قالب وردپرس درنا توس
Home / Business / Bill of the Month: Association Health Plan Leaves Out Mental Health Care Out: Shots

Bill of the Month: Association Health Plan Leaves Out Mental Health Care Out: Shots



Arline Feilen (left) and her sister, Kathy McCoy, at their mother's home in the suburbs of Chicago. The largest portion of the Error bill was $ 16,480 for four nights in a room shared with another patient. McCoy joked that it would have been cheaper to stay at the Ritz-Carlton.

Alyssa Schukar for KHN


hide caption

to change caption

Alyssa Schukar for KHN

Arline Feilen (left) and her sister, Kathy McCoy, at their mother's home in the suburbs of Chicago. The largest portion of the Error bill was $ 16,480 for four nights in a room shared with another patient. McCoy joked that it would have been cheaper to stay at the Ritz-Carlton.

Alyssa Schukar for KHN

Arline The mistake lost her husband to suicide in 2013. Three years later she lost her father to cancer. And in February, she lost her 89-year-old mother to a cascade of health problems.

"We were like glue, and the first Mother's Day without her was a killer. It just dragged me down," said Feilen, who is 56 and lives in suburban Chicago. "It was just loss after loss after loss and I just crumbled."

A few days after the painful vacation, she drank eight or nine light beers for several hours, trying to drown out the pain. She sent alarming texts to her sister and friends, raising concerns that she might hurt herself. A friend called 911 and called an ambulance that took her to Northwestern Medicine Central DuPage Hospital.

The error arrived at the emergency room in mid-May night and was moved to a shared room in the psychiatric psychiatric unit the following day. In total, she spent five nights in the hospital.

The error underwent a battery of tests: blood work, an abdominal ultrasound and an electrocardiogram. She was given group guidance, which her sister, Kathy McCoy, said really helped. She also started taking an antidepressant, Remeron.

When she got home, she stopped drinking beer. She continued to take the medicine and continued to advise. She came to see her mental health crisis as "another mountain I've climbed" – and recalled her achievement by holding her hospital wristband in her bedroom near a candle. Her grief began to subside.

Then came the bill.

Patient: Arline Feilen, the widow of a veteran, is a part-time medical transcriptionist living and living in Carol Stream, Ill. She purchased individual insurance in the open market, not through the exchange of Affordable Care Act.

Total Bill: $ 29,894.50, including $ 16,480 for rooms and tables in a semi-private psychiatric room and $ 3,999 for the ER. After the hospital reduced the bill because her insurance did not cover mental health, she owes $ 21,634.55.

Service Provider: Northwestern Medicine Central DuPage Hospital, a large suburban hospital in Chicago. It is part of the Northwestern Medicine Professional Health System .

Medical Service: The error received inpatient treatment for a depressive episode, including blood draw, an ultrasound, an electrocardiogram and behavioral health treatment.

What gives: The error has a "union health plan" purchased through the Affiliated Workers Association. It's called SelectCare 1, costs her $ 210 a month and doesn't cover mental health care.

This is a type of plan that the Obama administration limited. But someone like the Error is allowed again since the Trump administration gave a clear signal to sell plans that were previously considered to offer insufficient coverage.

Like other association plans, her does not have to include the 10 "important health benefits" required by the federal Affordable Care Act, such as mental health and substance abuse treatment. In ACA compliant plans, these benefits must be treated in the same way as physical needs.

Jennifer Snow, acting national director of advocacy and public policy for the National Alliance on Mental Illness, said the type of plan the error has is "allowed to undermine the ACA."

If you or someone you know may be considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (En Español: 1-888-628-9454; Deaf and Hearing: 1-800-799- 4889) or Crisis Text Line by sending HOME to 741741.

Last year, the Trump administration passed rules that make it easier for small employers to team up to offer insurance through these plans. In March, a United States District Court judge with 11 states and the District of Columbia challenged the law and invalidated much of those rules. But affiliation plans are still out there, and some states support wider access to them.

Sheri Boehle, an insurance agent who manages the Associated Workers Association, said that many people buy this type of insurance in a short period of time. For the right people, she said, it's a great alternative that can protect them from the cost of catastrophic physical health problems.

Boehle said that she always gives clients a brochure that explains exactly what is covered and what is not, and the error said she got one to say that treatment for mental health care would not be covered. The error said it was fine with her when she bought the policy many years ago because she did not expect to need that service.

To keep costs down while she was hospitalized, Errors said, she tried to refuse treatments like ultrasound, but was told she needed it. She got no answer when she asked how much she had to pay.

"I ask a simple question, and it should be a simple, limited answer, " she said.

Hospitals generally charge uninsured people much more than they charge people who have insurance. A 2017 report from the Health Care Cost Institute showed that the average bargain price for an emergency mental health admission was $ 9,293 for a commercially insured patient who stayed on average for a week. That's less than half of the Error's bill.

Getting answers about care costs can be extremely difficult for patients, even those who submit the bills without the help of insurance.

"Hospital rates are obviously opaque," said Ezra Golberstein, associate professor at the University of Minnesota's School of Public Health. "The easiest prices to get are how much to pay for parking and how much things cost at the snack bar."

The largest portion of the Error bill was $ 16,480 for four nights in a psychiatric unit room shared with another patient. Adding the night to the ER brings it up to $ 20,479 – most of the entire bill.

McCoy joked that it would have been much cheaper for the sister to stay in a Ritz hotel.

That's right. According to the site, five nights in the grandest suite at the Ritz-Carlton in downtown Chicago costs $ 12,895.

Resolution: Without asking, the hospital reduced Feen's bill by $ 8,968.35 because she lacked mental health coverage. This amount had already been deducted from the bill when she received it.

Hospital officials stated that Northwestern Medicine offers a variety of financial assistance programs for uninsured, underinsured and insured patients. Often, they said, a social worker or community partner helps the patient navigate the process, which includes filling out an application and providing support information and documents.

"In this case, we have tried repeatedly to contact this patient to provide guidance and assistance," the statement states.

The error said she was talking to a social worker at the hospital about costs and began filling out a financial aid form, but stopped when she came to a section asking about stocks and bonds. Although her annual income is below the poverty level – and she probably qualifies for Medicaid – she received a modest legacy from her parents that she has put into a retirement plan, she said, believing it meant she would not qualify.

When she bought insurance many years ago, Fail said, she began looking into plans for health care.gov that offer subsidies to many people with low or middle income. But she said she found them confusing and gave up.

NAMI's Snow said it is sometimes tough for consumers to know if a plan is in line with health care. Plans sold outside of health.gov may be labeled "Obamacare" but may not have the health benefits guaranteed.

"You have to be really careful not to buy one. They are always cheaper," she said. "But if it seems too good to be true, it probably is."

To find ACA-compliant plans, which must cover mental health, Snow suggested going to HealthCare.gov, the federal marketplace that covers most states. (It will guide you if your state creates its own ACA marketplace.)

The Takeaway: If you are not insured, you will generally face larger bills than patients with health insurance because you lack the insurance company's power to to negotiate prices with the hospital. Ask if you qualify for Medicaid or charity care. If you don't, you can negotiate with the hospital anyway to try to lower the bill. Armed with information about high-priced insurance companies pay for the care you received by consulting websites like Healthcare Bluebook or Fair Health.

When you buy insurance, make sure you know what's covered and what's not, which can be difficult to determine for plans – many of which are on the Internet – that don't have to follow all the federal rules health law.

"In the individual market, there are very 'buyer beware' of plans that are not ACA compliant," Golberstein said. "Read short-term health plans or health plans."

If the mistake could go back in time, she said she would surely have bought insurance that covers mental illness, affecting 1 in 5 American adults each year.

"I would definitely recommend it. You don't know what life will give you," she said. "I never imagined in a million years that I would need mental health care."

NPR produced and edited the interview with Kaiser Health News & Elisabeth Rosenthal for broadcast. Christine Herman of Illinois Public Media and Side Effects Public Media provided audio reporting.

Bill of the Month is a crowd survey by Kaiser Health News and NPR that dissect and explain medical bills. Do you have an interesting medical bill to share with us? Tell us about this .

Kaiser Health News is an ideal news service that covers health issues. It is an editorial independent program from the Kaiser Family Foundation that is not affiliated with the Kaiser Permanente.


Source link