in-network.” Often, even if a patient goes to a hospital that is considered in-network, the doctor who they get treated by might be not be part of that network. Even patients who are able to call their insurance beforehand to check their benefits aren’t always given up to date information. What’s worse – patients have no way of knowing who or what their insurance will cover until months later when the bills start to arrive.
New York’s Department of Financial Services is now working hard to crack down on this issue. The department has opened up an ongoing inquiry to investigate these “surprise” bills and the lack of accurate information given to people by insurers and medical providers. In short, they want to know why it’s so hard for patients who try to stay in-network to actually do so.
If you’re in this boat and are feeling like you’ve been duped – don’t lose hope. There are still a couple of things you can do:
First and foremost, you can call Community Health Advocates (CHA), New York’s statewide consumer assistance program. They can help you figure out why you’re getting medical bills and often help to get those bills resolved or reduced. And you won’t get any extra bills – CHA works for free. Give them a ring, toll free, at 1-888-614-5400.
If you think you’re insurance company is in the wrong, you can also file a complaint with the Department of Financial Services, who also has a Consumer Assistance Unit. Click here to file a complaint.
To learn more about this issue, check out the two recent Daily News articles:
“Hospital bill shock: Insurers’ fine print can hike costs to the sky.” (Daily News, 2/5/12)