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!
Did anyone read the Times this morning?
There’s an article out by Nina Bernstein about the latest in what seems to be an ever-growing list of insurance company shenanigans. This time, it has to do with provider reimbursement rates for out-of-network care.
You see, back in 2009 the state reached a settlement with insurance plans that required them to create a new database which used a fair method for calculating reimbursements to providers. The insurance plans dutifully did as they were told and created this new database, at a cost of $95 million. The problem is, they never used it.
Instead, they came up with a different way to price reimbursements, which ends up costing patients who must rely on out-of-network care much, much more. And, while this issue of pricing out-of-network reimbursements is a complex one and definitely part of a much larger problem surrounding health care costs in general, it really does highlight the need for improved health insurer regulations. This issue is of particular importance at this moment while our state policymakers are busy designing how our forthcoming state health insurance Exchange will work. Clearly this is an opportunity to make some much needed changes to our system!
Anyways, the article is a good one, and you should definitely check it out when you get a chance. Click here to read today’s article in the NY Times, titled, “Insurers Alter Cost Formula, and Patients Pay More.”
Good. That’s the idea behind the Young Invincibles‘ attention-getting “Friends with Benefits” headline, which marked the release of a new toolkit designed to help young adults get informed about health insurance coverage and benefits.
The new toolkit is available at www.gettingcovered.org and allows folks to download a series of one-pagers on different topics that are relevant to young people who, for the first time, may be considering their own mortality. These topics include things like: “Health insurance options when you’re out of school,” “How to join your parent’s insurance plan,” and “Why get covered?” Best of all, they’re available on a state-specific basis.
The whole thing is really useful, and really clever. So, if you know any young people, or if you’re a spring chicken yourself, be sure to download the toolkit! It’s a pretty easy read. Besides, what better way is there to get friends with benefits?