Health Literacy Month – What Consumers Should Keep Top of Mind About Their Health Coverage

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Americans are acutely concerned about paying for health care – even more than they worry about costs associated with retirement, college, housing or child care – according to a recent Consumers for Quality Care (CQC) survey.

October is Health Literacy Month and that’s a great time for the many Americans who are increasingly alarmed about rising health care costs to learn more about insurance policies and billing procedures that can inflate costs – like surprise medical bills, coverage denials and decreased pharmacy cost sharing benefits – and identify a few ways to mitigate some of these issues.

Whether your health insurance is through your employer,, Medicare or another source, open enrollment season is right around the corner, marking the one opportunity you have each year to review and change your coverage. Here are some of the potential issues you should be on the lookout for now and throughout the year.

  • Surprise Medical Bills:
    A recent Wall Street Journal article revealed that hospital care is the largest single component of total personal health care spending in the U.S. When we pay our insurance premiums and the rapidly rising deductibles and out-of-pocket costs, we reasonably expect that the coverage we are paying for so dearly will cover us when we need it. Instead, a West Health Institute/NORC Survey found that over half of Americans say they have received a medical bill in the past year for a cost they thought was covered by their health insurance. Many of these surprise bills result from “balance billing” for treatment at in-network facilities by out-of-network providers, while others result from a lack of customer understanding of complex health benefits and opaque pricing.
    What You Can Do: While policies can be complex and pricing isn’t always transparent, it’s important to understand what your insurance will and will not cover. Consumers should also be diligent in reviewing bills and explanations of benefits for errors that can be driving costs up. Click here for a tutorial on reading a medical bill and if your bill includes services you didn’t agree to, raise it with your health care provider’s billing office. Finally, more and more states are passing consumer protections against surprise medical bills and Congress is debating legislation that would require better transparency and set limits on what the patient may be charged for out-of-network treatment at in-network facilities. You can signal your support for these bills aimed at reducing health care costs and helping consumers avoid unexpected bills.
  • Emergency Department Policies:
    Some insurers are instituting policies that would force policy- holders to pay for an emergency room visit if they later deem it a non-emergency. These policies, which essentially require patients to diagnose themselves in order to ensure their condition is serious enough to be considered an emergency by their health insurer, are impacting customers while increasing profits for the insurers implementing them. The practice will likely mean patients will delay or go without emergency care rather than risk getting a surprise medical bill.
    What You Can Do: Note which insurance companies are implementing this policy and in which states. We know these denials have occurred in Georgia, Indiana, Kentucky, Missouri, New Hampshire and Ohio, and likely other states as well. If you encounter an issue with an emergency department denial, your best first step is to contact your state’s insurance commissioner. Click here for a State Insurance Commissioner contact information in the states consumers are most likely to encounter issues with after-the-fact emergency department denials.
  • Accumulator Adjustment Programs:
    Today, health insurance plans and prescription drug middlemen known as pharmacy benefit managers – or PBMs – are rolling out programs that make it harder to use cost sharing coupons that help patients afford their prescription drugs. Many Americans with chronic diseases, along with other patients, rely on medicines to manage their conditions. More and more patients are finding that when they use a cost sharing coupon, the plan is no longer counting the coupon towards their deductible or cap on total out-of- pocket costs. For some patients, their coupons run out before the end of the year—leaving them with unexpected and unaffordable cost sharing when they try to fill a prescription at the pharmacy.
    What You Can Do: If you currently use a coupon to help pay for your prescription drugs and have a choice of insurance plans, you should contact your insurer or the human resources department at your employer to find out if you will face any restrictions.

It is important to note that and the state marketplaces are open for enrollment from Nov. 1 to Dec. 15. No matter what type of insurance you have, make sure you shop around to find the best health plan for you for you and your family.

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