Healthcare insurance is not affordable for most, especially to the average citizen. Nitin Chhoda shares the role of The Affordable Care Act and how the average citizens can benefit from its coverage.
According to a Sept. 2012 study by The Kaiser Family Foundation, the average premiums for healthcare insurance in 2012 were $5,615 for an individual and $15,745 for family coverage.
The actual cost and available insurance and benefits vary widely throughout the U.S. and covered expenses are dependent upon the individual healthcare policy.
Many people saw passage of The Affordable Care Act as a panacea for all their healthcare insurance and benefits needs.
While the act did extend coverage to millions of uninsured individuals, the reality of their medical billingcoverage and the cost of being insured came as a surprise to many.
As different facets of The Affordable Care Act are phased in through 2014, basic coverage by certain plans will encompass essential services and impose no lifetime spending limits on those services. Basic healthcare coverage will include:
Emergency services
Hospitalization
Maternity benefits
Newborn care and pediatric services
Mental health and substance abuse services
Prescription medications
Preventative and wellness services
Chronic disease management
Oral care
Vision services
Lab and x-ray
Until all aspects of The Affordable Care Act take effect, individuals are still contending with standard healthcare insurance policies that are often limited in scope. They may provide coverage for visits to a physician, hospitalization and rehabilitation services, along with x-rays, lab tests, immunizations and well-child visits.
Mental health and substance abuse services, pap tests, and mammograms may also be included. Insurance and benefits policies usually include prescription medications, but not always.
Coverages and Caps
A host of services may not be covered, policies can contain provisos and require clients to purchase riders to their basic coverage to receive maternity benefits, cancer treatments, dental care and vision exams. Those services require an additional financial outlay. They’re viewed as optional insurance and benefits coverage rather than part of the overall insurance package.
Current healthcare insurance policies often contain monetary caps on services, lifetime benefit limitations, and require pre-approval for an array of tests, procedures and surgeries. For the majority of Americans, healthcare insurance is offered through the workplace.
To keep costs low, employers often contract with insurance and benefits companies for policies that offer rudimentary coverage for employees, while passing on a large portion of the cost to employees.
Today’s insured are being required to take greater responsibility for their own health and engage in preventative measures in an effort to identify, diagnose and treat potential health problems before they become critical.
Along with this is the current trend by the healthcare insurance industry of moving toward requiring clients to purchase individual insurance and benefits from a menu of optional services.
The Affordable Care Act will mitigate many of the problems individuals encounter with coverage by traditional policies, but many wonder what the ultimate cost will be to consumers. Higher deductibles, copays and premiums may be looming just over the horizon for many citizens.
Selling Policies are Limited
Healthcare insurance and benefits providers are often limited to selling policies by geographic areas and are only allowed to offer insurance across state lines under a specific set of circumstances. Those boundaries prevent a truly open market for consumers and could contribute significantly to continually rising healthcare costs.
After decades of controlling the healthcare insurance and benefits industry, dictating terms, and an era of record profits, healthcare insurance providers are being forced by presidential decree to extend benefits to the majority of Americans, regardless of pre-existing conditions.
The Affordable Care Act extends coverage to millions of Americans and provides an array of essential services, but insurance providers aren’t going to give up record profits without a fight, which could lead to even higher healthcare costs for Americans.
The Affordable Care Act was created in order to help uninsured or underinsured people with regard to their health care insurance.
Nitin Chhoda discusses how the act is evolving from time to time and making the coverage adjacent to the healthcare that the average people need. However, health insurance has become more and more expensive.
The Affordable Care Act was designed to extend coverage to those who had none, right inequities in coverage and lower healthcare practice management costs across the board, along with improving the quality of care for all Americans.
Some of those goals are beginning to be realized, but the cost of healthcare and insurance continues to increase with no abatement in sight.
The ranks of the uninsured will continue to swell as workers lose their employer-based healthcare insurance through job loss and outsourcing.
Healthcare Insurance are Expensive
The Affordable Care Act penalizes employers that don’t offer a healthcare and insurance option to employees, but the fines are far less than the cost of providing healthcare policies.
A growing number of business owners are choosing to pay a penalty that’s a fraction of what a single healthcare insurance policy would cost. The current state of healthcare reform establishes a system where costs for healthcare insurance continue to increase and benefits decrease.
The Affordable Care Act, created to extend healthcare and insurance to the majority of citizens, still leaves millions of individuals uninsured. It further penalizes individuals for their financial inability to purchase insurance, as well as those who have “high-end” policies.
Taxes on high end insurance programs beginning in 2018 encourages people to select less costly healthcare and insuranceplans where they shoulder more of the financial burden with higher premiums, co-pays and deductibles.
To avoid penalties and skyrocketing costs, individuals will choose the most inexpensive policies available and delay seeking medical attention when they can’t afford out-of-pocket expenses.
Part of the provisions in The Affordable Care Act provides programs to encourage clinicians to eliminate waste, improve care and safety for patients, and reduce expensive testing and procedures.
The “less is more” mentality brings the quality of care into question as healthcare and insurance providers attempt to meet the demand of millions of new patients flooding into the system.
The Effect
Therapists and other healthcare and insurance providers are being backed into a corner with the untenable position of sacrificing allotted time with patients in a system where clients have extensive waits for appointments.
Clinicians could be forced to pick and choose patients based on their insurance coverage or ability to self-pay, simply to keep their clinics solvent and continue to practice their profession.
In an effort by insurance companies to reduce their costs, homeopathic solutions could easily become the treatments of choice. Healthcare providers face increasing pressure by insurance companies to eschew a wide variety of tests and provide more extensive documentation to justify their decisions.
Therapists are effectively being second-guessed by those in organizations that have little or no medical experience, and no idea of the practicalities of a physical therapy clinic.
The Affordable Care Act provides for an array of essential services that new healthcare and insurance policies must provide, but consumers will ultimately pay the price for that coverage through increased out-of-pocket expenses.
Physical therapists will feel the effects through reduced reimbursements, a potential loss of patients, and increased collection costs.
The Future
In a perfect world, access to affordable healthcare would be available to all, insurance companies would forego record-breaking profits in favor of the common good, and clinicians would be free to treat patients as their profession calls them to do.
The future of affordable healthcare and insurance, benefits without penalties, and accessible treatment for all is in jeopardy. As currently written, all avenues lead back to many of the same problems that the Affordable Care Act was created to fix.
The multi-tiered healthcare system in the U.S. is a slow and ponderous process, but one that’s essential for the financial stability of practices and to ease the pain and suffering of patients. Nitin Chhoda explains health insurance and its relations to our current economy.
Healthcare is a complicated and convoluted process in the U.S. that involves patients, practitioners, health insurance providers and a multitude of clearinghouses established specifically for processing, verifying and paying claims.
Due to the many facets of the industry, it can leave even insured patients with insufficient health insurance coverage or none when they need it most, while clinicians are buried in a mountain of paperwork and rejected claims.
Healthcare in the 21st Century
Healthcare was a reactive system focused on treating ailments and illnesses as they appeared. The beginning of the 21st century saw a shift in the thinking of health insurance company executives toward preventative measures and ways for clients to avoid becoming ill or developing conditions such as diabetes and heart disease.
When the Affordable Health Care Act is fully implemented, millions of previously uninsured individuals will have access to a core group of services through health insurance policies obtained through their employment or management insurance exchange.
Health Providers
Health insurance providers are beginning to change their procedures by forcing patients to shoulder more of the cost burden and setting limitations on costs and treatments.
The result is that many clients that have health insurance are no better off than those without.
Due to these insurance practices, physical therapy management must develop and implement strategic plans to contract with the best paying providers and examine client health insurance coverage closely before beginning a treatment.
Decide Carefully
To remain solvent, clinicians will be required to make hard decisions about the patients they treat, the health insurance they accept and the providers with which they contract.
The technology embodied in an electronic medical record (EMR) system is a clinician’s best friend for verifying health insurance, providing enhanced documentation and submitting reimbursement claims.
Nitin Chhoda explains how insurance and healthcare in the United States differ from other countries. He discusses how healthcare is tied to insurance in order for Americans to afford proper healthcare.
Healthcare and Insurance in Other Places
In some countries, the price of healthcare itself is affordable to residents. For example, in Thailand the need for healthcare and insurance is negligible, especially if a patient is earning a first world level salary.
If you need to go to the doctor, you can afford to go. If you need surgery, it will cost you a lot of money, but it will not cost you even close to the amount you’d pay if you were in the United States.
Another example is the healthcare and insurance system in Norway. Rather than have health insurance, the government uses taxes to subsidize healthcare.
That means that when a Norwegian needs to go to the doctor, they pay an affordable rate, but the doctor also gets paid a good salary because an extra fee is added that is paid by the government. Even for expensive things, if you need healthcare you can get it and at the same time, everyone makes a really good salary.
Our Healthcare and Insurance System
In the United States, the system of a healthcare practice management is very different. The cost of healthcare and insurance is so high that it is unaffordable for most Americans. Especially if a serious accident happens or an illness is diagnosed, uninsured Americans will be responsible for paying all of the costs – hundreds of thousands of dollars.
Because the prices are so high and nobody can afford to pay for surgery in the U.S., instead we buy healthcare and insurance, just in case something bad happens.
Healthcare and insurance work similarly to car insurance. Most of the time you pay your monthly premium, or you pay it up front for the year or the quarterly price each quarter.
Your plan may include co-pays, which are the amounts that you pay when you go to the doctor for certain types of visits. It may also include a deductible, which is the amount you pay each year before you start to redeem your healthcare and insurance.
But if you get into a car accident, your insurance is meant to pay for the amount that you cannot pay. The damage to the other car, medical costs of people in the cars, and damage to your car and your medical expenses can all be covered by car insurance, depending on your policy.
The same is true of healthcare and insurance. If you are diagnosed with cancer, your insurance policy should cover the high costs of treatment.
Healthy or Not
If you are healthy, you don’t use your insurance for healthcare. But once something happens, you cannot get healthcare and insurance because no insurance company will accept you as a client if you are going to be expensive.
This is why healthcare and insurance are so intimately tied together in the U.S. Without insurance, you cannot afford healthcare when you need it.
Sadly, these days healthcare and insurance companies are largely unregulated and can charge incredible premiums for insurance.
That means that even if people want healthcare and insurance, they can’t afford to get it.
If you stop paying your insurance bills, you are no longer covered. That means that healthcare and insurance are unaffordable. In that situation, Americans do not have many options besides medical bankruptcy.
According to a Sept. 2012 study by The Kaiser Family Foundation, the average premiums for healthcare insurance in 2012 were $5,615 for an individual and $15,745 for family coverage.
Today’s insured are being required to take greater responsibility for their own health and engage in preventative measures in an effort to identify, diagnose and treat potential health problems before they become critical.
