Meg Vogel for KHN
Matthew Fentres was only 25 when he fainted while filling canola as a chef at a senior residential center six years ago. Doctors diagnosed him with viral cardiomyopathy, a heart disease that developed after a flu attack.
Three years later, in 2017, Fentress’ condition worsened and doctors placed him in a medically induced coma and placed a pacemaker and defibrillator. Although he has insurance, he cannot pay his due to the hospital he went to in Louisville, state. So Louisville Baptist Health Service sued him and he declared bankruptcy in his 20s.
“The curse of disease in America is a lifelong debt, which means you live a less appropriate life,” said Fentress, now 31, who still works for the senior center, providing basic services throughout the coronavirus pandemic. “The biggest crime you can commit in America is being sick.”
Financial fears resurfaced this year when a cardiologist suggested he undergo an ablation procedure to restore a normal heart rhythm. He says hospital staff have assured him that he will not be on the hook for more than $ 7,000, which is a huge distribution of his annual salary of $ 30,000. But if the procedure could curb the frequent, unnecessary heartbeats that filled him with anxiety, he decided the price was worth it.
He did the outpatient procedure at the end of January and it went well.
“Then I wasn’t afraid I would die any minute,” he said. “I felt much better.”
Then came the bill.
Patient: Matthew Fentres is a 31-year-old chef at Atria Senior Living who lives in Taylor Mill, Ky. Through his work, he has UnitedHealthcare insurance with a maximum of $ 7,900 in his pocket – close to the maximum allowed by law.
Total account: Fentress owes a balance of $ 10,092.13 for cardiology, echocardiography and family medicine visits on various dates in 2019 and 2020. It has paid some portions of that, but still owes $ 9,296. UnitedHealthcare paid a total of $ 28,920.52, including $ 27,561.37 for the care he received on the day of his procedure.
Service provider: Baptist Health Louisville, part of the non-profit system Baptist Health.
Medical service: Fentress underwent cardiac ablation on January 23, 2020. The outpatient procedure involved placing catheters into an artery in his groin that had been inserted into his heart. He also had related cardiac services, tests and visits to a primary care physician and cardiologist before and after the procedure.
What it gives: Fentress says he’s always taken care of getting a job with health insurance, “so I thought I’d be fine.”
But like nearly half of privately insured Americans under the age of 65, he has a deductible health plan, a type of insurance that experts say often leaves patients unable to. When he uses health care providers in his insurer’s network, his annual deduction is $ 1,500 plus co-insurance. His annual maximum out of pocket is $ 7,900 – more than a quarter of his annual salary.
What’s worse is that he was already dealing with earlier medical duties. Fentress owed about $ 5,000 after his hospitalization in 2017, also at Baptist Health Louisville, and created a monthly payment plan, but says he was sent to collections after missing a $ 150 payment. He declared bankruptcy after the hospital sued him.
He faced another bill about a year later when a panic attack sent him to the emergency department, he said. At that time, he received financial assistance from the hospital.
When he received his ablation bill this spring, he decided not to qualify for financial aid for a second time. So instead of applying, he tried to create a payment plan. But hospital officials said he would have to pay $ 500 a month, far beyond his means, forcing him to fear a new spiral to bankruptcy.
This precarious situation makes him “functionally uninsured,” says author Dave Chase, who defines this as a deduction for insurance greater than your savings. “It’s much more common [in the U.S.] than many people realize, “says Chase, founder of Health Rosetta, a company that advises large employers on health care costs.” We are the undisputed leaders in medical bankruptcy. This is a sad state of affairs. “
Jennifer Schultz, a professor of economics and co-director of the health management program at the University of Minnesota, Duluth, says Fentress is facing a difficult financial path. “Once you declare bankruptcy, your credit rating is destroyed,” she said. “It will be difficult for a young man to come back from this.”
A recent British Community Fund study found that just over a quarter of adults between the ages of 19 and 64 who reported problems with medical bills or debt were able to pay for basic necessities such as rent or food somewhere in the last two years. Three percent had gone bankrupt.
In the first half of 2020, the study found that 43% of adults in the United States between the ages of 19 and 64 were underinsured. About half of them were underinsured, meaning that they had deductibles representing 5% or more of their household income or that their health expenditure, excluding premiums, claimed 10% or more of household income in the last year.
In Fentress’s case, the $ 10,092 he owed the hospital was more than a third of what the insurer paid for his care. Most of his debt – $ 8,271.56 – was co-insurance, about 20% of the bill he had to pay after completing his deduction. As the bill covered services for two years, he owed more than his annual maximum. If all his care had been provided in 2019, he would have owed much less and the insurer would have been responsible for most of the bill.
Kunal Gurav, an Atlanta cardiologist who writes about medical expenses for the American College of Cardiology, says ablation usually costs about $ 25,000 to $ 30,000, a range confirmed by other experts.
The insurer’s payment for Fentress’s care this January day – about $ 27,600 – falls within the usual cost range, Gurav says, even without the extra thousands Fentress owes.
Schultz, a state representative for the Minnesota Democratic-Farmer-Labor Party, says nonprofit hospitals could potentially drop out or cut costs for needy patients.
“They definitely have a moral responsibility to ensure the public good,” she said.
Resolution: Charles Colvin, Baptist Health’s vice president of revenue strategy, said hospital officials quoted Fentress as an approximate cost for ablation, which was within a few dollars of the final amount, although his bill included other services such as tests and office visits. on different dates. Colvin says there are some allegations that UnitedHealthcare has not handled properly, which could slightly reduce his bill.
Maria Gordon Szydlo, communications director at UnitedHealthcare, says Fentress is responsible for 100% of healthcare costs until its annual deductions online, after which it pays a percentage of healthcare costs in co-insurance until it reaches its maximum out of pocket. So he will owe about $ 7,900 to his account, she says, and any new worries on the network will be fully covered for the rest of the year.
A hospital representative suggested that Fentress apply for financial aid. She followed by sending him a form, but he went to the wrong address because Fentress was in the process of moving. In September, he said he would finally fill out the form and was optimistic he would qualify.
While Fentress is trying to pass its previous account, it is now worried about something else: accumulating new bills if it concludes COVID-19 on the road as a core worker with existing health problems and the same insurance fee that can be deducted.
“I have no hope for a financially stable future,” he said. “It shouldn’t be such a struggle.”
Receipt: Insurance performs two functions for those who are lucky enough. First you need to take advantage of the agreed prices of insurers. Second, the insurer pays most of your medical bills after you have completed your deduction. Before that he didn’t pay anything.
Highly deductible plans have the lowest premiums, so they are attractive or may be the only plans you can afford. But understand that you will be asked to pay for everything except preventive care until you dial this number. And your deduction may be just part of the picture: Co-insurance is most of what Fentress owes.
Maximum pocket values are regulated by federal law. In 2021, the upper limit for highs will be $ 8,550 per single coverage.
Try to plan treatment and procedures with a view to the calendar: People with chronic illnesses and this type of insurance can save a lot of money if they have an expensive operation in December – when your expenses will be part of your pocket for the end of the year – not in January.
As always, if you face a large medical bill, ask for payment plans, financial aid, and charitable care. According to the website of the Baptist health system, the uninsured and insufficiently insured can receive discounts. Those with incomes equivalent to 200% to 400% of the federal poverty level – or $ 25,520 to $ 51,040 per individual – may be eligible for assistance.
If you do not qualify for help, still negotiate with the hospital. Arm yourself with information about the current rate that insurers pay for the care you receive by consulting websites such as Healthcare Bluebook or Fair Health.
Dan Weissman, host of Hand and foot podcast, announced the radio interview about this story. Joe Neil of NPR produces All things considered interview with KHN Editor-in-Chief Elizabeth Rosenthal.
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