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Our company receives many inquiries like this. Stella had approached us last April, emotionally distraught over the thousands of dollars in medical bills she was receiving related to the premature birth of her triplets. One of our expert medical billing advocates was assigned to take her case. She was very happy with the favorable outcome (a reduction in her final balance by an incredible amount), and so were we. Like Stella, we may be able to help you too.
The US is the most expensive nation in the world in which to have a baby – and it may factor into thousands of bankruptcies each year.
Tue 16 Jan 2018
Jessica Glenza in New York – The Guardian
Stella Apo Osae-Twum and her husband did everything by the book. They went to a hospital covered by insurance, saw an obstetrician in their plan, but when her three sons – triplets – were born prematurely, bills started rolling in.
The hospital charged her family $877,000 in total.
“When the bills started coming, to be very honest, I was an emotional wreck,” said Apo Osae-Twum. “And this is in the midst of trying to take care of three babies who were premature.”
America is the most expensive nation in the world to give birth. When things go wrong – – from preeclampsia to premature birth – costs can quickly spiral into the hundreds of thousands of dollars. While the data is limited, experts in medical debt say the costs of childbirth factor into thousands of family bankruptcies in America each year.
It’s nearly impossible to put a price tag on giving birth in America, since costs vary dramatically by state and hospital. But one 2013 study by the advocacy group Childbirth Connection found that, on average, hospitals charged $32,093 for an uncomplicated vaginal birth and newborn care, and $51,125 for a standard caesarean section and newborn care. Insurance typically covers a large chunk of those costs, but families are still often on the hook for thousands of dollars.
Another estimate from the International Federation of Health Plans put average charges for vaginal birth in the US at $10,808 in 2015, but that estimate excludes newborn care and other related medical services. That is quintuple the IFHP estimate for another industrialized nation, Spain, where it costs $1,950 to deliver a child, and the cost is covered by the government.
Even the luxurious accommodations provided to the Duchess of Cambridge for the birth of the royal family’s daughter Princess Charlotte – believed to have cost up to $18,000 – were cheaper than many average births in America.
Despite these high costs, the US consistently ranks poorly in health outcomes for mothers and infants. The US rate of infant mortality is 6.1 for every 1,000 live births, higher than Slovakia and Hungary, and nearly three times the rate of Japan and Finland. The US also has the worst rate of maternal mortality in the developed world. That means America is simultaneously the most expensive and one of the riskiest industrialized nations in which to have children.
American families rarely shoulder the full costs of childbirth on their own – but still pay far more than in other industrialized nations. Nearly half of American mothers are covered by Medicaid, a program available to low income households that covers nearly all birth costs. But people with private insurance still regularly pay thousands of dollars in co-pays, deductibles and partially reimbursed services when they give birth. Childbirth Connection put the average out of pocket childbirth costs for mothers with insurance at $3,400 in 2013.
In Apo Osae-Twum’s case, private insurance covered most of the $877,000 bill, but her family was responsible for $51,000.
Apo Osae-Twum was the victim of what is called “surprise billing”. In these cases, patients have no way of knowing whether an ambulance company, emergency room physician, anesthesiologist – or, in her case, a half dozen neonatologists – are members of the patient’s insurance plan.
Even though Apo Osae-Twum went to a hospital covered by her insurance, none of the neonatologists who attended to her sons were “in-network”. Therefore the insurance reimbursed far less of their bills.
There are few studies that estimate the number of families who go bankrupt from this type of unexpected expense. One of the best estimates is now outdated – conducted 10 years ago. But one of the authors of that research, Dr Steffie Woolhandler, estimates as many as 56,000 families each year still go bankrupt from adding a new family member through birth or adoption.
“Why any society should let anyone be bankrupted by medical bills is beyond me, frankly,” said Woolhandler. “It just doesn’t happen in other western democracies.”
Since Woolhandler conducted that research in 2007, 20 million Americans gained health insurance through the Affordable Care Act health reform law, and consumer protections were added for pregnant women. But Republicans and the Trump administration have pledged to repeal these consumer protections.
“People face a double whammy when they’re faced with a medical condition,” said Woolhandler. Bankruptcy is often, “the combined effect of medical bills and the need to take time off work”.
There is no nationwide law that provides paid family leave in the US, meaning most families forego income to have a child.
And although childbirth is one of the most common hospital procedures in the nation, prices are completely opaque. That means Americans don’t know how much a birth will cost in advance.
Dr Renee Hsia, an emergency department physician at the University of California San Francisco and a health policy expert likened the experience to buying a car, but not knowing whether the dealership sells Fords or Lamborghinis. “You don’t know, are you going to have a complication that is a lot more expensive? And is it going to be financially ruinous?”
According to Hsia’s 2013 study, a “California woman could be charged as little as $3,296 or as much as $37,227 for a vaginal delivery, and $8,312 to $70,908 for a caesarean section, depending on which hospital she was admitted to.”
Apo Osae-Twum and her family only found relief after a professional medical billing advocate agreed to take their case. Medical Cost Advocate in New Jersey, where Derek Fitteron is CEO, negotiated with doctors to lower the charges to $1,300.
“This is why people are scared to go to the doctor, why they go bankrupt, and why they forego other things to get care from their kids,” said Hsia. “I find it heartbreaking when patients say… ‘How much does this cost?’
This week President Trump made the first move to begin the replacement of the Affordable Care Act. By issuing this executive order, this will drive immediate compliance. However, it will touch off reactions from all healthcare stakeholders including patients, providers, insurers, employers and the government. No matter which side of the political aisle you sit on, be prepared. The coming changes to the Affordable Care Act will require cooperation and compromise not seen from Washington in many years. It should be an interesting year for healthcare in 2018.
By John Tozzi and Zachary Tracer, Bloomberg
October 13, 2017
The Trump administration is cutting tens of millions of dollars from organizations that help Americans enroll in Obamacare health plans, leaving some of the groups scrambling to shrink their operations weeks before enrollment for 2018 coverage opens on Nov. 1.
The organizations, called navigators, say the funding cuts have been arbitrary, opaque and don’t follow the Trump administration’s stated method for calculating the reductions. The groups had been counting on money for the final year of a three-year grant program, and most didn’t learn how deep the cuts would be until after last year’s funding expired on Sept. 1.
When the Trump administration announced in late August that it would make the reductions, it said they would hold inefficient groups accountable and navigators that met prior enrollment goals would maintain funding.
Navigator groups say it hasn’t worked out that way.
Catherine Edwards, the executive director of the Missouri Association of Area Agencies on Aging, said her group helped 3,945 people last year sign up for health insurance, exceeding their goal. Their grant was cut 62 percent, to $349,251, from $919,902.
“This administration has been doing everything it can to make sure the Affordable Care Act fails,” Edwards said. “They’re tying our hands behind our back to make sure this does fail.”
Edwards’ group had to cut enrollment help and advertising, and will field 52 navigators this year, down from 72, leaving some rural parts of the state without any enrollment assisters.
A spokeswoman for the Department of Health and Human Services declined to provide data on navigator groups’ performance or to explain why some organizations that appeared to meet their goals were cut.
Navigators focus on enrolling people with complex family or financial situations, and offer in-person assistance to those who have trouble enrolling online because of language barriers or lack of internet access. Some groups serve ethnic enclaves or vulnerable communities unreached by broader marketing campaigns.
The cuts are likely to hit rural areas the hardest, potentially depressing enrollment in parts of the country where insurers have already pulled back.
President Donald Trump, having watched Republicans in Congress fail to repeal the Affordable Care Act, has taken aim at the law using regulations and executive actions. On Thursday, Trump signed an executive order mean to make it easier for people to buy insurance that doesn’t meet the ACA’s standards, potentially drawing healthy people out of the ACA market. Late that evening, the administration said it would stop making subsidy payments to insurers that help lower-income people afford co-pays and other cost-sharing.
“We’re starting that process” of repeal and replace, Trump said at the White House Thursday.
The administration has also slashed advertising for Obamacare signups by 90 percent, and plans to take down the healthcare.gov website for maintenance periods in the middle of the season. Premiums for next year are rising as insurers say they’re uncertain about the law’s future.
A Nationwide Pattern
What happened to Edwards’ group in Missouri has happened around the country.
Covering Wisconsin, the larger of two navigator programs in that state, enrolled 2,287 people in private health plans and another 1,370 people in Medicaid last year, exceeding targets for both, director Donna Friedsam said in an email. Its funding was cut from to $576,197 this year, from $998,960 last year, a 42 percent reduction. As a result, its navigators won’t be in 11 of the 23 counties it served over the last year.
The Ohio Association of Foodbanks, the primary navigator in the state, helped nearly 9,000 Ohioans enroll in private plans and another 35,000 apply for Medicaid since 2013. The group “met, nearly met, or exceeded” goals for four years, said executive director Lisa Hamler-Fugitt. Despite that, funding was cut by 71 percent, to $485,000, from $1.7 million.
The funding cuts seem like sabotage, not accountability, Hamler-Fugitt said. Her group closed its navigator program and let most of its staff go rather than try to sustain it at the lower funding level.
“If we were such poor performers, why were we not notified and corrective action taken? Because we weren’t,” she said.
Smaller and Sicker
Along with the navigator cuts and other regulatory moves, confusion over Obamacare’s fate will likely lead to “a smaller, sicker group of enrollees,” said Sabrina Corlette, a research professor at the Georgetown University Health Policy Institute.
Customers who don’t shop around for coverage could “have huge sticker shock” if they do nothing and are automatically re-enrolled in their current plans, Corlette said.
The navigator grants are funded by a levy on health plans in the insurance marketplaces, which benefit from the marketing and outreach. Trump administration officials didn’t respond to questions about how unspent fees would be used.
Cut at the Last Minute
The Trump administration said in August that it would cut funding to the navigators by 39 percent, down from $62.5 million the last enrollment period. The cuts apply only to states that have health-care markets run by the federal government — 16 operate their own.
They were announced just days before the new grants were supposed to begin. The agency had affirmed grant amounts earlier in the year.
“All indications were everything was going very well,” said Allen Gjersvig, director of navigator and enrollment services at the Arizona Alliance for Community Health Centers. Staff at CMS told the group as late as Aug. 28 that the funding was on track, he said. Days later, the Alliance’s navigator grant was cut from about $1.1 million to $700,000.
His confusion isn’t unique. Of the 48 navigator programs that responded to a survey from the Kaiser Family Foundation, about half said no rationale was provided, and another 40 percent said the explanation was “very or somewhat unclear.”
The Palmetto Project in South Carolina had its navigator grant cut from $1.1 million to $500,000, and will have 30 navigators instead of the 62 it planned on, said Shelli Quenga, the organization’s director of programs. It plans to leave some rural areas without in-person help.
“I think there will be people who choose poorly,” Quenga said. “There will also be people who just give up.”
As of this writing, the Affordable Care Act, also known as Obamacare, still remains the law of the land, despite efforts to repeal and replace it. The uncertainty about where this is headed has created uncertainty in the marketplace and thus rising prices. There are 3 states where Obamacare premiums may rise more than 50% in 2018 including New York, Georgia, and Maryland. The reasons for this premium increase are enumerated in the article below. Is this a sign of things to come in 2018? Medical Cost Advocate can help you navigate our complex health care system and find the insurance plan that best suits your needs.
By Sean Williams, Aug 26, 2017
Despite President Trump having been in office for more than seven months now and Republicans retaining control of both houses of Congress, the Affordable Care Act, which is best known as Obamacare, remains the health law of the land.
The hallmark legislation signed into law by former President Barack Obama in March 2010 has taken care of its primary goal of reducing the uninsured rate. Between late 2013 and mid-2016, we witnessed the aggregate uninsured rate fall from 16% to around 9%, representing an all-time low, according to the Centers for Disease Control and Prevention.
However, Obamacare has also been a relatively unpopular law since its inception. Until recently, when Republicans tried unsuccessfully on numerous occasions to repeal and replace Obamacare, you could easily count on two hands just how many months over the past six-plus years that Obamacare had more “favorable” views than “unfavorable” when it came to Kaiser Family Foundation’s Health Tracking poll. Most Americans never really cared for the individual mandate, which required them to purchase health insurance, and they certainly disliked the Shared Responsibility Payment, which required them to pay a penalty if they didn’t purchase health insurance.
Nevertheless, rate requests have been submitted by insurance companies in nearly every state, and we’re heading into 2018 with the strong likelihood that Obamacare will remain law.
President Trump threatens to go nuclear on Obamacare
Of course, that doesn’t mean President Trump has to like what’s transpired.
The Commander in Chief has suggested that if Congress doesn’t get its act together and repeal Obamacare, he’d consider going nuclear and withholding cost-sharing reductions in order to topple the program. Cost-sharing reductions, or CSRs, are the subsidies paid to lower-income individuals and families making between 100% and 250% of the federal poverty level, and they help cover the costs of heading to the doctor (e.g., copays, deductibles, and coinsurance). More than 7 million people enrolled via Obamacare’s marketplace exchanges qualified for CSRs in 2017. Without CSRs, lower-income folks would have health insurance but would probably be unable to afford the copay and deductible costs of being seen by a doctor.
This all ties back to a 2014 lawsuit filed by the House Republicans against Sylvia Burwell, who at the time was the Secretary of the Department of Health and Human Services (HHS). The GOP argued that only Congress has the right to apportion federal funding, which in this case meant approving funds for CSR payments. Since these subsidies weren’t getting the alleged proper approval, Republicans sued. In May 2016, they won; however, Judge Rosemary Collyer stayed her order, given the likelihood of an appeal from the Obama administration, which did come in. That appeal remains in place today, though Trump has appointed Tom Price as the new HHS secretary. All Donald Trump would have to do is drop the appeal of the case, and Collyer’s order would halt further CSR payments to insurers and low-income individuals and families.
Insurers, not knowing what will happen, have been requesting significant rate hikes to take into account both adverse selection (i.e., getting more sick enrollees than expected) and the possibility that these CSR subsidies could be taken away, in which case members may not be able to pay their medical bills. According to ACASignUps.net, which has aggregated price request data for nearly every state, the average rate hike request if CSRs remain in place is almost 16% in 2018, while premiums could jump by an average of 30% if CSRs are taken away.
Three states with possibly the highest average rate-hike requests
As in years past, we’ve seen a wide variance of rate requests. Alaska, which is known for having the highest monthly premiums, could see premiums drop by an average of 30% to 22% next year, simply depending on whether or not CSRs are kept or taken away. The drop is thanks to a new reinsurance program within the state.
Oklahoma could also see premiums fall by 1.9% in 2018 if CSRs are paid, or rise by an average of 8.7% if they aren’t. While good news on the surface, it’s little consolation considering the 76% that Blue Cross Blue Shield of Oklahoma hiked rates in 2017.
At the other end of the spectrum, three states could be in line to hike premiums by more than 50% if CSRs don’t get paid. Please note the emphasis on that “if,” because it could mean significantly more money flowing out of the pockets of unsubsidized Americans come 2018 if CSRs get taken away.
These states are: