Patient receives higher bill with health insurance than without
NASHUA – Kathleen McLinden pays about $2,400 per year for health coverage through her employer, but it seems the bill for her recent emergency room visit would have been less without this insurance.
“Just the whole thought of it aggravates me,” the resident of 2 David Drive in Nashua said. “Someone who can’t afford, or just doesn’t have insurance, pays less.”
As Democratic presidential candidates promote ambitious “Medicare for All” or other universal health care proposals, some Republicans are still working to upend the provisions of President Barack Obama’s Affordable Care Act in favor of totally “free market” solutions to health care.
Amid this debate, patients and taxpayers such as McLinden are frustrated to learn the health insurance they work to keep is, in some cases, not really worth all that much.
“If I didn’t pay $200 a month to have insurance through my employer, I would have gotten a lower hospital bill,” McLinden said.
Billing statements obtained by The Telegraph show McLinden visited Southern New Hampshire Medical Center in Nashua for emergency care on Christmas Day. She declined to divulge the nature of her emergency to the newspaper.
The first billing statement, dated Feb. 4, shows total accumulated charges for the services at $4,485.49. However, there is then a line item for “Patient Pay/Adjustment,” which amounts to a credit of $3,845.84.
Application of this adjustment reduced McLinden’s bill for service to $639.65, which would be further discounted to $511.72 if she paid that amount within 45 days.
The bill did not offer much detail for how the hospital actually determined these charges, so McLinden called to see if she could get an itemized statement of the costs.
It was at this time, McLinden said, that she learned the hospital did not apply her health insurance to the Feb. 4 bill. Indeed, the statement shows an amount of “$0.00” in the line item for insurance.
“I had been there before for blood work,” McLinden said. “I just assumed they already had my insurance information.”
A handwritten note on the front of the first bill features a date of Feb. 18. It states, “Don’t pay — they did not put through insurance.” Therefore, McLinden followed this advice.
The second billing statement is dated March 6. The new document shows that “Anthem National PPO (preferred provider organization)” is the insurance company paying part of the claim.
The total charge is still $4,485.49, while the line item for insurance shows it is paying $2,437.11 toward the cost. There is also a “Patient Pay/Adjustment” of $786.74.
This then created a bill sent to McLinden in the amount of $1,261.64, which would be reduced to $1,009.31 if she pays within 45 days.
Suzanne Tammaro is a spokeswoman for Southern New Hampshire Medical Center, as well as the communications and marketing leader for the hospital’s parent company, SolutionHealth. She said this situation is due to the “government-mandated discount we must apply to patients without insurance.”
“While it is rare, there are times when the government-mandated discount for self-pay patients amounts to less than the insured patient,” Tammaro said.
U.S. Census Bureau data from the most recent available year show that in 2017, approximately 28.5 million Americans did not have health insurance. This is despite the options, mandates and penalties established by Obamacare.
“Why is anyone taking their employer’s insurance when you have to pay for it and then you pay more to the hospital for having it? This is crazy,” McLinden added.