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MrsKirkley

(180 posts)
Sun Nov 10, 2013, 10:36 AM Nov 2013

Does the Affordable Care Act make it illegal for hospitals to demand entire deductibles up front?

I'm glad the health care law is helping so many people get health insurance, but I hope it can be improved to help more. Unfortunately, the way the law is written is leaving many poor American families ineligible for the subsidies they need because their low paying employers offer high deductible family health insurance. I've read that if a patient needs surgery or expensive cancer treatment, hospitals can demand the entire deductible up front. What if the low income family member needing treatment doesn't have good enough credit to get a $5,000+ loan to pay for the deductible or doesn't know anyone who can come up with it? Does anyone know if the health care law makes demanding entire deductibles upfront illegal starting in 2014?

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Does the Affordable Care Act make it illegal for hospitals to demand entire deductibles up front? (Original Post) MrsKirkley Nov 2013 OP
First, it might be helpful Le Taz Hot Nov 2013 #1
A relative of mine went in for a kidney procedure and... Hugin Nov 2013 #4
The affordable care act begins in ernest in January, so this payment loudsue Nov 2013 #10
Their reply was "they are not a bank" when he asked about financing the co-pay. Hugin Nov 2013 #26
So what did he do? nm rhett o rick Nov 2013 #14
He hit me and other family up for some "loans". Hugin Nov 2013 #29
Here are a few: enlightenment Nov 2013 #9
kick Hugin Nov 2013 #2
Kaiser was going to charge me $115 for a $15 prescription.. SoCalDem Nov 2013 #7
I have a kidney stone right now. xmas74 Nov 2013 #8
Good question. I, too, would like to know the answer. n/t Laelth Nov 2013 #3
... Hugin Nov 2013 #6
I think a better question would be, "Does the ACA change the current practice of requiring rhett o rick Nov 2013 #15
That's certainly possible. Laelth Nov 2013 #17
I dont either and would. I just didnt like the implications of the question. rhett o rick Nov 2013 #18
ACA is not responsible and ACA makes it worse Yo_Mama Nov 2013 #37
Surely there's a copy of the actual law somewhere or other , dipsydoodle Nov 2013 #5
The answer is "no" enlightenment Nov 2013 #11
I sort of did. StrayKat Nov 2013 #13
I hadn't heard of this trend. StrayKat Nov 2013 #12
There's a whole shit load of cracks to fall through. L0oniX Nov 2013 #16
Message auto-removed Name removed Nov 2013 #19
Hello ~ Alice B. TokeLess. In_The_Wind Nov 2013 #20
Hospitals are not lending institutions. JNinWB Nov 2013 #21
How can one choose a low deductible policy if their employer only offers a high deductible policy MrsKirkley Nov 2013 #22
I have been involved in selecting small group coverage for many years. JNinWB Nov 2013 #23
Many people select high deductible plans because they can't afford the premiums on low... Humanist_Activist Nov 2013 #25
For many, a $6300 deductible plan might as well be $50,000. JNinWB Nov 2013 #28
They aren't consumers, they are patients who need medical care... Humanist_Activist Nov 2013 #31
They are consumers... Keefer Nov 2013 #33
Many of us have no choice whatsoever Yo_Mama Nov 2013 #36
I've never experienced a hospital that demanded payment up front. lumberjack_jeff Nov 2013 #24
i was hospitalized for a few days a couple years ago. the bill came six weeks later. dionysus Nov 2013 #27
ACA institutionalized this growing trend Yo_Mama Nov 2013 #35
Several other interesting bits of info: JNinWB Nov 2013 #30
Of course not and if they did the phony penalty would involve a wag of the finger TheKentuckian Nov 2013 #32
No, it does not Yo_Mama Nov 2013 #34

Le Taz Hot

(22,271 posts)
1. First, it might be helpful
Sun Nov 10, 2013, 10:39 AM
Nov 2013

if you included a cite for your claims. Did you read this somewhere? Hear it? What/Where?

Hugin

(32,778 posts)
4. A relative of mine went in for a kidney procedure and...
Sun Nov 10, 2013, 10:49 AM
Nov 2013

Had to cough up $2500.00 (the entire deductible) before they would even touch him. He is a stock man at a large retailer and does not have that kind of money laying around nor does he qualify for a loan.

loudsue

(14,087 posts)
10. The affordable care act begins in ernest in January, so this payment
Sun Nov 10, 2013, 11:24 AM
Nov 2013

the hospital is asking for isn't related to the ACA, I feel certain. I've had procedures where I was not required to come up with all of it at once, but I did have to put down $100 or so. They ALWAYS ASK for the deductible, but all he has to do is work it out with the business office at most hospitals.

Hugin

(32,778 posts)
26. Their reply was "they are not a bank" when he asked about financing the co-pay.
Sun Nov 10, 2013, 03:13 PM
Nov 2013

He had little choice but to come up with the money. He's lucky to have some resources (his relations) which some others I've heard of did not.

Hugin

(32,778 posts)
29. He hit me and other family up for some "loans".
Sun Nov 10, 2013, 03:21 PM
Nov 2013

Which, I'm pretty sure won't be re payed and we could ill afford either.

But, he had to have something done asap and it was only going to get worse and more expensive if he put it off longer. As, he was unable to work until he received treatment.

enlightenment

(8,830 posts)
9. Here are a few:
Sun Nov 10, 2013, 11:23 AM
Nov 2013

I chose older articles because the question is not about the ACA but about whether or not hospitals demand payment up front:

http://www.northjersey.com/news/137872133_More_hospitals_demand_payment_on_the_spot.html?page=all

http://health.usnews.com/health-news/best-hospitals/articles/2010/07/23/patients-beware-hospitals-are-increasingly-requiring-cash-up-front
This article discusses both uninsured and insured patients

http://www.modernhealthcare.com/article/20121013/MAGAZINE/310139953


There is, apparently, a report from mid-October that suggests that the ACA is causing this and if you Google "hospital charging deductible up-front" you'll see page after page where it has been repeated. I deliberately ignored it because it looks like fear-mongering, but I suspect that it plays off these earlier reports and the fact that yes, hospitals admit that they want the bills paid up-front. I think anyone who has dealt with hospital care in the last five years or so can attest to the increasingly strong-arm tactics that some use; it's something that I lay at the feet of the increased privatization of hospitals - profits come before care.

Hugin

(32,778 posts)
2. kick
Sun Nov 10, 2013, 10:43 AM
Nov 2013

I know several people who have had to do this deductible up front stuff before necessary procedures and it is IMHO discriminatory.

SoCalDem

(103,856 posts)
7. Kaiser was going to charge me $115 for a $15 prescription..
Sun Nov 10, 2013, 11:09 AM
Nov 2013

(our drug plan has a $100 deductible).. I said Keep the eye drops..went to Walgreens & paid less than $15 (because of their funky little card the guy filled out for me)..

xmas74

(29,658 posts)
8. I have a kidney stone right now.
Sun Nov 10, 2013, 11:14 AM
Nov 2013

I was given a prescription for flomax. My insurance company charged a higher amount than Walgreen's. The clerk saw the total, waved over the pharmacist and he said there was no reason to pay that amount and brought it down to about $7.50. Insurance? Wanted $50.

 

rhett o rick

(55,981 posts)
15. I think a better question would be, "Does the ACA change the current practice of requiring
Sun Nov 10, 2013, 12:27 PM
Nov 2013

the deductible up front?" The way the question is written implies that the ACA may be responsible for this.

 

rhett o rick

(55,981 posts)
18. I dont either and would. I just didnt like the implications of the question.
Sun Nov 10, 2013, 12:50 PM
Nov 2013

DU should have a pinned thread somewhere to track discussion of the ACA.

Yo_Mama

(8,303 posts)
37. ACA is not responsible and ACA makes it worse
Sun Nov 10, 2013, 07:37 PM
Nov 2013

Many buying insurance on the exchanges have no option but high deductible plans and most small employers are going to have to shift their employees to exchanges.

ACA provides subsidies on a 70/30 actuarial payout. This requires either high deductibles or high copays. If you have a high copay the hospital will require cash up front also.

Same with outpatient care. If free preventive treatment finds a problem, some people are going to be shit out of luck seeking treatment.

dipsydoodle

(42,239 posts)
5. Surely there's a copy of the actual law somewhere or other ,
Sun Nov 10, 2013, 10:57 AM
Nov 2013

probably as a PDF , and the contents should answer your question.

Try here : http://www.hhs.gov/healthcare/rights/law/

enlightenment

(8,830 posts)
11. The answer is "no"
Sun Nov 10, 2013, 11:38 AM
Nov 2013

Searching the entire 2,409 page document using "deductible" (looking at each incident of the word) and "hospital" (again looking at each incident of the word).

Nothing in the legal language that suggests the law prohibits hospitals (or doctors) from demanding the full deductible up-front. It might have been added to another, existing law. That's part of the problem with the ACA - to really get a sense of what it does and doesn't do, you have to have several federal statutes open in front of you.

There is federal law from 1986 (EMTALA) that prohibits emergency rooms from denying emergency care, though that has nothing to do with the question posed. It is possible that is where they made changes, but I doubt it . . . and I don't feel like digging it up to see!

StrayKat

(570 posts)
13. I sort of did.
Sun Nov 10, 2013, 11:48 AM
Nov 2013

I searched the GPO one. I saw nothing about this.

I used "dedu" as the search and there seemed to be more hits for tax deductions than mentions of deductibles. The ACA is not very protective.

StrayKat

(570 posts)
12. I hadn't heard of this trend.
Sun Nov 10, 2013, 11:43 AM
Nov 2013

But, reading about it, I'm reminded of the old days when hospitals always checked your insurance first when you came into an emergency room and then decided IF and how they were going to treat you.

"Large majorities of hospitals have organized their admission process where they want to see a check or credit card before they take you to your room," says Ron Luke, a consultant to healthcare providers in more than 25 states. Among them are Inova Fairfax in Northern Virginia and North Shore in Manhasset, N.Y. Insured workers, too, are feeling the pain, as many are choosing high-deductible plans, and copays and coinsurance charges just keep going up.- US News & World Report



Response to MrsKirkley (Original post)

JNinWB

(250 posts)
21. Hospitals are not lending institutions.
Sun Nov 10, 2013, 01:22 PM
Nov 2013

We would not consider going to Bank of America, or Citibank, for a hip replacement; why expect hospitals to finance health services? Hospitals should be assured of full payment from the insured patients, not the taxpayers.

Individuals, who select high deductible policies must realize that a hospitalization will cost the full deductible and make prior arrangements for payment. Credit cards, equity lines, borrowing from dad and savings accounts can be used. Anyone going in for elective surgery should make financial arrangements in advance of the procedure.

I'm sure that hospitals already have arrangements with lenders to work with those who need financial assistance to pay their hospital bills. Hospitals can not refuse to provide emergency services, but they need to be paid.

I'm in favor of Single Payer, but that's not what we have.

MrsKirkley

(180 posts)
22. How can one choose a low deductible policy if their employer only offers a high deductible policy
Sun Nov 10, 2013, 01:46 PM
Nov 2013

and the fact that their employer offers health insurance makes them ineligible for subsidies they need purchase a lower deductible plan?

JNinWB

(250 posts)
23. I have been involved in selecting small group coverage for many years.
Sun Nov 10, 2013, 02:40 PM
Nov 2013

It is more challenging now, but it has (almost) always been an unappreciated chore. Providing health ins. for a small group has been difficult---balancing the affordability of the premiums against the needs of the employees. The workers are rarely happy with their coverage and the employer is almost always the one to "blame".

It is very hard to provide insurance for lower-income employees, who would (with/ACA) be qualified for subsidies on the exchanges. Employer provided insurance is based on age and number of family members, not the employees salary. I predict that most small employers will stop offering coverage and increase salaries, somewhat, to encourage purchases from the exchanges.

This transition to the ACA (Covered CA) will be pretty bumpy for all employers. Our current group policy extends until next November with a somewhat better provider network than similar ACA plans. But, I can see small groups soon discontinuing coverage for all employees who will then need to purchase from the market

As employer-provided plans become indistinguishable from the exchange plans, the annual deductibles will become the same at @ $6500.

 

Humanist_Activist

(7,670 posts)
25. Many people select high deductible plans because they can't afford the premiums on low...
Sun Nov 10, 2013, 02:52 PM
Nov 2013

deductible plans. That's perhaps the most egregious thing about our private healthcare system, its set up to cost the poor everything, so they can never have assets of any sort, and are lucky to hold onto a (crappy, old)car for primary transportation.

Even worse for poor people with chronic conditions, who would love to be able to have a low deductible, but can't afford the premiums, and basically just do without health care all together because they can't use what insurance they can afford.

JNinWB

(250 posts)
28. For many, a $6300 deductible plan might as well be $50,000.
Sun Nov 10, 2013, 03:17 PM
Nov 2013

People selecting plans need to understand that the deductible or annual out-of-pocket, do not always begin unless there are out-patient or hospital charges. The new plans, even the Bronze cover an annual, complete physical exam and comprehensive testing. Many chronic conditions can be diagnosed at the time of this exam.

Some plans cover additional office visits and prescription drugs with co-pays that do not require deductibles. This is why exchange consumers will need to carefully analyze their current annual costs to be able to select the appropriate plan. Sometimes, paying a higher, monthly premium will be cheaper than paying deductibles.

What consumers will have examine closely is the individual deductibles, Rx co-pays (and formularies) and provider networks. This will be very difficult---here in CA, some plans have not yet decided on, and published, their provider networks. Insurance companies are offering different providers for their group plans and their exchange offerings.

Deductibles, restrictive formularies and provider networks are ways that exchange plans can provide low premiums.

 

Humanist_Activist

(7,670 posts)
31. They aren't consumers, they are patients who need medical care...
Sun Nov 10, 2013, 03:52 PM
Nov 2013

you seem to be under the erroneous assumption that many people have a choice, when they don't.

Yo_Mama

(8,303 posts)
36. Many of us have no choice whatsoever
Sun Nov 10, 2013, 07:30 PM
Nov 2013

The only plans offered in many counties have these high deductibles. If you don't qualify for cost-sharing, you are up the creek without a paddle.

 

lumberjack_jeff

(33,224 posts)
24. I've never experienced a hospital that demanded payment up front.
Sun Nov 10, 2013, 02:44 PM
Nov 2013

Not to say that they don't exist, but I've never seen it.

dionysus

(26,467 posts)
27. i was hospitalized for a few days a couple years ago. the bill came six weeks later.
Sun Nov 10, 2013, 03:17 PM
Nov 2013

took a year to pay them off.

JNinWB

(250 posts)
30. Several other interesting bits of info:
Sun Nov 10, 2013, 03:39 PM
Nov 2013

Hospitals can check your policy information, finding out how much is left on your deductible and request payment at the time of admission.

Do not accept COBRA until you check the exchanges to see if you are entitled to a subsidy; if you take even one day of COBRA, you cannot qualify for the subsidy that year. (You have a 62 day window to accept COBRA. If you decline COBRA and have a medical emergency within that window, you can still sign up.)

If you do not qualify for a subsidy on the exchange, you can purchase your policy through a broker, who can compare all the various exchange plans for you. (A broker told me this, so.....)

California exchange subsidies are based on the Federal Poverty Limit not California's, which is higher. This will really hurt low-income Californians.

TheKentuckian

(24,949 posts)
32. Of course not and if they did the phony penalty would involve a wag of the finger
Sun Nov 10, 2013, 04:10 PM
Nov 2013

and publication of the wrongdoing, at most.

Enforcement is pretty weak all the way around but stronger on the individual than any "stakeholders" at any time. The ultimate sanction is not being able to sell on the exchanges, which is not even a credible threat in many markets and where it is credible, it probably doesn't mean much in the way of profits.

On the other hand, they will definitely hold our refunds if nothing else.

Yo_Mama

(8,303 posts)
34. No, it does not
Sun Nov 10, 2013, 07:22 PM
Nov 2013

As for the ACA Silver deductibles, for really low income people who buy on the exchange (up to 200% of FPL), there is significant reduction for policies bought on the exchange. There is a small reduction for 200-250% of FPL.

Everyone else is up the creek, and yes it is a problem if you need a test or procedure for something that's not an immediate emergency, because yes, to get that MRI or biopsy or whatever you may have to come up with thousands of dollars. And many moderate income people don't have it.

This trend has been increasing for years.

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